Esophageal Function and pH Testing

What is pH testing?

pH testing or studies are a very useful adjunct to endoscopy in helping patients who may suffer from GERD or heartburn. These studies can also help with the evaluation of pain that may not be related to GERD.

Currently, we use two different studies to quantify or measure the acid that enters the esophagus. One modality utilizes a flexible and narrow catheter that is placed in the nostril and guided into the esophagus. A recording device is on the patient’s exterior, and the patient can document pain or reflux episodes. The recording period is 24 hours. This traditional device has several acid sensors, including one proximal in the esophagus, and thus is useful for patients who have supra-esophageal symptoms, or symptoms of acid reflux that may cause pulmonary disease, chronic cough, or other non-esophageal injury in addition to standard reflux symptoms.

Our newer pH study device is called a Bravo capsule. Medtronic is the manufacturer, and excellent information can be found here.

This device is placed during an upper endoscopy and wirelessly transmits pH data for 48 hours to a recording device worn by the patient.

Your Associates in Gastroenterology physician will discuss the procedure best indicated for you, as well as instruct you whether to continue or taper off of your anti-acid medications prior to the procedure.

Bravo capsule

This picture demonstrates the Bravo capsule after it has been placed in the distal esophagus. This device records pH exposure in the esophagus for 48 hours, transmitting the data wirelessly to an external recording device. The Bravo capsule is then shed as the esophageal mucosal cells turn over, and the capsule is passed with normal elimination.

What is Esophageal Manometry?

Esophageal manometry is a very important study in the diagnosis of motility (movement) disorders of the esophagus. A catheter with pressure-sensing devices is placed into the esophagus by a skilled GI nurse, and a study is made of the swallowing movement in patients, in response to both dry and wet (you will sip water) swallows. This simple study yields very good information about the strength and coordination of a patient’s swallow, and can diagnose conditions like achalasia and esophageal spasm.

What preparation is required for a pH or a manometry study?

We ask that you not eat or drink after midnight the day before your procedure.

Your Associates in Gastroenterology physician will instruct you beforehand whether to continue or taper off of your anti-acid medications prior to the procedure.

What happens before your procedure?

This procedure will be scheduled for you at Penrose Main Hospital on Nevada Avenue. Please check in to the GI lab one hour before your procedure time.

What happens during the procedure?

If you are having a 24 hour catheter-based pH study, the nurses at Penrose will place the device early on the morning of your procedure in the GI lab. They will instruct you in the use of the diary/recording device and answer all of your questions.

If you are undergoing a Bravo placement, the Bravo capsule is placed at the conclusion of a standard EGD/upper endoscopy.

If you are undergoing a manometry, a catheter with pressure-sensing devices is placed into the esophagus by a skilled GI nurse, and a study is made of the swallowing movement in patients, in response to both dry and wet (you will sip water) swallows.

What happens after your procedure?

Your study report will be ready within seven days of the procedure. Typically, the time is even less. Your primary/referring Associates in Gastroenterology physician will then have access to your report and advise you of the findings. If you have not heard from your physician, please call 719-635-7321 to discuss the findings.

If you underwent upper endoscopy for the purpose of placing a Bravo capsule, the limitations of driving and working apply as you will have been given conscious sedation.

What are the possible complications of these procedures?

The Bravo device attaches to the lining of the esophagus and is shed within a few days of placement. To date, no problems with either failure to dislodge or failure to pass the capsule have been reported.