This test is performed in few medical centers. It involves the same procedure as the 24-hour esophageal pH monitoring (a tube passes through the nose into the esophagus at the level of the lower esophageal sphincter). It measures both acidic and non-acidic reflux in the esophagus over 24 hours. This test is important for people with reflux symptoms who experience bile reflux, rather than acid reflux, and thus have normal results in the 24-hour esophageal pH monitoring. Conducting the 24-hour impedance pH monitoring does not require performing the 24-hour esophageal pH monitoring, as it is included in it. Unfortunately, impedance monitoring cannot be done with a wireless capsule like the wireless pH monitoring (Bravo).
24-Hour Esophageal pH Monitoring
The esophageal pH monitoring records the pH in your esophagus to determine if you have gastroesophageal reflux disease (GERD). The test can also be performed to assess the effectiveness of medications or to make a decision regarding surgery.
How is esophageal pH monitoring performed?
A thin, small tube with a microscopic device at the tip, which detects acid, passes through your nose into the esophagus and is placed about five centimeters above the lower esophageal sphincter. The tube is secured to the side of your face with clear tape. The end of the tube that comes out of your nose is connected to a portable recording device that is worn on your belt or over your shoulder. The recording device has buttons that you will press to mark certain events. A nurse will explain how to use the device.
How can I prepare for esophageal pH monitoring?
Seven days before the monitoring period, do not take proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole. Two days (48 hours) before the monitoring period, do not take H2 blockers: ranitidine, cimetidine, famotidine, or prokinetic medications, such as domperidone and metoclopramide.
Six hours before the monitoring period, do not take antacids (such as Milk of Magnesia or any other brands).
Four to six hours before your appointment, do not eat or drink. Please note: sometimes, your doctor may want you to continue taking certain medications during the monitoring period to determine their effectiveness.
Once the esophageal pH monitoring has started, what do you need to know and do?
Activity: Follow your usual daily routine. Do not reduce or change your activities during the monitoring period. Doing so may make the test less useful.
Note: Do not take a bath or shower; the equipment cannot get wet.
Diet: Eat regular meals at your usual times. If you do not eat during the monitoring period, your stomach will not produce acid as it normally does, and the test results will not be accurate. Eat at least two meals a day. Consume foods that tend to increase your symptoms. Avoid snacks. Avoid candies or lozenges and do not chew gum during the monitoring period.
Position: Remain upright throughout the day. Do not lie down until you go to bed (unless lying down during the day is part of your routine).
Medications: Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
Symptom recording: Press the appropriate button on your recording device when symptoms occur (as explained by the nurse).
Event recording: Record the time when you start and stop eating and drinking (anything other than tap water). Record the time you lie down (even resting) and when you get up. The nurse will explain this as well.
Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your doctor. You will return the next day to have the device removed. The information from the recording device will be transferred to a computer, and the results will be analyzed.
What happens after the 24-hour esophageal pH monitoring?
Esophageal pH monitoring records the pH in your esophagus to determine if you have gastroesophageal reflux (GERD). The test can also be performed to assess the effectiveness of medications or to make decisions regarding surgery.
48-Hour Wireless Esophageal pH Monitoring (Bravo)
Esophageal pH monitoring records the pH in your esophagus to determine if you have gastroesophageal reflux (GERD). The test can also be performed to assess the effectiveness of medications or to make decisions regarding surgery.
A small capsule is temporarily placed on the wall of the esophagus during an endoscopy. The capsule measures pH levels in the esophagus and wirelessly transmits the information to a receiver (about the size of a mobile phone) worn on your belt. The receiver has buttons that you will press when you experience gastroesophageal reflux symptoms such as heartburn (the nurse will explain which symptoms to record). You will be asked to keep a diary to log certain events, such as when you start and stop eating, drinking, when you lie down, and when you get up. All of this will be explained by the nurse.
How can I prepare for esophageal pH monitoring?
Inform your doctor if you have a pacemaker or defibrillator, a history of bleeding, vascular diseases, or any other previously known issues with your esophagus. Seven days before the monitoring period, do not take proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole.
Two days (48 hours) before the monitoring period, do not take H2 blockers: ranitidine, cimetidine, famotidine, or prokinetic medications, such as domperidone and metoclopramide.
Six hours before the monitoring period, do not take antacids (such as Milk of Magnesia or any other brands).
Four to six hours before your appointment, do not eat or drink. Please note: sometimes, your doctor may want you to continue taking certain medications during the monitoring period to determine their effectiveness.
Once the esophageal pH monitoring has started, what do you need to know and do?
Activity: Follow your usual daily routine. Do not reduce or change your activities during the monitoring period. Doing so may make the test less useful.
Note: Do not take a bath or shower; the equipment cannot get wet.
Diet: Eat regular meals at your usual times. If you do not eat during the monitoring period, your stomach will not produce acid as it normally does, and the test results will not be accurate. Eat at least two meals a day. Consume foods that tend to increase your symptoms. Avoid snacks. Avoid candies or lozenges and do not chew gum during the monitoring period.
Position: Remain upright throughout the day. Do not lie down until you go to bed (unless lying down during the day is part of your routine).
Medications: Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
Symptom recording: Press the appropriate button on your recording device when symptoms occur (as explained by the nurse).
Event recording: Record the time when you start and stop eating and drinking (anything other than tap water). Record the time you lie down (even resting) and when you get up. The nurse will explain this as well.
Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your doctor. You will return the day after tomorrow to return the receiver and the diary. The information from the recording device will be transferred to a computer, and the results will be analyzed.
What happens after the 48-hour wireless esophageal pH monitoring?
Return to your normal diet and medications. Your doctor will discuss the test results with you during your next scheduled appointment.
Normal activities—such as swallowing, eating, and drinking—will cause the capsule to detach and be expelled from the digestive system within an average of 7 to 10 days. You should not undergo an MRI (magnetic resonance imaging) for one month after the capsule is placed.
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