Which test directly measures esophageal pressure dynamics to diagnose motility disorders?

• A. Esophageal manometry
• B. Endoscopy
• C. 24-hour pH monitoring
• D. Barium swallow

Answer: (A)

Direct measurement of how the esophagus and lower esophageal sphincter behave during swallowing is provided by esophageal manometry. This test uses a small catheter with multiple pressure sensors that is inserted through the nose into the esophagus. As you swallow, it records the pressure waves along the esophageal body and at the lower esophageal sphincter, giving a real-time map of peristaltic strength, timing, and LES relaxation.

High-resolution manometry enhances this by providing detailed pressure topography, showing metrics like peristaltic amplitude, coordination, and the integrated relaxation pressure of the LES. These pressure patterns are essential for diagnosing motility disorders such as achalasia (impaired LES relaxation with abnormal or absent peristalsis), distal esophageal spasm (uncoordinated, high-pressure contractions), and other forms of ineffective or absent esophageal motility.

Endoscopy, 24-hour pH monitoring, and barium swallow each provide different information—anatomy, acid exposure, or bolus transit visualization—but they do not directly measure esophageal pressure dynamics.