What is esophageal pH monitoring?
Esophageal pH (pH is a measure of the acidity or alkalinity of a solution) monitoring is a procedure for measuring the reflux (regurgitation or backwash) of acid from the stomach into the esophagus that occurs in gastroesophageal reflux disease (GERD).
When is esophageal pH monitoring used?
Esophageal pH monitoring is used to diagnose GERD, to determine the effectiveness of medications that are given to prevent acid reflux, and to determine if episodes of acidic reflux are causing episodes of chest pain. Monitoring esophageal pH also can be used to determine if acid is reaching the pharynx (lower throat) and is possibly responsible for such symptoms as cough, hoarseness, and sore throat.
How is esophageal pH monitoring performed?
Esophageal pH monitoring is performed by passing a thin plastic catheter a sixteenth of an inch in diameter through one nostril, down the back of the throat, and into the esophagus as the patient swallows. The tip of the catheter contains a sensor that senses acid. The sensor is positioned in the esophagus so that it is just above the lower esophageal sphincter, a specialized area of esophageal muscle that lies at the junction of the esophagus and stomach and prevents acid from refluxing back up into the esophagus. In this position the sensor records each reflux of acid. The catheter protruding from the nose is connected to a recorder that registers each reflux of acid.
The patient is sent home with the catheter and recorder in place and returns the next day to have them removed. During the 24 hours that the catheter is in place, the patient goes about his or her usual activities, for example, eating, sleeping, and working. Meals, periods of sleep, and symptoms are recorded by the patient in a diary and/or by pushing buttons on the recorder. After the catheter is removed, the recorder is attached to a computer so that the data it has gathered can be downloaded into the computer where it is analyzed and put into graphic form.
Alternatively, the procedure can be modified by placing the sensor in the upper esophagus or pharynx to determine if refluxed acid is reaching the pharynx. This is done during an endoscopy procedure while under sedation. This procedure is the type of pH monitoring we perform most often and is called Bravo pH monitoring.
BRAVO PH MONITORING
The most recently-developed device for monitoring esophageal pH uses a capsule also known as the Bravo Capsule. The capsule contains an acid sensing probe, a battery, and a transmitter. The probe monitors the acid in the esophagus and transmits the information to a recorder that is worn by the patient on a belt. The capsule is introduced into the esophagus on a catheter through the nose or mouth and is attached to the lining of the esophagus with a clip. The catheter then is detached from the capsule and removed. Thus, there is no catheter protruding from the nose. The capsule transmits for two days or three days, and then the battery dies. Five to seven days later, the capsule falls off the esophageal lining and is passed in the stool as the capsule is not reusable.
The advantages of the capsule device are related to the absence of a catheter connecting the probe to the recorder. There is greater comfort without a catheter in the back of the throat, and patients are more likely to go to work and do more of their normal activities without feeling self-conscious about the appearance of the catheter to others. The disadvantages of the capsule are that it cannot be used in the pharynx (where it would be impossibly uncomfortable) and, so far, it has not been used in the stomach.
ESOPHAGEAL MANOMETRY STUDY
Why the Test is Performed
The esophagus is the tube that carries food from your mouth into the stomach. When you swallow, muscles in your esophagus squeeze (contract) to push food toward the stomach. Valves, or sphincters, inside the esophagus open to let food and liquid through. They then close to prevent food, fluids, and stomach acid from moving backward. The sphincter at the bottom of the esophagus is called the lower esophageal sphincter, or LES.
Esophageal manometry is done to see if the esophagus is contracting and relaxing properly. The test helps diagnose swallowing problems. During the test, the doctor can also check the LES to see if it opens and closes properly.
How the Test is Performed
During esophageal manometry, a thin, pressure-sensitive tube is passed through your nose down the esophagus and into your stomach.
Before the procedure, you often receive numbing medicine inside the nose. This helps make the insertion of the tube less uncomfortable.
After the tube is in the stomach, the tube is pulled slowly back into your esophagus. At this time, you are asked to swallow. The pressure of the muscle contractions is measured along several sections of the tube.
While the tube is in place, other studies of your esophagus may be done. The tube is removed after the tests are completed. The test takes about 1 hour.
How to Prepare for the Test
You should not have anything to eat or drink for 4-6 hours before the test. If you have the test in the morning, do not eat or drink after midnight. Tell your health care provider about all medicines you are taking. These include vitamins, herbs, and other over-the-counter medicines.
The LES pressure and muscle contractions are normal when you swallow.
What Abnormal Results Mean
Abnormal results may indicate:
A problem with the esophagus that affects its ability to move food toward the stomach (achalasia)
A weak LES, which causes heartburn (GERD)
Abnormal contractions of the esophagus muscles that do not move food effectively to the stomach (esophageal spasm)