Your gastroenterologist will order a motility test to accurately diagnose your condition and develop an effective treatment plan that addresses your symptoms and manages your disorder. The two most common motility tests are:
- Antroduodenal (small bowel) manometry – These tests provide information regarding the muscle activity of the stomach and small bowel during fasting, after a meal and during sleep. These tests may help determine what area of the gastrointestinal (GI) tract is not working properly – the stomach, small intestine or both. The findings may help your physician to manage treatment and help improve symptoms.
- Esophageal manometry – These tests can diagnose several conditions that result in food sticking after it is swallowed. For example, achalasia is a condition in which the muscle of the lower esophageal sphincter does not relax with each swallow to allow food into the stomach. Esophageal manometry is also used to evaluate patients who might have gastroesophageal reflux disease (GERD).
Preparation for Motility Tests
Your gastroenterologist will provide specific instruction to prepare for your motility test. Those preparations may include:
- Do not eat or drink after midnight the night before the test.
- It is best to wear a button-down shirt the day of the test.
- Some medications may be stopped before your motility test. Promotility agents, such as Reglan (metoclopramide), Zelnorm (tegaserod), erythromycin, Motilium (domperidone), and antispasmodics, including Bentyl, Donnatal, Levsin and Robinul are usually stopped two days before the test.
- Medications that are not essential should not be taken for two days until after the test is completed.
Small Bowel Motility Test
Small bowel manometry is a motility test that uses a catheter (thin tube) with pressure sensors to record the contractions of the GI tract.
Before the tube is passed, the inside of your nose is numbed and an anesthetic spray or gargle will be used to numb the back of your throat. The catheter containing the pressure sensors is then passed through the nose and into the stomach and small intestine.
Proper positioning of the catheter is assisted and confirmed by either X-ray fluoroscopy (an imaging technique that captures real-time objects with X-ray) or endoscopy with conscious sedation, which blocks pain and allows you to relax without full sedation.
During the test, special meals will be given to determine how food affects GI tract motility. Usually, ingesting food increases the gastric and small bowel contractions. The first meal with the catheter is usually given in the late morning and is often an egg sandwich and water.
Since X-rays are used to place the catheter, this test should not be done if you could be pregnant. Women will need to give a urine sample in the morning of the test for a pregnancy test.
Esophageal Motility Test
An esophageal motility test (esophageal manometry) takes approximately 45 minutes. Before testing, your technician will verify that you have not eaten anything within six hours of the study.
At the start of the test, you will be sitting upright. One nostril will be anesthetized with a numbing lubricant. Your technician will pass a thin, flexible, plastic tube (1/8 inch in diameter) through the numbed nostril, down into the back of your throat and into the esophagus as you swallow.
With continued swallowing, the tube is passed into the stomach. There may be some gagging during some of the passage, but it easily controlled by following instructions. Occasionally, the tube is passed through the nose and not the mouth.
With the tube inside the esophagus, you will lie down on your back. After a short rest to allow the pressure to equilibrate, the test will begin. The pressures generated by the esophageal muscle will be measured when the muscle is at rest and when you swallow.
During the test, the technician will ask you to swallow water. Multiple swallows are tested to allow measurement of the lower esophageal sphincter (the barrier to reflux), the esophagus (the swallowing tube), and the upper esophageal sphincter (in the throat).
Pressure recordings are made throughout the study and the tube is withdrawn. You can usually resume regular activity, eating and medicines immediately following the test.
Esophageal Motility Test Side Effects
Although esophageal manometry may be slightly uncomfortable, the procedure is not painful because the nostril is numbed. Once the tube is placed, patients talk and breathe normally. Side effects of an esophageal motility test are generally minor and include:
- Mild sore throat
- Sinus problems (uncommon)
Occasionally, the tube may enter the larynx (voice box) and cause choking. When this happens, the problem is recognized immediately and the tube is rapidly removed.