This leaflet has been designed to help answer some of the questions you may have about your appointment and to help you prepare for an oesophageal manometry and either a 24-hour pH or pH/impedance monitoring test.
Please read the leaflet at least one week before your appointment and follow the instructions carefully, as this information explains what is involved and how to prepare for it. You will be having both manometry and either a pH test or combined pH and impedance test depending on your symptoms.
What is oesophageal manometry?
This is a test that measures the pressure activity within the oesophagus and the sphincters (bands of muscle) at the top and bottom of it. An assessment can then be made of how well the oesophagus is working and whether contractions are co-ordinated.
What is 24-hour pH monitoring?
This is a test that measures the amount of acid coming up (reflux) into the oesophagus from the stomach over a 24-hour period. This allows us to establish whether your symptoms are due to acid reflux.
What is 24 hr impedance monitoring?
This is a test that measures the amount of liquid or gas coming up into your oesophagus from the stomach over a 24hr period. This allows us to establish if your symptoms are related to non-acid reflux or gas.
Why are these tests necessary?
The tests provide valuable information regarding your condition and help work out what is the best treatment for you. Unfortunately, there are no other less invasive tests available that will give us this information at the present time.
What are the risks from having the test?
The risk of causing serious harm to you with these tests is very small but includes bleeding or damage to your nose, throat, larynx (voice-box) or oesophagus. There is no published information on how often these problems occur however they are uncommon. Occasionally people may feel faint whilst putting the tube into the oesophagus. You may commonly experience a runny nose, sore throat or slight discomfort on swallowing which will go away when the tube is removed.
Important Medication instructions:
Before the test you should take your medication as normal except for the following:
7 DAYS before the tests you must stop taking:
Lansoprazole (Zoton), Pantoprazole (Protium), Omeprazole (Losec), Esomeprazole (Nexium), Rabeprazole (Pariet),
2 DAYS before the tests you must stop taking: Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid) and Cimetidine (Tagamet), Metoclopramide (Maxalon), Cisapride (Propulsid), Domperidone (Motilium).
12 HOURS before the tests you must stop taking: Antacids / alginates which include Gaviscon, Peptac, Maalox and Rennie’s.
This is so that we can obtain an accurate assessment of the amount of acid that is refluxing. These should not be restarted until after the 24-hour catheter (tube) is removed as taking these will affect the results of the investigation (test). If you feel this would be difficult, please contact the number on the letter.
Please have nothing to eat for four hours before the test, clear fluids/water is allowed until two hours prior.
If you have diabetes controlled by diet only follow the standard instructions as above. If you take medication / insulin, please contact the number above if the timing of your appointment would cause difficulties with blood glucose control.
Please do not wear make-up on the day of your examination: this will prevent the tape used to secure the tube from sticking. If you are allergic to any tape, please inform the person performing the test. Wear loose comfortable clothes.
On arrival
A doctor or nurse will explain the procedure to you. This is to ensure you understand the test and all its implications. You will be asked to sign a consent form if you agree to have the procedures carried out.
During the test
Unfortunately, you cannot be put to sleep or sedated during the procedure. You will be asked to sit upright on a couch. A catheter (tube) with pressure sensors will be passed via your nose into your oesophagus. The tube is made of soft plastic and only about 5mm wide and most people manage to swallow the tube without too much difficulty. This will involve drinking water to ease the passage of the tube. Once the tube is in place you will be asked to lie on your back on the couch.
The tube will be taped to your nose to stop it moving during the test. You will be given drinks of water using a syringe to put a small amount of water (5ml) in your mouth and then be asked to swallow it. You will then be assisted to sit up on the couch and will be given more drinks of water. You may also be given biscuits to chew and swallow during the test. This will be clearly explained throughout the procedure. If you have any food allergies or need a gluten free biscuit, please let the person performing the test know, you can bring a suitable biscuit with you if preferred. The test usually takes 20 to 30 minutes to complete. The tube is then removed.
A second tube is then inserted in the same way as the first. The tube is positioned in your oesophagus at an exact point which is 5cm above the junction with your stomach. Putting the second tube in only takes a few minutes.
It is a much thinner tube that tends to be less uncomfortable. It is positioned in the same way as the previous tube and secured to our nose using Elastoplast, an alternative can be used if there are known allergies. After which time you will be able to return home with this tube in place. The tube records activity within your oesophagus for 24hours.
Will I be able to feel the tube?
During the test you will feel the tube in the back of the throat. You may find it uncomfortable, but you should not feel any pain. Some people find bread and other dry food difficult to swallow. Sucking on a boiled sweet can ease this. You can eat and drink normally with the tube in place. Whilst the tube is in place you should not take any antacid medication such as Peptac or Gaviscon.
Can I carry out my normal activities during the recording period?
Yes. It is important that you carry out your normal activities as far as possible during the recording period to see if they might be related to your symptoms. There are no restrictions on eating, smoking, alcohol, and activity, therefore. You should not however undertake strenuous physical exercise such as jogging or bike riding that could result in damaging the monitoring equipment. Showering or having a bath should be avoided for the same reasons.
Who can I contact for help or advice during the 24-Hour pH test?
Following insertion of the pH tube the doctor and nurse will explain how to use the monitoring equipment during the recording period and where to return the equipment the next day. If you have any further questions or feel unsure regarding the advice you have been given, please contact the Endoscopy Department during office hours (9am – 5pm) Monday – Friday on (0191) 4452586
Risks
There is a small risk that the tube could slide up or down in your gullet during the recording period causing increased discomfort and possibly vomiting. If either of these problems occur, you can, if necessary, remove the tube yourself as described below or alternatively you can attend the Emergency Care department at the hospital where it can be removed for you.
Instructions for removing the pH tube:
At the end of the 24hr period the tube needs to be removed. Please return to the endoscopy unit reception desk. An endoscopy nurse will be available to take the tube out. This will only take a few minutes and should not be uncomfortable to do. After this you can go home. If preferred, you can remove the tube at home and return the recording box and written recordings at the end of the 24-hour period to the endoscopy department. You can discuss this with the doctor/nurse at the time of your appointment. The tube should never be cut due to the risk of it being swallowed.
Instructions for returning the equipment:
Specific instructions on when to return the equipment will be given on the day of the test. It is important to return the equipment as we cannot report the results of the test until we have been able to download the information. Please re-start taking your usual indigestion medicine until you are seen at the hospital with results of the tests.
When will I know the results?
The results of the test will be analysed before a diagnosis can be made. Once this is done the consultant in charge of you care will be informed and decide the next course of action. It is reasonable to expect to hear from the hospital within 4 weeks of having the test. If you do not and wish to speak to someone regarding this, please contact your consultant’s secretary by ringing the Hospital on (0191) 4820000.