If swallowing, heartburn or chest discomfort are affecting day-to-day life, our Upper GI Motility Service can help you get clear answers, quickly. Everything happens under one roof in Harley Street, from specialist tests to advanced treatments such as POEM for achalasia, so you can move from worry to a clear plan in as few visits as possible. Led by consultant gastroenterologists with sub-specialty expertise in oesophageal motility.
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Upper GI Motility
Also known as: oesophageal physiology, oesophageal function testing, reflux and motility diagnostics
Get answers fast
See a doctor or consultant within days
Advanced imaging and tests
Quick access to leading diagnostics on-site
World-class specialists
Expert support guiding your next steps
How we can help
When the muscles and nerves of the oesophagus are not working smoothly, eating and drinking can feel difficult, painful or unpredictable. Heartburn that won’t settle, food sticking, a lump-in-the-throat sensation or chest pain after eating can all point to an upper GI motility problem – and many people spend months trying treatments that don’t quite work because the underlying cause hasn’t been pinned down.
Our service is built around getting you a precise diagnosis, then matching it to the right treatment. Every test is personally reported by your consultant, so your results are interpreted in the full context of your symptoms rather than as numbers on a page.
We can help if:
- Heartburn or reflux is not improving on standard acid-suppressing medication, or you would like to review long-term PPI use
- You’re struggling to swallow solids, liquids or both, or food feels like it’s sticking
- Swallowing is painful (odynophagia)
- You have persistent chest pain for which no heart-related cause has been found
- You have a constant lump-in-the-throat sensation, chronic cough, hoarseness, throat-clearing or laryngeal hypersensitivity
- You have excessive belching or regurgitation
- You need expert assessment before or after anti-reflux, bariatric or achalasia surgery, including symptoms that return after POEM, fundoplication or oesophageal dilation
- You’ve already had tests or treatment elsewhere but still don’t have answers, and would like a fresh expert opinion
More about GI Motility Testing at The London Clinic
More information
- Heartburn and gastro-oesophageal reflux disease (GORD)
- Achalasia (all subtypes)
- Oesophagogastric junction outflow obstruction (OGJOO)
- Oesophageal spasm, hypercontractile (“jackhammer”) oesophagus and ineffective motility
- Functional heartburn and reflux hypersensitivity
- Barrett’s oesophagus
- Dysphagia (difficulty swallowing)
- Globus (lump in the throat)
- Laryngopharyngeal reflux (LPR) and laryngeal hypersensitivity
- Oesophageal strictures (peptic, post-surgical, post-radiation)
Achalasia is a condition where the muscles at the bottom of the oesophagus don’t relax properly, making it hard for food and drink to pass into the stomach. It can cause swallowing difficulty, regurgitation, chest discomfort and weight loss.
Our team offers the full range of modern treatments – including POEM (per-oral endoscopic myotomy), pneumatic balloon dilatation, Botox injection and EsoFLIP-guided dilatation – and will recommend the option best suited to your subtype, symptoms and overall health.
The best treatment depends on the type of achalasia you have – there are three subtypes – and your consultant will explain which applies to you after manometry testing.
Upper GI motility tests are generally very safe and well tolerated, and your consultant will go through the specific risks of any test or procedure with you before you agree to go ahead.
All tests and treatments carry some level of risk. Your consultant will explain the specific risks relevant to you before you consent to any procedure. The information below is a general guide.
As a guide:
- High-resolution manometry and pH-impedance studies – short-lived nasal or throat discomfort while the soft tube is in place, occasional nosebleed, and very rarely minor trauma to the oesophagus during insertion. Most people tolerate these tests well.
- BRAVO wireless pH monitoring – the capsule is placed during a gastroscopy, so the usual gastroscopy risks apply. During the recording you may feel mild chest discomfort, and occasionally the capsule detaches earlier than planned; capsule retention is very rare.
- FLIP panometry and EsoFLIP – carried out during a gastroscopy, so the risks are those of the gastroscopy itself. Up to around 1% risk of perforation, which is higher for tight, complex or angulated strictures; bleeding and short-lived reflux can also occur.
- Gastroscopy – a sore throat or bloating for a short time afterwards is common; bleeding, a small tear (perforation) or a reaction to sedation are rare. Overall complication rates are very low in experienced hands.
- POEM (per-oral endoscopic myotomy) – a more involved procedure. Risks include air tracking into the chest or abdomen (usually settles on its own), small mucosal injuries, bleeding and a small risk of delayed perforation. Some reflux after POEM is expected and we plan for this with pH testing and acid-suppression treatment afterwards.
- Pneumatic balloon dilatation – a recognised risk of an oesophageal tear (perforation) of around 1–2% per procedure, managed with careful patient selection and post-procedure monitoring.
- Botox injection – generally very safe. The effect is temporary, typically lasting 6–12 months, and repeated injections can occasionally cause scarring that may make later surgical treatments (POEM or Heller myotomy) more technically demanding.
- Oesophageal dilation for strictures – up to around 1% risk of perforation, which is higher for tight, complex or angulated strictures; bleeding and short-lived reflux can also occur.
