High Resolution Oesophageal Manometry and pH Monitoring

  • Reference Number: HEY-291/2016
  • Departments: GI Physiology

Introduction

This leaflet has been produced to give you general information about your forthcoming high resolution oesophageal manometry and 24 hour pH monitoring.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you or contact the Department of GI Physiology.

What is High Resolution Oesophageal Manometry and 24 hour PH monitoring?

Following discussion with your doctor they advised that a high resolution oesophageal manometry and 24 hour pH monitoring is performed.

High resolution oesophageal manometry is a test that measures the pressure activity within the oesophagus and the sphincters (ring like muscles which close a natural orifice or passage at either end of the oesophagus). The multi-pressure sensor catheter (tube) has sensors situated at 1cm intervals and allows for measurement along the entire length of the oesophagus and sphincters at each end simultaneously (please see diagram). This enables an assessment of how well the muscles in the oesophagus and the sphincters at either end are working and whether contractions within the oesophagus are coordinated.

A 24 hour pH monitoring measures the amount of acid coming up (refluxing) into the oesophagus from the stomach over a 24 hour period. This allows us to establish whether your symptoms are due to acid reflux.

High Resolution Manometry trace and the related anatomy
of the oesophagus, sphincters and stomach:

Diagram produced by the Hull & East Yorkshire Hospitals NHS Trust.

Why do I need high resolution oesophageal manometry and 24 hour PH study?

The tests provide valuable information regarding your condition and will help to decide what the best treatment is for you (practical advice, medication or surgery). Unfortunately, there are no other less invasive tests available that will give us this information.

Can there be any complications or risks?

The risk of causing serious harm to you with these tests is very rare but may include bleeding or damage to your nose, throat, larynx (voice-box) or oesophagus, there is no published information on how often these problems occur but it is very rare. Occasionally people may feel dizzy whilst putting the tube into the oesophagus, a member of staff from the Department of GI Physiology will care for you during your tests. You may commonly experience a runny nose, sore throat or slight discomfort on swallowing that usually goes away once the tube is removed.

How do I prepare for the high resolution oesophageal manometry and 24 hour PH study?

Please read this information leaflet carefully. Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

If you are requesting ambulance transport, please contact your GP for details on how to book this. Ensure to tell the ambulance service that your appointment is 30 minutes earlier than it is to allow time for transport delays, and remember to book transport for the following day for removal of the pH tube. Unfortunately late arrival at the hospital may mean that there is insufficient time to carry out the procedure resulting in its cancellation.

Please refrain from wearing make-up and do not apply moisturiser to your face or neck. It is advised that you should wear loose fitting clothing (ladies: skirt or trousers and a top i.e. separate items of clothing) as you will be required to pass the tube underneath your clothing.

Do not have anything to eat or drink for 4 hours prior to the monitoring, although you may drink water up to 2 hours prior to the test. However, if you are diabetic, please continue with your normal diet.

If you are on any medication for your heart, breathing problems or hormone replacement therapy, please continue to take them as usual. However, it is important that you stop taking any of the following (please discuss with doctor).

7 days before your appointment:

Any proton pump inhibitor such as:

  • omeprazole (Losec)
  •  lansoprazole (Zoton)
  •  rabeprazole (Pariet)
  •  esomeprazole (Nexium)
  •  pantoprazole (Protium)

3 days before your appointment:

Any Histamine H2 -receptor antagonist or drugs listed here:

  •  ranitidine (Zantac)
  •  cimetidine (Tagamet)
  •  nizatidine (Axid)
  •  famotidine (Pepcid)
  •  domperidone (Motilium)
  •  metoclopramide (Maxolon)
  •  mebeverine (Colofac)
  •  alverine citrate (Spasmonal)
  • buscopan or baclofen (Lioresal)

If you need to stop any medication prior to the test please obtain antacids such as Gaviscon Advance from your GP or chemist. Take one dose after meals and an extra dose at bedtime. Please do not take any antacids on the day of the test.

On the morning of the test please take any other medication that you would normally take with a sip of water.

What will happen?

You should go to the Department of GI Physiology, which is situated next to Ward 14 at Castle Hill Hospital.

You do not need to be accompanied by a family member or friend for this appointment. They will not be able to come into the room whilst you have the procedure performed but there is plenty of seating in the waiting area should you wish to bring someone with you for support.

A member of staff from the Department of GI Physiology will meet and greet you and explain the procedure to you. This is to ensure that you understand the test and the possible side effects. You will be asked to sign a consent form if you agree to have the procedures carried out. A member of staff from the Department of GI Physiology will then start the procedure.

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 stomach. This will involve drinking water to ease the passage of the tube.

Once the tube is in place it is secured in place with a ribbon around your head. The procedure will then begin and we will then give you small measured (5ml) sips of water to swallow approximately ten times. Following this we will ask you to eat a white bread roll covered with margarine (if you are unable to eat white bread or would prefer to bring your own bread roll / margarine please feel free to do so).

Once this is completed we will have the information to place the overnight 24 hour pH catheter (tube). The pressure sensor tube is then removed and replaced by the much thinner 24 hour pH tube that is much more comfortable. This tube will stay in place for 24 hours. This new pH tube will be attached to a recording device (slightly bigger than a smart phone).

Following insertion of the pH tube a member of the Department of GI Physiology team will explain how to use the monitoring equipment during the recording period and instructions for returning the next day. The process of placing both tubes takes about 60 minutes, after which time you will be able to return to work / home.

It is important that you carry out your normal activities as far as possible during the 24 hour recording period to see if they might be related to your symptoms. There are minor restrictions on eating and activity, this will be explained to you at your appointment (you will press buttons on the machine and fill in a paper diary to give us this information). You should not shower or take a bath as it could result in damaging the monitoring equipment.

You cannot take your normal anti-reflux or indigestion medication during this 24 hour period, as it will prevent accurate monitoring results. If you ignore the advice and take any anti-reflux or indigestion medication during this period you will be required to have the 24 hour pH test repeated.

If required, a member of staff from Hull and East Yorkshire Hospitals NHS Trust will be available for you to speak to 24 hours a day (contact details and telephone number will be provided when you attend the department).

Please be aware that you will be required to return to the department the following day to have the pH tube removed. We will remove both the pH tube and the recording equipment from you. We would expect you to be in the department no longer than 15 minutes before you are free to go home or to work.

There is a video link showing the procedure which you may find helpful.

https://vimeo.com/264425886/20cc3ba2e5

What happens afterwards?

The results of the test will be analysed before a diagnosis can be made. Once this is done the report will be sent to the consultant in charge of your care. They will decide what the most appropriate treatment is for you. You should expect to hear from the hospital within 4 weeks of having the test. If you have not heard from the hospital within 4 weeks, please contact your consultant’s secretary by ringing the hospital switchboard, on telephone number (01482) 875875 and asking for your particular consultant’s secretary.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact The Department of GI Physiology on telephone number (01482) 622155.

You should not experience any problems after your tests, however please feel free to contact the department if you have any concerns.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.