We don’t usually think about the contraction of muscles (motility) that moves the food we eat through our digestive systems. Yet, it is a complex progression and if these contractions function abnormally, anywhere in the process, it can result in unwelcome symptoms.
With each bite of food or sip of liquid, the body begins a carefully choreographed process of moving what we eat and drink through the entire digestive system. Sphincter muscles from the esophagus to the anus are responsible for this transportation process.
The medical field that studies this function of the gut is called motility. When the strength or coordination of these muscles fail, a person can develop problems such as dysphagia (difficulty swallowing), gastroparesis (abnormal emptying of the stomach) or constipation. Motility testing can help isolate the source of the problem and give doctors insights into the best course of treatment.
Unexplained difficulty swallowing, either for liquids or solid food, is known as dysphagia. If tests such as a barium swallow with x-ray and upper endoscopy do not reveal any blockages or narrowing of the esophagus (food pipe) that might be causing the condition, Dr. Nikolla can use a pressure-sensitive diagnostic tool called a manometer to discover the source of a potential motility problem.
Measuring the pressure
Esophageal manometry is a short, office-based and non-painful procedure during which a thin, flexible catheter is inserted through the patient’s nose, down the esophagus and into the stomach. Patients are then asked to swallow, up to 10 times. Pressure sensors in the catheter measure the strength of the esophageal muscle contractions that occur during the swallowing process (peristalsis). The information received is transferred to a computer and analyzed by the doctors. Esophageal manometry can be performed for symptoms of dysphagia, in evaluation of patients with chest pain in whom heart problems have been ruled out and before surgeries for hiatal hernia repairs and esophageal reflux.
Dr. Nikolla says one of the conditions she is seeing more often through esophageal manometry is achalasia, which is caused by damage to nerve cells in the esophagus. This damage impedes the proper relaxation of the muscles at the end of the esophagus. As a result, food does not move through the esophagus into the stomach. Symptoms include dysphagia, regurgitation of food and chest pain.
Achalasia can be treated in several ways. Patients may be prescribed a course of medications, such as nitrates or calcium channel blockers, to help relax the esophageal sphincter. Botox injections to relax the
affected area of the esophagus are also an option, as is stretching of the sphincter muscles by pneumatic balloon dilation. In some cases, surgery to cut the taut muscles may be necessary to permanently correct the problem.
Patients suffering from chronic constipation or fecal incontinence (stool leakage) may benefit from anorectal manometry testing. Manometry lets the physician measure the strength of the anal sphincter muscles; the sensation in the rectum and the neural reflexes that are all needed for normal bowel movements.
The test may reveal high muscle pressure in the anal canal—which can cause constipation—or low pressure, which may result in fecal incontinence. By analyzing muscle and nerve function at different points in the anal canal, doctors can diagnose conditions such as dyssynergia, which indicates the pelvic muscles do not relax and contract correctly.
When anorectal manometry indicates damage to the anal sphincter muscles, Dr. Nikolla may recommend bio-feedback exercises and other therapies to restore muscle strength (for fecal incontinence) or muscle relaxation techniques (to address constipation). Other treatment options include the implantation of a neurostimulator, a device that sends continuous, small electrical impulses to the nerves that control the anal and rectal sphincter muscles. At times, surgery might be needed to repair muscle defects.
“Motility issues can significantly impact a person’s quality of life,” Dr. Nikolla says. “But given the testing and treatment options we have available today, they shouldn’t. We can help patients regain control of their digestive symptoms.”