Overview
Esophageal pH (pH is a measure of the acidity or alkalinity of a solution) monitoring is a procedure for measuring the reflux (regurgitation or backwash) of acid from the stomach into the esophagus that occurs in gastroesophageal reflux disease (GERD).
The esophageal pH test is an outpatient procedure performed to measure the pH or amount of acid that flows into the esophagus from the stomach during a 24-hour period.
The procedure is commonly used to help confirm the diagnosis of GERD or to identify the cause of various symptoms, including:
- Heartburn , primarily in patients who have had a normal endoscopy and who have failed medical treatment or may be considered as candidates for surgery
- Uncommon symptoms of GERD (gastroesophageal reflux disease), such as chest pain, chronic cough, asthma, and other throat symptoms
The test may also be performed to evaluate the effectiveness of current treatments for heartburn or reflux. This test is often recommended for those whose symptoms aren’t helped by medications.
Why it is done
Esophageal pH monitoring is used to diagnose GERD, to determine the effectiveness of medications that are given to prevent acid reflux, and to determine if episodes of acidic reflux are causing episodes of chest pain. Monitoring esophageal pH also can be used to determine if acid is reaching the pharynx (lower throat) and is possibly responsible for such symptoms as cough, hoarseness, and sore throat.
Risks
Esophageal reflux monitoring is very safe. You will likely feel some discomfort in the nose and throat, but this is temporary and mild. Rarely, there could be a nosebleed as a result of the procedure. Extremely rarely, there could be a tear in the wall of the esophagus, throat or lung.
Procedure
How you prepare
- Do not eat or drink for four to six hours before your esophageal pH test.
- Tell your doctor if you are pregnant, have a lung or heart condition or any other diseases, or are allergic to any medications.
Can I Continue to Take Medication Before the Esophageal pH Test?
There are several medications that may affect the results of an esophageal pH test.
These include:
- Proton pump inhibitors: Dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex),
- H2 blockers: cimetidine (Tagamet) and famotidine (Pepcid)
- Antacids: Alka-Seltzer, Gaviscon, Maalox, Milk of Magnesia, Mylanta, Tums
- Calcium channel blockers: diltiazem (Cardizem), nifedipine (Adalat, Procardia),and verapamil (Calan, Verelan)
- Nitrates: Isordil, Isosorbide, Nitrobid, Nitrodisc, Nitroglycerin (NTG), Nitropatch
- There are other drugs that may affect the test results. Talk to your doctor about all medications you are taking before undergoing the procedure.
- Do not discontinue any medication without first consulting with your primary or referring doctor. If proton pump inhibitors need to be discontinued, you will take a week off these drugs before doing the test.
How it’s performed
Esophageal pH monitoring is performed by passing a thin plastic catheter a sixteenth of an inch in diameter through one nostril, down the back of the throat, and into the esophagus as the patient swallows. The tip of the catheter contains a sensor that senses acid. The sensor is positioned in the esophagus so that it is just above the lower esophageal sphincter, a specialized area of esophageal muscle that lies at the junction of the esophagus and stomach and prevents acid from refluxing back up into the esophagus. In this position the sensor records each reflux of acid. The catheter protruding from the nose is connected to a recorder that registers each reflux of acid.
The patient is sent home with the catheter and recorder in place and returns the next day to have them removed. During the 24 hours that the catheter is in place, the patient goes about his or her usual activities, for example, eating, sleeping, and working. Meals, periods of sleep, and symptoms are recorded by the patient in a diary and/or by pushing buttons on the recorder. After the catheter is removed, the recorder is attached to a computer so that the data it has gathered can be downloaded into the computer where it is analyzed and put into graphic form. The procedure can be modified by placing the sensor in the upper esophagus or pharynx to determine if refluxed acid is reaching the pharynx.
The most recently-developed device for monitoring esophageal pH uses a capsule also known as the Bravo Capsule. The capsule contains an acid sensing probe, a battery, and a transmitter. The probe monitors the acid in the esophagus and transmits the information to a recorder that is worn by the patient on a belt. The capsule is introduced into the esophagus on a catheter through the nose or mouth and is attached to the lining of the esophagus with a clip. The catheter then is detached from the capsule and removed. Thus, there is no catheter protruding from the nose. The capsule transmits for two days or three days, and then the battery dies. Five to seven days later, the capsule falls off the esophageal lining and is passed in the stool as the capsule is not reusable.
The advantages of the capsule device are related to the absence of a catheter connecting the probe to the recorder. There is greater comfort without a catheter in the back of the throat, and patients are more likely to go to work and do more of their normal activities without feeling self-conscious about the appearance of the catheter to others. The disadvantages of the capsule are that it cannot be used in the pharynx (where it would be impossibly uncomfortable) and, so far, it has not been used in the stomach.
Results
At your next appointment, your doctor will discuss the results of your esophageal pH test with you. You may resume your normal diet and activities. You may feel a temporary soreness in your throat. Lozenges may help.
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