WELCOME TO THE PHYSIOLOGY LAB
Welcome to Valley Gastroenterology’s Gastrointestinal Motility and Physiology Laboratory, located in our office in Arcadia. At our lab we perform High Resolution Esophageal Manometry, 24 hour pH Studies, and the Bravo 96 Hour pH study. Our goal is to better understand the physiology of a patients esophagus and the pH level of reflux the patient is experiencing, with the hopes of having the ability to provide a more focused treatment of a patient’s motility disorder affecting their esophagus. Symptoms of motility disorders that affect the esophagus can include gastroesophageal reflux, trouble swallowing, and chest pain. The services performed at this lab can be ordered by any physician. We recommend consulting with your physician or contacting our office if you have any questions or are experiencing these symptoms.
PROCEDURES WE PERFORM AT THE PHYSIOLOGY LAB
Your esophagus connects your throat to your stomach. When you swallow, the muscles in your esophagus contract to push food down into your stomach. Near the bottom of your esophagus there’s a little muscle, or valve. This valve stays closed except when food or liquid is swallowed, or when you belch or vomit.
What does manometry mean?
Manometry is another word for testing. So when we say esophageal manometry, we mean we’ll be testing your esophagus. What we’re specifically looking at is the pressures and the pattern of muscle contractions in your esophagus. We look at these contractions because if you have any abnormalities in the contractions, or in the strength of the muscle or valve at the lower end of the esophagus, this can cause you pain, heartburn, and/or difficulty swallowing.
What type of prep should I do before esophageal manometry?
It is best to have an empty stomach for the test, so please do not eat or drink anything for at least 6 hours before your scheduled appointment. It’s also important to ask us about any medications you take. Many medications can affect esophageal pressure and the natural muscle contractions required for swallowing, so we may ask you to change the timing of your medicines before the test.
What will the test be like?
The first thing we’ll do is will apply a cream to numb the inside of your nostrils. Next, we’ll place a thin, flexible, lubricated tube through your nose and down into your stomach while you swallow sips of water. You’ll either be sitting up or lying on your back, and we’ll connect the tube to a computer for the test. During the test, it is important to breathe slowly and smoothly, and remain as quiet as possible. We’ll ask you to avoid swallowing unless instructed to do so. We will slowly pull the tube out, and as we do this the computer will record the pressures in different parts of your esophagus. The test may cause some discomfort in your nose or throat.
In some cases, your doctor may decide it’s better to pass the tube through the mouth instead. We’ll inform you if we believe this is a better option for your particular case.
What can I expect after the test?
After the test, you may experience mild sore throat, stuffy nose, or a slight nosebleed. These are normal, and generally should improve within hours. Unless we tell you otherwise, you can resume normal meals, activities, and any interrupted medications.
Are there risks associated with esophageal manometry?
All medical procedures have some risk, but we perform them because there is more benefit than risk. Serious side effects of esophageal manometry are extremely rare, but it is possible that you could experience irregular heartbeats, aspiration (when stomach contents flow back into the esophagus and are breathed into the lung), or perforation (a hole in the esophagus). During insertion, the tube may be misdirected into the windpipe before being repositioned. We take precautions to prevent risks.
What is the esophageal pH test?
An esophageal pH test measures the pH in your esophagus. We perform this test to see if you have gastroesophageal reflux disease (GERD), or to determine the effectiveness of medications or surgery for GERD.
What is reflux?
Esophageal reflux is a condition in which stomach acid moves up into the esophagus, where it does not belong. You have a sphincter, or valve, at the bottom of your esophagus. The job of this sphincter is to stay closed, unless food or liquid needs to pass into the stomach. If the sphincter does not close tightly, stomach acid can splash back up into the esophagus and this is known as gastroesophageal reflux. If reflux occurs regularly, it can cause permanent damage to the esophagus. The esophageal pH test measures how often reflux happens, and how much acid the reflux contains.
What happens during the pH test?
During the test we’ll guide a thin, small tube through your nose, and down your esophagus. The tube has a small device on the tip that senses acid, and this will be positioned about two inches above the lower esophageal sphincter. The end of the tube that comes out your nose is attached to a portable recorder that is worn on your belt or over your shoulder. The recorder has some buttons on it that you will press to mark certain events. We’ll go over these instructions in detail before you leave the office.
How do I prepare for the 24-hour esophageal pH test?
Seven days before the monitoring period, you should do not take proton pump inhibitors. These include Prilosec (omeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Dexilant (dexlansoprazole).
Two days (48 hours) before the monitoring period, do not take the H2 blockers. These include Zantac (ranitidine), Tagamet (cimetidine), Pepcid (famotidine), Axid (nizatidine); or the promotility drug, Reglan (metoclopramide).
