Concierge oesophageal physiology · London
Oesophageal (high-resolution) manometry, gold-standard test for achalasia, dysphagia and pre-fundoplication assessment.
A thin pressure catheter is passed through the nose into the oesophagus. It records how the muscle works across 10 test swallows. The trace grades disorders like achalasia and ineffective motility. It is a required step before anti-reflux surgery.
- Thin nasal catheter measuring oesophageal muscle pressures during swallows
- Chicago Classification 4.0 standard
- Diagnoses achalasia, jackhammer, EGJ outflow obstruction
- Mandatory before anti-reflux surgery (LINX / fundoplication)
- Complements pH-monitoring and Bravo
- 30-minute test in the endoscopy suite
Why patients choose us
- 01
The right hands
We route you to a consultant gastroenterologist with high-resolution manometry expertise — placement, Chicago 4.0 interpretation and onward surgical pathway under one clinician.
- 02
Reads that change management
Manometry is only useful when the Chicago 4.0 classification is set against your symptoms — that is what decides POEM, Heller, LINX or a functional pathway.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private oesophageal manometry costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Standard high-resolution manometry, inclusive of placement and report: £850–£1,400, with the written report within 5–7 days.
| Study type | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| High-resolution oesophageal manometry (standard) | £850–£1,400 | 30 min | 5–7 days |
| HRM + 24-hour pH monitoring (combined study) | £1,400–£2,200 | 2 visits | 7–10 days |
| Pre-fundoplication / LINX HRM work-up | £1,100–£1,700 | 30 min | 5–7 days |
| HRM + Bravo pH study (paired physiology) | £2,400–£3,600 | 2 visits | 7–10 days |
| Post-fundoplication surveillance HRM | £950–£1,500 | 30 min | 5–7 days |
| HRM + consultant follow-up (management planning) | £1,200–£1,800 | 30 min | 7–10 days |
Prices vary by clinic, whether paired pH-monitoring or Bravo is bundled in, and whether a management consultation follows the study. We come back with a firm quote within one working day.
The problem
Manometry is only useful when it changes the plan.
The numbers are the answer — integrated relaxation pressure, distal contractile integral, distal latency — and the person interpreting them decides POEM, Heller, LINX, fundoplication or the functional pathway. We route you to a consultant who does all three.
-
Progressive dysphagia to solids and liquids?
We arrange urgent HRM and endoscopy in parallel — the Chicago 4.0 diagnosis often follows within a fortnight.
-
Considering LINX or fundoplication?
We deliver a full pre-op physiology work-up — HRM plus pH/Bravo — so surgical selection is grounded in data.
-
Non-cardiac chest pain after cardiology clear?
We work up spastic and hypercontractile disorders — jackhammer and distal spasm are treatable, not incidental.
Preparation and journey
From consultation to report — what happens, in order.
One consultant from first message to reported study — usually inside two weeks.
Phase 1 · Before your study
Consultation and medication washout
Phase 2 · In the endoscopy suite
~30 minutes of study time
Phase 3 · After
Chicago 4.0 report and plan
- 01
Before
Consultant gastroenterology consultation
A private consultant confirms the study is the right test and reviews your dysphagia, reflux history and any prior imaging.
- 02
Before
Fast 6 hours
Nil by mouth for six hours before the study so the oesophagus is empty and swallow physiology is not confounded by food residue.
- 03
Before
Withhold prokinetics and smooth-muscle relaxants
Prokinetics, calcium-channel blockers and nitrates are held for 48 hours where safe, so they do not distort motility measurements.
- 04
On the day
Catheter passed via nose
A thin, well-tolerated solid-state pressure catheter is passed through the nose and positioned across the oesophagus and lower sphincter.
- 05
On the day
Baseline 30-second resting recording
A short resting recording establishes baseline sphincter pressures and oesophageal tone before test swallows begin.
- 06
On the day
10 × 5 mL water swallows
You take ten timed 5 mL water swallows in the supine position — the standard Chicago Classification 4.0 protocol.
- 07
After
Post-test report with Chicago 4.0 classification
A consultant-signed report with your Chicago 4.0 diagnosis, integrated relaxation pressure and a concrete management recommendation.
Typical end-to-end: 10–14 days. Urgent slots: within one week.
What it shows
What high-resolution manometry diagnoses — and what those findings mean.
Manometry answers a specific set of questions — does the sphincter relax, does peristalsis reach the stomach, and is contraction normal, weak or excessive. The eight findings below are the ones that change management.
