What diagnostic test is considered the gold standard for evaluating esophageal motility?

• A. Esophageal endoscopy
• B. Barium swallow
• C. Esophageal manometry
• D. CT esophagography

Answer: (C)

Measuring the pressure dynamics of swallowing is the best way to assess how well the esophagus propels a bolus and how the lower esophageal sphincter relaxes. Esophageal manometry does this directly by recording pressures along the esophagus during each swallow, revealing the sequence and strength of peristaltic waves and whether LES relaxation is appropriate. This direct physiologic assessment is why manometry is considered the gold standard for evaluating esophageal motility, including conditions like achalasia or distal esophageal spasm. Other tests provide useful information but focus on structure or anatomy rather than the contractile function itself: endoscopy looks at mucosa and detects lesions; a barium swallow visualizes shape and gross transit but not precise peristaltic patterns; CT esophagography offers anatomical detail without quantifying esophageal muscle contractions.