Written patient information for each test or procedure will be sent to you in advance so you have time to read it and prepare any questions.
What to expect
Step 1 Preparing for your tests
You'll receive clear written instructions about fasting (typically 6 hours for solid food and 2 hours for liquids) and any medicines you may need to pause before your appointment. Where possible, we'll group your tests into a single visit to save you multiple trips.
Step 2 During your visit
A specialist nurse or physiologist will welcome you, run through a safety checklist and explain each step before you start. Tube-based tests are placed gently by an experienced team. Most in-clinic tests take 60 minutes; 24-hour pH studies involve wearing a thin tube home and returning the next day.
Step 3 Your results and plan
Your study is personally reviewed and reported by an expert motility consultant so the findings are interpreted in your full clinical context. At your follow-up, they'll explain the findings in plain language and give you a written plan covering treatment options and next steps.
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The tests you may have
Tests are tailored to your symptoms and, where it's safe to do so, combined into one visit. Each study is personally reported by a Consultant Gastroenterologist using the latest international standards - Chicago Classification v4.0 for motility and the Lyon Consensus 2.0 for reflux - so your diagnosis is precise and internationally benchmarked.
The latest international standards for interpreting motility and reflux results (Chicago Classification v4.0 and Lyon Consensus 2.0), so your diagnosis meets the same benchmarks used by leading centres worldwide.
The leading test for how the oesophagus moves. A fine, soft tube is passed through the nose into the oesophagus to measure the pressure and timing of muscle contractions as you swallow.
A small capsule is attached to the lining of your oesophagus during gastroscopy and records acid exposure for up to 96 hours, giving a fuller picture than a standard 24-hour study because reflux varies from day to day.
The leading test for reflux. A thin tube worn for 24 hours measures both acid and non-acid reflux, how high it travels and how it links to your symptoms – particularly useful when standard reflux medication hasn’t worked.
Performed during a gastroscopy, FLIP panometry uses a small balloon to measure how easily the oesophagus and its valve stretch and respond. As a newer technology it can pick up problems that other tests miss and gives information that manometry and pH studies can’t, including guiding treatment decisions during POEM.
A therapeutic version of FLIP panometry, used to gently and precisely stretch the oesophageal valve in achalasia, or to treat certain strictures.
A camera test of the oesophagus, stomach and the first part of the small bowel, usually the first step in your pathway to rule out structural causes such as inflammation, hiatus hernia or Barrett’s oesophagus.
Treatments we offer
Once we have a clear diagnosis, your consultant will talk you through a personalised treatment plan, and where investigations point to a treatable condition, the same specialist team can move directly to the right procedure rather than handing you over to a separate team. Where anti-reflux surgery is the right next step, we’ll coordinate referral into the appropriate surgical pathway.
Options may include:
- POEM (per-oral endoscopic myotomy) for achalasia
- Pneumatic / balloon dilatation, Botox injection, EsoFLIP dilatation, Diet and lifestyle support, Swallowing and breathing exercises with specialist therapists
- Endoscopic mucosal resection (EMR) for early changes in the oesophageal lining Argon plasma coagulation (APC)
- Tailored medication review and Lyon 2.0-guided acid-suppression strategy, including PPI step-down
- Psychology and gut–brain support for functional heartburn, reflux hypersensitivity and other disorders of gut–brain interaction (DGBI), delivered alongside your medical care
Related experts
World-class consultants, in collaboration with Northwestern Medicine’s specialists Dr John Pandolfino, Dr Dustin Carlson and Dr Aziz Aadam.
Book your appointment or refer a patient
Don't wait for symptoms to worsen. If heartburn, swallowing problems or chest discomfort are affecting your daily life, our Upper GI Motility Service can get you answers - often within days.
For referring clinicians
Our Upper GI Motility Service accepts referrals from GPs, gastroenterologists, surgeons and ENT specialists. We offer:
- Rapid consultant access, typically within days
- All studies personally reported by a Consultant Gastroenterologist (Chicago Classification v4.0 / Lyon Consensus 2.0)
- A complete diagnostic-to-treatment pathway on one site, including POEM
- Clinically actionable reports designed to guide next steps
Why choose The London Clinic?
Trusted for over 90 years, The London Clinic is an independent charitable hospital that reinvests into care, research, and support for those who can’t easily access private treatment. The London Clinic works in collaboration with Northwestern Medicine Kenneth C. Griffin Esophageal Center, giving the team access to international expertise for the most complex motility cases.
Consultant access within days
Fast access to a specialist who will personally oversee your care from first appointment through to treatment.
Diagnosis to the highest international standards
Every study reported against Chicago Classification v4.0 and Lyon Consensus 2.0.
All your tests and treatments on one site
At Devonshire Place, with a full 13-bed ICU and a consultant-led MDT of specialist nurses, radiologists, dietitians and therapists.
In collaboration with Northwestern Medicine
Access to world-leading expertise at Kenneth C. Griffin Esophageal Center in Chicago for the most complex cases.