Which test is used to evaluate esophageal motility abnormalities such as DES or achalasia?

• A. Manometry
• B. Endoscopy
• C. Barium swallow
• D. Ultrasound

Answer: (A)

Measuring the pressure dynamics of the esophagus during swallowing is essential for diagnosing motility disorders. Esophageal manometry, especially high-resolution manometry, directly records the pressure waves along the esophagus and the relaxation of the lower esophageal sphincter as you swallow. This lets you see whether peristaltic waves are coordinated and whether the LES relaxes properly.

In distal esophageal spasm, manometry shows premature, uncoordinated contractions in the distal esophagus with normal LES relaxation, indicating altered propulsive patterns rather than a failure of opening the LES. In achalasia, it reveals impaired or absent LES relaxation coupled with abnormal or absent peristalsis in the body of the esophagus, sometimes with abnormal distal contractions depending on the subtype. Because it provides a direct, functional map of esophageal muscle activity and sphincter behavior, manometry is the best test for these motility abnormalities.

Endoscopy looks at the lining and structural issues, and a barium swallow shows overall shape and transit patterns but does not quantify peristalsis or LES relaxation as precisely. Ultrasound isn’t used to evaluate esophageal motility.