Esophageal Function Testing
pH Monitoring
While it may seem obvious to the patient that they have reflux, studies show that using symptoms alone to diagnose GERD can be inaccurate. There are several findings that will confirm the diagnosis of GERD. Esophagitis found at the time of EGD is a good indication of abnormal acid presence in the esophagus, although, rarely, certain other conditions or even medications can cause esophagitis. Presence of Barrett’s esophagus on biopsies taken at the time of endoscopic examination is also evidence of GERD. The “gold standard” for the diagnosis of GERD, however, is to measure how frequently acid invades the esophagus and how long it stays there. This testing is called prolonged ambulatory pH monitoring, and can be done several ways.
Catheter monitoring requires a small catheter be inserted through a nostril and properly positioned in the esophagus, usually based on measurements of the esophagus that are taken at endoscopic exam. The patient then wears the catheter home for 24 hours while it records data from the esophagus on a small computer worn on the belt.
The Bravo technique utilizes a small capsule-shaped sensor that is placed into the esophagus through the mouth. It is wireless, and transmits data for 48 hours to a receiver worn on the belt. The patient is usually unaware of the capsule during monitoring, and it passes spontaneously from the gastrointestinal tract after the test.
Both procedures provide accurate data and require the patient to be off all acid-reducing medications during testing. The only anesthesia required is some numbing spray in the throat or nose, although the Bravo capsule is occasionally placed under sedation at the time of EGD.
Because it is provides longer monitoring and is more comfortable for the patient, your surgeon is likely to utilize the Bravo system. It is considered the “state of the art” in pH monitoring. The catheter system measures acid at two levels instead of one, however, and there may be occasional patients in whom that technique is a better choice.
Esophageal Manometry
The esophagus is a muscular tube that ends at a muscular valve called the lower esophageal sphincter (LES). The muscular function of the esophagus and LES can be measured with a pressure sensing catheter inserted through an anesthetized nostril. The patient is instructed to take sips of water during the test to demonstrate how much pressure the esophagus and LES can produce. This information is useful in planning anti-reflux surgery or in the evaluation of other swallowing problems. We utilize a technique called high resolution manometry to obtain the best data available for the diagnosis and treatment of esophageal problems. Manometry testing usually takes about 30 minutes and does not require sedation.
Our surgeons utilize the most advanced monitoring techniques available for esophageal function testing, and were leaders in making this testing available in North Georgia. Although a nurse or physician’s assistant may take part in placement of the monitors, all interpretation of testing is done by Dr. Graybeal. He trained with international experts in esophageal diseases and esophageal function testing and has the experience of many years and hundreds of tests.
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