Clinical applications of esophageal manometry and pH monitoring

The esophagus functions to transport swallowed food from the mouth to the stomach while selectively preventing the reflux of liquid gastric contents. Ideally, esophageal function is subconscious. Perceived difficulty swallowing (dysphagia), pain during esophageal transit (odynophagia), or regurgitation of esophageal contents are all symptoms suggestive of peristaltic dysfunction that are likely to prompt a clinical evaluation. Similarly, valvular dysfunction at the distal end of the esophagus (evident by frequent heartburn, belching, or acid regurgitation) is a frequent instigator of clinical evaluation. Esophageal dysfunction is also invoked in the evaluation of chest pain deemed not to be of cardiac origin. These are the main clinical circumstances for which physiological esophageal testing (manometry or pH monitoring) is called upon as an aid in diagnosis or management. This review focuses specifically on the current clinical applications of these tests, using available data to suggest reasonable guidelines for their application.