-
Achalasia types I / II / III
Absent oesophageal peristalsis with a failure of the lower sphincter to relax — subtyped I, II or III to guide POEM or Heller selection.
-
EGJ outflow obstruction
Raised integrated relaxation pressure with preserved peristalsis — a Chicago 4.0 diagnosis that may need supportive testing.
-
Absent contractility
No effective oesophageal contractions on any swallow — a red flag for scleroderma-type oesophagus.
-
Ineffective oesophageal motility
Weak or failed peristalsis on ≥70% of swallows — a caution for tight anti-reflux wraps.
-
Distal oesophageal spasm
Premature contractions with short distal latency — often the cause of non-cardiac chest pain and intermittent dysphagia.
-
Jackhammer oesophagus
Hypercontractile swallows with markedly elevated distal contractile integral — a driver of chest pain and dysphagia.
-
Hiatus hernia identified
Manometric double-hump identifies and characterises a sliding hiatus hernia — decisive before anti-reflux surgery.
-
Red flag: type I / III achalasia — POEM or laparoscopic Heller MDT pathway
Type I and type III achalasia enter a formal MDT pathway for endoscopic myotomy (POEM) or laparoscopic Heller myotomy.
Next steps
The treatment options manometry actually directs.
The Chicago 4.0 diagnosis maps to a defined menu of onward options — from endoscopic myotomy to targeted anti-reflux surgery to structured motility follow-up.
-
Botulinum toxin injection
Endoscopic botulinum toxin to the lower oesophageal sphincter — reserved for frail patients who cannot tolerate definitive therapy.
-
Pneumatic balloon dilatation
Graded endoscopic pneumatic dilatation of the sphincter — an established, durable option for type II achalasia.
-
Laparoscopic Heller myotomy
Surgical division of the lower oesophageal sphincter with partial fundoplication — the traditional definitive treatment for achalasia.
-
Peroral endoscopic myotomy (POEM)
Incisionless endoscopic myotomy — first-line for type III achalasia and spastic disorders in expert hands.
-
Anti-reflux surgery selection with LES data
Manometry data on sphincter pressure and peristalsis is what determines LINX vs full or partial fundoplication.
-
Prokinetic therapy
Medical prokinetic therapy for ineffective motility, calibrated to the manometric findings and symptom pattern.
-
Structured neurogastro / motility follow-up
Neurogastroenterology follow-up when the diagnosis is a functional motor disorder rather than a mechanical one.
-
MDT review
Multidisciplinary review with gastroenterology, upper-GI surgery and radiology for complex or borderline cases.
Our vetted London network
A small panel of clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
-
Consultant gastroenterologists with high-resolution manometry and Chicago 4.0 reporting experience
-
Solid-state HRM catheters with current-generation topography analysis
-
Reporting integrated with pH-monitoring, Bravo and endoscopy as needed
-
Onward POEM, Heller, LINX or fundoplication pathway if the study directs it
Safety and eligibility
A well-tolerated test — with a short list of caveats.
High-resolution manometry is well tolerated and the risks are small. The practical points are which patients are suitable, what medication to hold, and which alarm features go straight to endoscopy.
-
Painless, radiation-free
A thin catheter and gel — no needles, no radiation, no sedation for the standard study.
-
Well-tolerated nasal placement
Local anaesthetic to the nose and back of the throat makes catheter passage brief and tolerable.
-
Fast 6 hours
Nil by mouth for six hours before the study, so the oesophagus is empty for interpretable swallows.
-
Withhold motility-active drugs
Prokinetics, nitrates and calcium-channel blockers are held for 48 hours where safe.
-
Continue essential medication
Cardiac, anti-hypertensive and neurological medication is continued unless your consultant specifies otherwise.
-
Small risk of nose bleed or gagging
A minority of patients experience brief epistaxis or gagging as the catheter is passed; both settle within minutes.
-
Alarm features go to endoscopy first
Dysphagia with weight loss, GI bleeding or a suspected malignant obstruction go to urgent endoscopy and biopsy, not manometry alone.
-
Not for uncooperative patients
The study relies on ten timed swallows in a fixed position — patients unable to follow instruction need an alternative pathway.
-
A normal study is not a full clear
A normal manometry does not exclude eosinophilic oesophagitis or mucosal disease — endoscopy with biopsy may still be needed.
Red flags — manometry alone is not enough
The clinical scenarios below need a wider work-up — endoscopy with biopsy, imaging or a multidisciplinary discussion — not manometry in isolation.
