24 hours pHmetry and impedancemetry

What is a pH-metry?

The pH-metry is a test that allows for the measurement of the degree and intensity of gastroesophageal reflux (stomach contents that return from the stomach to the esophagus).

What is the impedancemetry?

The impedancemetry is a technique that can be used alongside the 24-hour pH-metry which uses electric resistance to register episodes of reflux, including solids, liquids, or a mixture of both. Additionally, it determines the direction of the bolus, whether it moves to or from the stomach.

How is this test different from a conventional pH-metry?

The primary advantage of a pH-metry impedance test compared to conventional pH-metry is that the former allows us to determine whether the contents returning into the esophagus are acid or alkaline. This important difference allows for a more specific treatment for the patient.

What does the test consist of?

A thin, flexible tube is introduced through the nose and into the esophagus, stopping 5 cm above the start of the stomach. This tube remains connected to a small, portable recording device that measures the pH values within the esophagus once every 4 seconds during the 24 hours of the test.

The patient will record the start and end times of meals and taking of beverages (except water) as well as sleeping time, waking time, and the times in which symptoms appear (regurgitation, pain, coughing, etc).

The remainder of all daily activities should be continued normally.

What are the indications for this test?

Your physician will indicate this test for the following reasons:

– To diagnose or rule out gastroesophageal reflux disease (GERD)

– Following medical treatment for GERD

– To determine association of atypical symptoms (coughing, pain, aphony, etc.) with GERD

– To determine the benefits and risks of anti-reflux surgery

– To assess the existence of GERD following anti-reflux surgery

How long does the test last?

The pH-metry impedance test lasts 24 hours.

What are the complications of this test?

The only complications are those related to the placing of a nasogastric tube.

Can the pH-metry test and esophageal manometry be performed at the same time?

Generally, both tests are performed simultaneously. The manometry tube is placed first, in order to locate the lower esophageal sphincter, followed by the pH-metry tube.

How do I prepare for a pH-metry?

You will be required to fast, avoiding food starting 8 hours prior to the procedure, and will need to pause the use of anti-secretory medication such as:

– Esomeprazol

– Lansoprazol

– Dexlansoprazol

– Omeprazol

– Pantoprazol, etc

Avoid antacids such as:

– Almagato

– Dimeticona

– Magaldrato

– Aluminum gels

Avoid prokinetic medications such as:

– Cinitaprida

– Itoprida

– Metoclopramida

– Cisaprida

These medications will be paused for at least 7 days prior to the pH-metry procedure.

What should I expect from the procedure?

The pH-metry is an outpatient procedure that is performed without sedation. The majority of the patients tolerate the procedure well. Once over, you can resume normal activities immediately.

Results:

The medical report of the test will be ready 2-3 days after the procedure. The results can be part of preoperative evaluation or be used to help identify the cause of symptoms experienced by the patient.

Please plan to discuss the test results with your physician on your following appointment.

What is Bravo pH-metry or wireless pH-metry?

This consists of placing a small capsule, 3 cm in size, via an endoscope. This capsule is sensitive to pH changes inside the esophagus and sends measurements wirelessly to an external device.

This method avoids the common discomfort caused by the nasal tube during the 24-hour pH-metry impedance test and is able to take measurements for a period of 72 hours. After the test concludes, the capsule detaches from its test location and is eliminated through normal bowel movements. This test requires a previous esophageal manometry.

In our outpatient unit we are able to perform pH-metry tests of both types. The Bravo pH-metry’s disadvantage lies in the need for an endoscopy in order to place the capsule in the lower third of the esophagus, making it unable to take pH measurements of the upper portion

Bravo system: