Tests and Procedures David's Experience

3-1-98

If you are considering some of the testing available to further understand your physical state, I would like to share the following with you. I have had what I consider to be, the full test suite for GERD and would like to share the Manometry and 24 Hour PH procedures in detail with you. ( I have had an Upper GI, Endoscopy, Manometry, 24 Hour PH and CT scan ... I highly recommend all of these if considering the Nissen, even if your doctor does not )

MANOMETRY:

The Manometry is done to check for esophageal motility or the proper contractions in the esophagus. This is essential to push food down to the stomach. The actual procedure takes only fifteen minutes. Consider this test another of life's adventures.

There is NO pain involved with this procedure and once you understand every step, there is no apprehension as well. Preparation for this test is to simply not eat that morning. In your normal clothing, you will lay on your side in a standard doctor's office setting. The doctor or technician performing the test will lubricate the end of a small tube (half the diameter of a straw or less), also called a probe and explain what is going to occur. While sitting on the exam table, they will insert the tube into a nostril slowly and feed it in to the back of your throat. This may make you have the sensation of sneezing and your eyes may water but note that should this occur, it is an involuntary reaction and not due to pain. Once the tube is at the back of your throat, you will be asked to gulp some water while the tube passes by your windpipe. This is easy and almost undetectable. From this point forward, you will only feel a mild sensation of what I would describe as a hair in the back of your throat (not bad at all) and the tube sliding over the sensitive membrane in your nose and sinuses.

From 8 to 12 inches of this tube lay in your stomach and it is slowly brought back out the same way it went in. The tube has four points of measurement on it. Each point of measurement simply has the ability to detect pressure and they are spaced approximately 2 to 4 inches apart. You will be able to view the monitor that the doctor or technician are using to guide the test and collect results. You will be able to talk, breath and swallow fine during the entire procedure, so ask questions. It's all very exciting and interesting.

The tube (or probe) is then completely removed and you are done! You have immediate feedback on the results because you are watching and asking questions. While it is an experience, it is also a snap and I would not hesitate to do it again.

24 HOUR PH TEST:

The 24 Hour PH test is in some respects similar to the Manometry but can be a little more uncomfortable due to the length of time. The purpose of this test is to measure the level of acidity in the esophagus, just above the lower esophageal sphincter (or LES).

Preparation for this test is to be off of prescription acid reduction medication for four days prior to the procedure. Antacids like Gaviscon can be taken up to 6 before the test. A technician or doctor will lubricate the end of small diameter tube (even smaller than that used in the Manometry) and insert it in the same manner as the Manometry.
Once placed in your esophagus, you are x-rayed to ensure proper placement of the probe. This probe must be just above the LES. Any adjustments are made and you are given a small harness supporting a data recorder. ( Please note that the "probe" is simply the end of the tube and it is not larger and appears no different than the rest of the tube)
You are then instructed to go about your normal day and indicate on a log and possibly press a button on your recorder at every meal or severe symptom. The following day you return to have the probe removed which is quick and easy. A technician will compile the results within a weeks time but you will have a good indication of the results because you are able to monitor the ph levels yourself. The data recording device will have a display indicating the actual ph, 7.0 being neutral and anything under 4.5 showing significant acidity. This is a priceless opportunity in which one can link the physical symptoms of GERD with the internal activity. I encourage experimentation near the end of the test. For instance, I tried eating a few acidic goodies, pushing during a bowel movement and a little Gavison to measure the response. I did these things only within the last hour of the test, so we would all have our results.

Hope someone finds this useful. Feel free to contact me with any questions, no matter how small.

David

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