- Achalasia
- Suspected malignant EGJ obstruction
- Rapid dysphagia + weight loss
- Post-fundoplication dysphagia
- Systemic sclerosis oesophagus
- Post-radiotherapy stricture
- Recurrent aspiration pneumonia
- Chagas disease differential
- Eosinophilic oesophagitis differential
Reading your report
A manometry report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts, benchmarked against Chicago Classification 4.0.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication, medications and symptoms
Your details, the reason for the study, current motility-active medication and the symptoms that anchor interpretation.
- 02 Technique
Catheter position and swallow protocol
Sensor placement, number of interpretable swallows and any technical caveats (poor tolerance, artefact).
- 03 Findings
IRP, DCI, distal latency and peristalsis
Integrated relaxation pressure, distal contractile integral, distal latency and peristaltic integrity across the ten test swallows.
- 04 Impression
Chicago 4.0 classification: read this first
The Chicago 4.0 diagnosis — achalasia subtype, EGJOO, spastic disorder, ineffective motility or normal — with the concrete next step.
Next steps the study directs
Depending on the Chicago 4.0 diagnosis, the report will point to one of these onward paths.
- Botulinum toxin injection (frail patients)
- Pneumatic balloon dilatation
- Laparoscopic Heller myotomy
- Peroral endoscopic myotomy (POEM)
- Anti-reflux surgery selection with LES data
- Prokinetic therapy
- Structured neurogastro / motility follow-up
- MDT review
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about oesophageal manometry.
Quick answers on cost, medication washout, catheter tolerance, Chicago 4.0 and when manometry belongs before anti-reflux surgery.
-
What does oesophageal manometry actually change in my management?
It answers the questions endoscopy cannot: is the muscle of your oesophagus working, does the lower sphincter relax, and — most decisively — which Chicago 4.0 diagnosis applies. The answer moves you between POEM, laparoscopic Heller, pneumatic dilatation, LINX or fundoplication, or the functional motility pathway.
-
Why is manometry mandatory before anti-reflux surgery?
Because operating on an oesophagus with undiagnosed achalasia or absent peristalsis produces disastrous post-operative dysphagia. Every candidate for LINX or fundoplication should have manometry to exclude a motility disorder and to calibrate the type of wrap.
-
How much does a private oesophageal manometry cost in London?
Standard high-resolution manometry, inclusive of catheter placement and consultant Chicago 4.0 report, is typically £850–£1,400 in our network. Combined studies with pH-monitoring or Bravo push the total higher — we quote a firm figure across two or three options.
-
What is Chicago Classification 4.0?
It is the international framework for interpreting high-resolution manometry — a hierarchical algorithm that starts with the integrated relaxation pressure of the lower sphincter and moves through peristaltic integrity and contractile vigour to a single diagnosis (achalasia I/II/III, EGJOO, absent contractility, distal spasm, jackhammer, ineffective motility or normal).
-
Do I need to stop my medication beforehand?
Prokinetics, calcium-channel blockers and nitrates are held for 48 hours where safe. Essential cardiac and neurological medication is continued. Your consultant confirms the plan in the pre-test call.
-
Is the catheter painful?
The catheter is thin and passed with local anaesthetic to the nose and throat. Most patients describe brief discomfort as it passes, then unremarkable tolerance for the swallow protocol. Sedation is not used, because we need you awake and swallowing on cue.
Sources
- British Society of Gastroenterology. Guidance on oesophageal physiology testing.
- International Working Group for Chicago Classification of Oesophageal Motility Disorders (v4.0).
- European Society of Neurogastroenterology and Motility. Position statements on high-resolution manometry.
- American Gastroenterological Association. Clinical practice update on oesophageal motility disorders.
Last reviewed 2026-07-30. Next review 2027-07-30. Reading time ~6 min.
Related tests
Looking for a different test?
-
Bravo pH study
Wireless 48–96 hour oesophageal pH capsule — the companion physiological work-up before anti-reflux surgery.
Learn more -
Bravo Alpha oesophageal pH
The extended Bravo Alpha wireless pH test — placement, tolerance and results.
Learn more -
Gastroscopy
Diagnostic upper GI endoscopy — the mucosal look that precedes and complements manometry.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Acid Reflux
Related condition guide.
Learn more -
Crohns Disease
Related condition guide.
Learn more -
Colectomy
Related treatment option.
Learn more -
Cholecystectomy
Related treatment option.
Learn more
In practice, in London
How esophageal manometry tends to unfold when you go private
With esophageal manometry, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for esophageal manometry vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
A typical private booking for esophageal manometry in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For esophageal manometry specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for esophageal manometry isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.