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What is a 24 hr pH probe?
The lower
esophageal sphincter is a specialized muscle at the lower end of the esophagus
which remains tightly closed most of the time. This is supposed to open only
to allow food and liquids to enter the stomach. Occasionally, the lower
esophageal sphincter opens inappropriately, allowing stomach acid and bile to
wash up into the esophagus. This is called acid reflux and can cause
discomfort and heartburn. Almost everyone has experienced heartburn
occasionally but when it happens on a regular basis, it can lead to damage and
scarring in the esophagus.
pH is a
measure of the acidity. Most people are familiar with pH tests done on soil or
a swimming pool. An esophageal pH test measures how often stomach acid flows
into the lower esophagus and the degree of acidity during a 24-hour period.
What
equipment is used for this test?
The equipment
for esophageal pH consists of a small thin probe at the end of tubing. This
probe measures acidity. The tubing is gently inserted through the nose, down
to the end of the esophagus. It is attached to a small portable recorder that
is carried on the patient’s waist. Over a 24-hour period, the acidity in the
lower esophagus is recorded. When the patient experiences reflux or other
symptoms, the patient presses a button on the recorder. This marks a time so
the physician can see how it relates to the acid level measured by the probe.
The recorder is then analyzed and a report sent to the physician.
What are
the reasons for having this test?
There are a
number of symptoms that originate in the esophagus including heartburn,
difficulty swallowing of food or liquid, and chest pain. A measure of the
esophageal pH is of great importance in evaluating symptoms and allows the
physician to diagnose and treat problems of acid reflux. This exam is often
done before and after medical and surgical treatment of acid reflux into the
esophagus.
How do I
prepare for this test?
Do not take any reflux, heartburn, or stomach medications (such as Prilosec,
Aciphex, Prevacid, Nexium, Protonix, Pepcid, Zantac, and Axid) five (5)
days before your test unless your doctor tells you otherwise.
Medications such as Tums, Maalox, Mylanta, Gaviscon, and Rolaids
may be taken up to 24 hours to the test. Please take all of your other prescription medications with a sip of
water the day of the test.
You will be given detailed instructions on what to do for this test. Other than avoiding certain medications, you should not have anything
to eat or drink after midnight the day before your test. We will need to have all pertinent records sent over to the hospital
ahead of time.
What can I
expect during the test?
It takes
about 10 to 15 minutes to insert and place the pH probe. While the patient is
seated in a chair or lying on his/her side, a soft thin tube is passed through
the nose. Upon swallowing, the tip of the tube enters the esophagus and the
nurse or technician quickly passes it down to the desired level. There may be
some slight gagging at this point, but it is usually controlled by following
instructions. The tubing is then attached to the waist recorder and the
patient is sent on to his/her regular daily activities.
What will
the results of the test show?
Generally, an
esophageal pH test will show a small amount of acid seeping into the esophagus
at various times during the day and night. This is normal for almost everyone
and the patient may not even be aware of these symptoms. However, if the usual
protective mechanisms of the esophagus do not function properly, the test will
show a greater degree and duration of stomach acid in the esophagus.
Are there
any side effects or complications?
Generally,
there are no serious problems associated with esophageal pH testing. Once the
tube is in place, it is usually easily tolerated.
What are
the benefits and alternatives?
The primary
benefit of the exam is that the physician has clear documentation of the
degree and duration of acidity in the esophagus. With this information, a
specific treatment program can be outlined or reassurance provided if the exam
is normal.
Other examinations may be
used to study the esophagus such as upper GI series and endoscopy but nothing
takes the place of esophageal pH monitoring. This is often done in association
with esophageal manometry.
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