Esophageal Manometry: What you need to know
An esophageal manometry test is performed to measure the pressures of the esophagus when you swallow. Usually this is done when people have symptoms of food getting stuck, regurgitation, or chest pain. Sometimes it is done before stomach surgery for reflux to make sure the esophagus is healthy which would be important to know before the surgery. You might be wondering, “But I’ve already had an endoscopy and a barium swallow, why do I need this?” While endoscopy and barium swallows are good at looking at structural problems with the esophagus, the manometry is vital to examine the function of it.
Nobody enjoys getting the manometry test but thankfully it’s short. First the nose gets numbed with a local anesthetic gel. Then a small tube is introduced through the nose, down the back of the throat, and into the esophagus. You will be given water to drink as the tube is going down to help it float down easily. Once the tube is down the worst is over. You will then be given ten sips of salt water to swallow which will let me see how the esophagus functions. Once ten swallows are done, the tube is removed and you are free to go!
Esophageal Manometry and pH/impedance: What you need to know
Why?: An esophageal manometry test is performed to measure the pressures of the esophagus when you swallow. Usually this is done when people have symptoms of food getting stuck, regurgitation, or chest pain. Sometimes it is done before stomach surgery for reflux to make sure the esophagus is healthy. Sometimes it is only done before the placement of a pH probe (see below) to get the correct position. While endoscopy and barium swallows are good at looking at structural problems with the esophagus, the manometry is vital to examine the function of it.
How?: Nobody enjoys getting the manometry test but thankfully it’s short. First the nose gets
numbed with a local anesthetic gel. Then a small tube is introduced through the nose, down the back of the throat, and into the esophagus. You will be given water to drink as the tube is going down to help it float down easily. Once the tube is down the worst is over. You will then be given ten sips of salt water to swallow which will let me see how the esophagus functions. Once ten swallows are done, the tube is removed and you are free to go!
24 hour pH/impedance:
Why?: A 24 hour pH/impedance study is performed to measure the amount of acid and non-acid reflux that occurs in a span of a day. Usually this is done when patients have symptoms of reflux, heartburn, regurgitation, chest pain, cough, or who might be getting surgery for reflux. You might wonder, “But I’ve already been told I have GERD why would I need this?” In cases where the acid reducing medications (eg Prilosec, Protonix) are not helping your symptoms, we need to figure out if it’s because the medication is not reducing the acid enough, whether your symptoms are from NON-acid reflux (reflux that is not acidic), or from other causes like hypersensitive esophagus.
How?: A much smaller tube is introduced down the nose and into the esophagus. The tube is so small that while it might feel strange, it will not cause pain or discomfort. After the tube is secured with tape and looped behind an ear, you go home with the tube in place. Try and go about your day as normally as possible. Eat the normal foods you eat. Drink the normal fluids you drink. You will record each and every symptom in a diary, as well as the times you eat, drink, or lay down. 24 hours later, you will return to us and we will remove the tube. Once the study is uploaded into our computer, I can analyze the data. This is where the diary is important—by writing down all the details, I will be able to tell you exactly whether your symptoms occur at the same time as reflux. This is important because if it does not, the treatment would be different.
Anorectal Manometry: What you need to know
An anorectal manometry is performed in patients who have symptoms like constipation, fecal incontinence, or rectal pain. The purpose is to record the pressures of the anal sphincter. This helps determine whether an anorectal disorder is contributing to the symptoms. For example in constipation there is an entity called “dyssynergy” which is where the sphincter contracts rather than relaxes when you try and defecate. In fecal incontinence the pressure of the sphincter can be too low to keep feces in when you need to.
The anorectal manometry is a quick test. You will not be sedated. A small tube (less than the size of a finger) is inserted into the rectum. Baseline pressures will be recorded while you lay on your left side. Afterward, I will ask you to squeeze the sphincter as tight as you can, as if trying to hold in stool. Then I will ask you to bear down as if you’re trying to defecate. Finally, I will be inflating a little balloon inside the rectum to get some information about sensation. This does not hurt except may make you feel like you have the urge to defecate (which you won’t!). The whole test lasts 15 minutes or so.
Wireless pH probe (Bravo): What you need to know
A wireless pH probe (or Bravo), is performed in patients who have symptoms that might be consistent with acid reflux. This could be heartburn, regurgitation, chest pain, or throat symptoms/cough. Sometimes the wireless pH study is performed ON acid suppressive therapy but it is highest yield when performed OFF acid suppressive therapy. Doctors order this test when they either want to positively confirm that you have acid reflux (because sometimes symptoms of heartburn can be from other causes), to rule it out, or to make sure the acid suppressive medications are working adequately (eg when you are known to have reflux and you have a condition like Barrett’s esophagus that makes it necessary for your acid to be well controlled).
The pH probe is placed while you are asleep during your endoscopy. It is a tiny chip that sticks onto the esophagus by suction. It falls off by itself after a few days and passes through your intestine to be eliminated with your stool. It is so small you probably won’t see it. Most patients feel totally normal after the procedure. Some might feel a “foreign body” sensation in the chest which is completely normal. On very rare occasion some patients have pain after the placement but it subsides quickly. It is extremely rare that it causes so much discomfort that it has to be removed endoscopically. The chip records the acid information wirelessly for 48 hours. The recording device (which is the size of the old large cell phones) has to stay within 2 feet from you—it is possible to take a shower that way. It is absolutely important to keep a very strict diary of all symptoms, all food and drink, and all times when you’re sleeping or laying down. The reason this is important is that when I analyze it I can try and associate your symptoms with reflux activity to the minute. If you drink something acidic like coffee or soda, it is important I know, because otherwise it will look like an acid reflux event when really it’s just the acidity of the drink that gets recorded. Make sure to find out from us whether you need to stop your acid medications 1 week before the test.
What is a low FODMAP diet?
FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides, and Polyols. These are short chain carbohydrates that are poorly absorbed in the body and are thus available for bacteria in the colon to ferment and produce bloating and gas. Patients with IBS may find eating a diet high in FODMAPS make their symptoms worse. A recent study published in the journal Gastroenterology (link to gastrojournal.org) provided scientific evidence that eating a low FODMAP diet reduces IBS symptoms, when compared to a normal diet.
The following list of foods is a guideline for the types of foods to avoid because they contain fodmaps
|Mango||Asparagus||Rye||Custard||Chickpea||High frcutose corn syrup|
|Pear||Broccoli||Bread||Ice cream||lentils||Fruit juice|