Esophageal function tests are performed by Digestive Health physicians at Digestive Health - Southwest Endoscopy Center (Bravo pH monitoring) and Mercy Regional Medical Center (high resolution esophageal manometry with impedance testing, catheter-based pH monitoring) on the order of a Digestive Health provider.
Esophageal Manometry (high resolution manometry with impedance testing)
Performed at Mercy Regional Medical Center
Esophageal manometry may be used to evaluate problems with swallowing (dysphagia), chest pain suspected to be due to esophageal disease, and other problems that may be due to problems with esophageal function. It may also be used to assist in the placement of a pH monitoring probe and for the preoperative assessment of esophageal peristaltic function in patients being considered for anti-reflux surgery. No sedation is used for this procedure. A soft flexible catheter (tube) is passed through a nostril and gently advanced to the stomach. Measurements are made over the course of 10 minutes during a series of test swallows. Minor coughing or choking is not unusual for a few minutes, particularly during insertion of the catheter.
Preparation
You may consume only clear liquids after midnight. All fluid intake must be discontinued 2 hours before the procedure. Medications that may affect upper gastrointestinal motility should be discontinued 24 hours before the procedure unless your physician instructs otherwise. Examples include:
-nitroglycerin (tablets, pastes, patches, ointments)
-antispasmodics: dicyclomine (Bentyl®), hyoscyamine (Levsin®)
-metoclopramide (Reglan®)
-urecholine (Bethanecol®)
-baclofen (Lioresal®)
-domeperidone (Motilium, in Canada)
Esophageal pH Monitoring (Bravo wireless capsule-based)
Performed at Digestive Health - Southwest Endoscopy
Prolonged monitoring of lower esophageal acid levels is most often used to confirm a diagnosis of gastroesophageal reflux disease when the diagnosis is suspected but uncertain (such as when a patient fails to respond to generally effective treatment), or when surgical treatment is being considered. Proton pump inhibitor medication (PPI) are commonly discontinued 7 days before testing (though in some cases your doctor may perform this test without suspending treatment). Endoscopic examination precedes Bravo capsule placement for localization of anatomic landmarks. The monitoring capsule is attached to the wall of the esophagus 6 cm above the junction of the esophagus and stomach. The capsule then transmits measurements of acid exposure to an external recorder for a 48 hour period. The capsule eventually dislodges and passes out of the body spontaneously. No nasal catheter is necessary for this form of pH monitoring. We recommend that you follow your normal dietary and activity routine during the course of monitoring.
What is the Bravo pH monitoring system?
What are the benefits and risks of Bravo pH monitoring?
Preparation
-Preparation for placement of the monitoring capsule are generally the same as for routine upper endoscopy (EGD)
-Discontinue proton pump inhibitors (Prilosec®, Zegerid® or omeprazole; Nexium® or esomeprazole, Prevacid® or lansoprazole, Aciphex® or rabeprazole, Protonix® or pantoprazole, Dexilant® or dexlansoprazole) 7 days before testing.
-Discontinue H2 antagonists (Tagamet®, Zegerid® or cimetidine, Zantac® or ranitidine, Pepcid® or famotidine, Axid® or nizatidine) 3 days before your procedure.
-You may consume only clear liquids after midnight.
-All fluid intake must be discontinued 2 hours before the procedure.
Esophageal pH Monitoring (catheter-based)
Performed at Mercy Regional Medical Center
Prolonged monitoring of lower esophageal acid levels is most often used to confirm a diagnosis of gastroesophageal reflux disease when the diagnosis is suspected but uncertain (such as when a patient fails to respond to generally effective treatment), or when surgical treatment is being considered. Proton pump inhibitor medication (PPI) are generally discontinued 7 days before testing. Esophageal manometry (see above) precedes pH monitoring for localization of anatomic landmarks, though manometry may be performed immediately prior to pH testing. A soft flexible catheter (tube) is passed through a nostril and positioned in the esophagus, about 2 inches above the opening to the stomach. The probe at the tip of the catheter measures the pH (acidity) every 5 seconds during the study, which usually lasts 24 hours. Once positioned, the catheter is taped to your cheek and you are discharged with instructions to return the following day for removal. The testing catheter is connected to a recorder you will wear on a shoulder strap. You may not shower during the test and vigorous physical activity is not generally allowed. We do typically recommend that you maintain your normal diet during the course of testing. Minor coughing or choking is common for a few minutes, particularly during insertion of the catheter.
Ambulatory impedance monitoring may be performed in conjunction with pH monitoring.
Preparation
-Discontinue proton pump inhibitors (Prilosec®, Zegerid® or omeprazole; Nexium® or esomeprazole, Prevacid® or lansoprazole, Aciphex® or rabeprazole, Protonix® or pantoprazole, Dexilant® or dexlansoprazole) 7 days before testing.
-Discontinue H2 antagonists (Tagamet®, Zegerid® or cimetidine, Zantac® or ranitidine, Pepcid® or famotidine, Axid® or nizatidine) 3 days before your procedure.
-You may consume only clear liquids after midnight.
-All fluid intake must be discontinued 2 hours before the procedure.
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