ESOPHAGEAL ph TESTING
Esophageal ph testing is a diagnostic test to determine if a patient has a condition know as GERD (Gastro-Esophageal Reflux Disease).
The terms heartburn, acid reflux, and GERD are often used interchangeably however they really have very different meanings. Acid reflux is a common medical condition that can range in severity from mild to serious. Gastroesophageal reflux disease (GERD) is the chronic, more severe form of acid reflux. Heartburn is a symptom of acid reflux and GERD in addition to other digestive disorders.
What is Gastroesophageal Reflux disease (GERD)?
The process when stomach acid flows back into the esophagus is referred to as GERD. Symptoms may range from the typical of heartburn or regurgitation, to the not so typical such as difficulty swallowing, asthma, cough, hoarseness, sensation of a lump in the throat or chest pain. Most people experience the symptoms of GERD from time to time. From mild GERD that occurs twice or less a week to moderate to severe that occurs over three times a week.
Causes of GERD
The muscle that protects the bottom of the esophagus from gastric contents from entering the esophagus is called the lower esophageal sphincter. When a person swallows the lower esophageal sphincter relaxes to allow food and liquid to flow in to the stomach. After this process it closes again. If the sphincter is weak or is abnormal the stomach contents can flow back up into the esophagus and irritate the lining of the esophagus.
- Certain types of hernias such as hiatal or paraesophageal hernias
- Connective tissue disorders
- Delayed stomach emptying
- Large meals
- Eating late at night
- NSAIDs (motrin, ibuprofen)
This is damage to the esophagus from stomach acid that may cause and open sore or visible irritation. This can cause pain with swallowing, the feeling of food sticking or even bleeding.
This is narrowing due to scar formation that may occur related to long term exposure to GERD. This can cause the feeling of food sticking and when severe block food from entering the stomach
This is precancerous changes in the lower lining of the esophagus that are associated with the increased risk of esophageal cancer.
A thin, flexible tube with a light and camera is passed through your mouth down your throat and esophagus in to the stomach. An endoscopy may detect inflammation of the esophagus (esophagitis/ulcer) or other complications. When the test is normal other tests may need to be performed to detect the presence of GERD since reflux may not result in visual damage yet still cause treatable symptoms.
Esophageal pH testing
This is a 24-hour monitored test to measure acid levels of a patient during routine daily activities to determine whether there are symptoms related to acid reflux.
High resolution esophageal manometry and impedance testing
This is a test performed in the doctor’s office as an outpatient procedure to measure the movement of muscles of the esophagus and the force in which food and liquids move up and down to determine GERD.
Lifestyle modifications are usually the first avenue such as avoidance of certain foods including citrus fruits and juices (grape fruit, tomato, pineapple, and oranges), coffee (regular and decaffeinated), caffeinated soft drinks, or tea are some of the more common.
- Maintain a healthy weight
- Elevate the head of the bed
- Stop smoking
- Sit up at least three hours after eating
- Avoid above mentioned foods and drinks
- Avoid Tight fitting clothing
- Chew thoroughly and eat slowly
Antacids may provide quick relief. However, antacids alone won’t heal the inflamed esophagus damaged by stomach acid. Overuse of these agents may lead to kidney problems, diarrhea, or hide cancer.
Acid Reducing Agents
These are agents include ranitidine (Zantac), cimetidine (Tegamet HB), famotidine (Pepcid AC), and Nizatidine (Axid AR). These medications block H-2 receptors and decrease stomach acid output. They do not act as quickly as antacids, but provide longer relief up. In addition to the above medications that are over the counter, prescription medications with increased strength are available. These medications are generally well tolerated but may be associated with a slight increase in B12 deficiency and bone fractures.
Acid Production Blockers and heal the esophagus
These medications are known as proton pump inhibitors. These agents are stronger than acid reduction medications, and also allow time for the damaged esophagus to heal. Over-the-counter medications include lanasoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC). Longer acting and prescription strength proton pump inhibitors are also available. These medications are usually well tolerated, but have been associated with diarrhea, headache nausea, and B12 deficiency, as well as chronic use may be associated with hip fracture, dementia, and chronic kidney disease. Our physicians at Associates in Digestive Health are specially trained and can discuss GERD with patients. If you would like to make an appointment to discuss acid reflux, contact us.
Surgery and Other Procedures
Sometimes patients do not wish to use long term medications due to inconvenience or long-term side effects and prefer surgical options. These procedures are also used to help with bariatric patients.
The following procedures would be performed by a surgeon:
After appropriate testing to ensure safety and likelihood of response to surgery the top part of your stomach is wrapped around the lower esophageal sphincter to tighten the muscle and prevent reflux. Fundoplication is minimally invasive when performed laparoscopically. This may be performed either as a complete or partial wrap.
A tiny ring of magnetic beads is wrapped around the junction of the stomach and esophagus. The attraction between the beads keeps the esophagus closed and reduced acid reflux, but weak enough to allow food to pass through. This device may be implanted using minimally invasive surgery.