Esophageal Manometry, 24-Hour Esophageal pH Study
Esophageal manometry is the recording of muscle pressures and coordination of activity in the esophagus. It can evaluate the action of the muscle waves (peristalsis) in the main portion of the esophagus, as well as the muscle valve at the lower end of it (the lower esophageal sphincter, or LES). A 24-hour esophageal pH study is the monitoring of the levels and changes of acid content in the esophagus, over a 24-hour period, during which the patient conducts his or her normal daily activities. Both tests are valuable methods of recording and evaluating the muscles of the esophagus and LES, as well as determining the cause of many symptoms. This information can help the doctor develop effective treatment plans for most patients with esophageal disorders.
How your esophagus works
The esophagus is the "food pipe," the tube that carries food and liquid from the throat to the stomach. The wall of the esophagus contains muscle that automatically contracts when a person swallows. This contraction occurs as a sweeping wave (peristalsis) down the esophagus, taking food or liquid from the throat to the stomach. The LES, located where the esophagus meets the stomach, is a specialized muscle that stays closed most of the time, opening only when swallowed food is moved down the esophagus, or when a person burps or vomits. This muscle protects the lower esophagus from acid and bile normally found in the stomach. These can cause pain and heartburn, and, in time, can lead to damage and scarring in the esophagus. A number of symptoms can originate in the esophagus, including difficulty swallowing foods or liquids, heartburn, and chest pain. Further, the backing up, or reflux, of acid into the esophagus can cause wheezing, cough, and asthma symptoms. Studies may also be done as part of testing before esophageal surgery.
When scheduling either of the following procedures, be sure to tell your doctor what medications, if any, you are taking!
When you arrive at the hospital
Refer to "Planning Your Visit". You do not need to have a driver accompany you for these tests.
Before the procedure, you will be asked several questions about your medical history, the medications that you take, your allergies, and other things. PLEASE BE SURE TO TAKE A LIST OF YOUR MEDICATIONS WITH YOU. A registered nurse with special training and experience in this area usually performs the actual tests, and the physician evaluates the results.
The preparation for either procedure usually requires the patient to take no food or liquid for approximately 8 hours before the exam, and to avoid several medications, including the following.
For seven days prior to the study, do not take
For three days prior to the study, do not take
For 24 hours days prior to the study, do not take
If you take heart or blood pressure medications, CHECK WITH YOUR PHYSICIAN
What to expect during the procedures
The patient is seated on the side of a bed. Numbing medication is applied to the lining of the nose. Occasionally an intravenous line is started in the patient's arm, and a medication is given, to temporarily mimic some of the symptoms the patient has been having. A thin, flexible tube (motility probe), with pressure sensors at different locations, is passed through the nose and into the esophagus. As the probe is slowly pulled back through the nose, the sensors measure pressures at several different locations in the esophagus. The entire procedure takes about 30 to 45 minutes. There may be slight nasal discomfort after the test. The information is transmitted to a computer that records the pressures on graphs, then analyzes the information. The record is sent to the doctor, who reviews the information. He/She may outline a specific treatment plan or, if the exam is normal, may determine that further study is necessary.
A 24-hour esophageal pH study
The patient is seated on the side of a bed. A very thin, wire-like, flexible tube (pH probe) is lubricated with numbing medication, slowly passed through the nose and into the esophagus, positioned at the correct depth, and taped in place. The probe has sensors at two different levels, and is attached to a small monitor, about the size of a transistor radio. After receiving an explanation of how to maintain a written diary-noting such things as meal times, activities, and symptoms-the patient goes home, wearing the monitor as one would a small purse. For the next 24-hours, the patient lives normally, performing all usual activities, eating normally, and correctly completing the diary, then returns to the facility, where the probe is removed. Removal takes only a few moments. The patient may experience slight nasal discomfort while the probe is in place, and perhaps for a while after it is removed. The information on the monitor and diary is transferred into a computer, which analyzes the data. The physician then evaluates and interprets the information.
Esophageal manometry and 24-hour esophageal pH study may be done on the same day, or on different days.