6 hours before the monitoring period, do not take antacids such as Alka-Seltzer, Gaviscon, Maalox, Milk of Magnesia, Mylanta, Phillips, Riopan, Tums or any other brands.
4 to 6 hours before your appointment do not eat or drink
Please note: Occasionally, your doctor may want you to continue taking a certain medication during the monitoring period to determine if it is effective. We will give you specific instructions on any medications.
What will I be doing the 24 hour test?
Follow your usual daily routine in terms of activities*. Do not reduce or change your activities during the monitoring period, because we want to track what happens in your daily life, and how reflux is affected. If you limit your normal activities, the results could be less useful.
*Note: do not take a tub bath or shower; the equipment can’t get wet.
Eating: Eat your regular meals at the usual times. If you do not eat during the monitoring period, your stomach will not produce acid as usual, and the test results will not be accurate. Eat at least two meals a day. Eat foods that tend to increase your symptoms (without making yourself miserable). Avoid snacking. Do not suck on hard candy or lozenges and do not chew gum during the monitoring period.
Lying down: Remain upright throughout the day. Do not lie down until you go to bed (unless napping or lying down during the day is part of your daily routine).
Medications: Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
Recording symptoms: Press the appropriate button on your recorder when symptoms occur (as discussed with the nurse).
Recording events: Record the time you start and stop eating and drinking (anything other than plain water). Record the time you lie down (even if just resting) and when you get back up. We will explain this in detail before you leave the office.
If you think you may be experiencing any unusual symptoms or side effects, please call our office.
What happens after the 24-hour esophageal pH study is over?
The day after the test, you’ll return to our offices to have the device removed. We’ll attach the device to a computer to download the results, which we’ll then analyze. You will not be able to get your results the same day because the data needs to be analyzed first.
Once the monitoring period is over, you can go back to your normal diet and medications. If you have any discomfort in your throat, lozenges or hard candy may help ease this. We’ll discuss the results of your test with you during your next scheduled appointment.
What is the Bravo pH Monitoring System?
The Bravo system is a capsule that we stick to the side of your esophagus for a short period of time. This capsule measures pH levels in your esophagus. If you experience acid reflux, the Bravo capsule will capture data and send it to our computer. This will allow us to understand if you’re suffering from reflux disease, and how to best help you.
How does the capsule work?
The Bravo capsule is about the side of a normal gel cap pill. We’ll attach it to the side of your esophagus using a small amount of suction. This usually takes a few minutes to do. For up to 48 hours, data will be transmitted wirelessly to a small receiver we’ll have you wear on your waistband.
During the study, you’ll be eating like normal and engaging in your regular activities. This will help us understand the reflux patterns in your daily life. The Bravo capsule is disposable, and after a few days the pH capsule will spontaneously detach and pass through your digestive system.
What are the benefits of the Bravo test?
Patients often appreciate the convenience of the Bravo capsule, because it does not have a catheter attached throughout the testing process. This makes it easier to go about your normal activities while data is being collected. Information can be sent wirelessly even if the receiver is up to 3 feet away from you, so you can shower or sleep without worrying about interrupting the data collection.
Are there risks to the Bravo capsule?
There are some risks to any medical procedure, but if we recommend the Bravo capsule to you, it’s because we believe the benefits outweigh any risk. There are certain people who should have not the Bravo test. These conditions would disqualify you: bleeding diathesis, strictures, severe esophagitis, varices, obstructions, a pacemaker, or an implantable cardiac defibrillator. Additionally, because the capsule contains a small magnet, you should not have an MRI study within 30 days of undergoing the Bravo pH test.
Serious complications are extremely rare, but can include perforation, hemorrhage, aspiration, fever, infection, hypertension, respiratory arrest, and cardiac arrhythmia or arrest.
What happens during the Bravo placement?
You will sit or lie down while your doctor inserts the capsule into your esophagus. After the capsule is in place, suction is applied, drawing a small amount of tissue into the capsule. The capsule is locked in place with typically little or no discomfort.
As soon as the capsule is attached, it begins measuring the pH levels in your esophagus. The data is sent to a receiver you’ll keep on your waistband. The receiver is the size of a standard pager, and has three symptom buttons. Simply press the appropriate button during the study when you experience heartburn, regurgitation, or chest pain.
You will also be asked to record periods of eating and sleeping in a diary throughout the test. We will give you complete instructions at the time of your test.
What happens after the test?
After the study period, you’ll return the receiver and diary to our office. We’ll then uploaded the data to a computer, and analyze your results to determine if you have GERD and the best treatment option. You will not be able to get your results the same day, because the data will need to be downloaded and analyzed first.
The disposable capsule will spontaneously detach and pass through your digestive system a few days after the test period.