Gastroenterology - Antroduodenal Manometry (Small Bowel Manometry)

This leaflet has 3 aims:

1. To help you become better informed and more involved in your care.
2. To explain what happens on the day of the procedure.
3. To answer some of the questions commonly asked about the procedure.

If you have any questions, access or communication needs such as an interpreter please contact the department stated on your appointment letter.

Reasonable adjustments will be considered for all disabled users of this service.

Please make sure that you read the following information CAREFULLY.

Your doctor has referred you for antroduodenal manometry (also known as small bowel manometry) because you are experiencing problems with your small bowel. The most common complaints that doctors refer patients for this test are abdominal pain and/or difficulty with eating.

When you come for your appointment, it would be helpful to us if you could bring with you a list of your medications.

If you have any heart or breathing problems/conditions, we would appreciate it if you could notify us of these conditions before you attend for your appointment.

What is antroduodenal manometry?

The test provides us with information on the strength and function of the muscles (peristalsis) in the first part of your small bowel. We will look at the way in which the muscles work when you eat and when you are fasted.

What will happen during the test?

You will be with us for approximately 5-6 hours. This time includes asking you some questions about your symptoms, explaining to you what will happen during the study and obtaining consent from you to undertake these investigations. After we have asked you questions about your symptoms and obtained your consent you will be asked to sit on the couch, the physiologist will explain what they would like you to do in order to successfully insert the tube via your nose. Once the tube is in your stomach, we will ask you to lay on your right side as the tube is moved through your stomach into the small bowel. The tube will be taped to your nose to keep the tube in place, using medical tape. We will record a fasting period, then you will be given a test meal (cereal with milk is the standard meal – if you have dietary requirements, please contact the department) and we will also record a fed period. Once the test is completed the tube will be removed you are free to go home.

Is the test painful?

The test should not cause you any pain. We can use a local anaesthetic in your nose (Xylocaine) to numb your nose if you would prefer. However, if abdominal pain is a usual symptom for you then you may experience this pain during the study.

What do I need to do before the test?

You will need to stop certain medications (see list below), prior to the test. We also ask that you do not eat or drink anything 4 hours prior to your test.

7 days prior to the test: Omeprazole (Losec, Pyrocalm, Mezzopram); Esomeprazole (Nexium, Emozul, Guardium, Ventra); Lansoprazole (Zoton, Prevacid); Pantoprazole (Protium, Pantoloc); Rabeprazole (Pariet).

3 days prior to the test: Cimetidine (Tagamet); Nizatidine (Axid); Famotidine (Pepcid); Domperidone (Motilium); Metoclopramide (Maxolon); Ondansetron; Alverine; Baclofen (Lioresal), Mebeverine (Colofac); Peppermint Oil (Colpermin, Mintec,), Merbentyl (diclomine, Bentyl), Hyoscine (Buscopan), Pro- Banthine, Spasmanol, Colesevalam, Prucalopride.

If you are taking:

• any regular pain medication such as codeine, tramadol, fentanyl or any other morphine/opiate-based medication
• any medication for angina or high blood pressure such as nifedipine, verapamil or diltiazem etc

Please contact the department prior to your appointment, contact details are on your appointment letter.

Please continue with all other medications.

Will I be able to ask questions?

You can ask questions at any time prior to, during the test and after the tests.

When will I get the results?

The results of your test will be sent to your hospital consultant, and you should hear from them within a few weeks.

Benefits and Risks

The benefit of having this test is that it will help your doctor determine the problem with your small bowel. It can help them manage your symptoms and, in some cases, decide which medication to give you. It will also help them to decide on your future management.

There are no known serious risks associated with small bowel manometry. People who are claustrophobic sometimes have difficulty with this test due to the catheter being inserted via the nose, but please discuss with us if this is a problem for you. If you have oesophageal varices (prominent veins in your gullet) we would not go ahead with this test. Some people experience discomfort due to stopping their medication, this is quite normal. Occasionally nose bleeds may occur but these are rare. There is a risk of perforation, however this is very small and as far as is known not associated with this test.

There is no equivalent alternative to this investigation other than not going ahead with this investigation. Occasionally a barium follow through is performed as an alternative, but this test does not give the same information as small bowel manometry.

Smoking Policy

Northern Care Alliance operates a smoke free policy. To find out what this means for you, pick up the leaflets available at the hospital. For advice on stopping smoking contact 0161 212 4050.