Antroduodenal Manometry

The manometry test was one of the tests Jonathan had done for the first time. I found the whole thing really interesting. The purpose of the test was to measure the strength and coordination of Jonathan's upper G.I. nerves/muscles after he ate a meal. In some kids there are issues with the nerves and muscles firing at the wrong time farther down the pathway, slowing down the process.  Imagine how hard it would be to squeeze all the toothpaste out of a tube if you started squeezing from the bottom but halfway though the process squeezed at the very top. A lot of toothpaste would go the opposite direction back down to the end of the tube.

At some point in the past some really smart people figured out that you could measure these contractions using changes in pressure in millimeters of mercury, or mmHG, the same thing meteorologists use for the weather (barometric pressure). So, they removed Jonathan's g-tube and placed a catheter through the same hole to measure these changes in pressure.  If you look at the drawing below, the line represents the catheter placed and the dots on the line represent the sensors that are located all along the catheter. These sensors sit in precise locations, ready to measure the pressure (and therefore contractions) when food is eaten.

After his procedures on Monday (including the placement of the catheter) Jonathan wasn't allowed to eat or drink anything the rest of the day. The next day, Tuesday, the nurse came into his room and hooked up the catheter to the machine and computer that would record the results.  The system started recording for a couple of hours before the test started to make sure everything looked good and all was calm with Jonathan's system. The first picture shows the contraption that Jonathan was hooked up to that then fed data to the computer.

Once we were all ready to go, Jonathan had about 30 minutes to eat a 300 calorie meal of his choice. We ordered breakfast for him about an hour prior to the test time...a double donut, juice and Cheetos breakfast of champions.  He only ate half of one donut, but with everything else it was enough. For the test they needed to cut his eating and drinking off after 30 minutes so that we could measure a discrete set of food as it moved down the line. The third picture shows a sample of how the readings showed up on the computer and were recorded.  This picture was taken right after Jonathan started eating, which is readily apparent when looking at the aqua colored line. The left side of this picture are readings taken before he started to eat and the right side are the readings after her started to eat. The difference is pretty obvious. Jonathan didn't mind this test too much because all he had to do was stay in bed without moving, finally get to eat yummy food, and watch Toy Story 1, 2 and 3 all in one sitting. 

Although the doctor reviewed the results the following week, I know them as I type this blog. Overall things looked good. This test did not reveal any major findings.  However, there was a small "misfiring" of one of the areas in the upper small intestine. The problem wasn't major, but it could be periodically slowing down the speed at which food moves through his system. Considering his motility test came back normal, this isn't a huge concern for me. It's something to be aware of and keep in the back of our mind for the future.  It certainly, given the results of everything else, is just one factor of a couple of factors (according to the doctor/nurse) of what we have been experiencing with Jonathan for the last 5 years. We think what is really going on is a combination of a few things, which I will get into in an upcoming post. 

For now, we are glad to check this one off the list since it is one of the last things left to do.  Although there is probably an issue here worth monitoring, this could have been a lot worse.