MedStar Georgetown Esophageal Disease Program offers tests to evaluate problems of motility of the entire GI tract as well as diagnostic testing for heartburn. Motility is the process of moving food and waste products (via a series of coordinated muscle contractions) through the digestive system.
Motility disorders of the gastrointestinal system include:
- Fecal incontinence
- Ineffective esophageal motility
The Esophageal Disease Program also offers a specialized motility lab for evaluating esophageal symptoms such as:
- Typical and atypical symptoms of heartburn
- Chest pain not caused by heart problems
- Swallowing disorders known as dysphagia
- Symptoms associated with GERD - Gastroesophageal Reflux Disease
High Resolution Esophageal Manometry
Esophageal manometry is the gold standard for evaluation of problems with esophageal motility. Esophageal manometry can be used in detecting abnormalities in the lower esophageal sphincter, contraction abnormalities in the body of the esophagus of those patients experiencing refractory gastroesophageal reflux disease. Impedance testing is able to determine if liquids and solids are passing through the esophagus appropriately. In addition to standard esophageal manometry, high resolution manometry with impedance testing can be used to evaluate swallowing problems, esophageal reflux, esophageal spasms, and/or achalasia.
Manometry testing can be completed within twenty to thirty minutes in the MedStar Georgetown University Hospital's endoscopy suite by our trained motility lab nurses. This is a catheter based procedure. The catheter is placed through the nose and into the esophagus for the diagnostic testing. This catheter is removed after completing the manometry testing. Patients are asked to have nothing to drink or eat approximately 8 hours prior to the esophageal manometry testing.
The esophageal manometry measures the squeezing pressure of the esophagus in multiple locations in the esophagus. If impedance testing is performed in addition to manometry, impedance sensors detect changes in bolus transit as liquids pass through the esophagus to the stomach. The measurements of the squeezing pressures from all measured locations in the esophagus are recorded. All manometry studies are analyzed by our gastroenterologists. The results take approximately 1-2 weeks to be analyzed.
pH and impedance testing
pH and impedance testing is frequently using to determine if a patient has gastroesophageal reflux disease, laryngopharyngeal reflux disease or NON-acid reflux disease. The pH and impedance testing also can determine if a patient's anti-reflux medication is adequately working. The pH study allows for the amount of acidic and alkaline material that refluxes into the esophagus and throat from the stomach within a 24 hour period. The impedance portion of the test evaluates for any non-acid reflux.
Patients are required to not eat or drink anything four to eight hours prior to the pH and impedance testing. This is a catheter based procedure. The catheter is placed through the nose and into the esophagus. This catheter does stay in place for a 24 hour monitoring period. This is an outpatient procedure and patients are encouraged to proceed with their normal daily activities while the catheter is in place. During this 24 hour monitoring period, the patient will have a monitor to record their symptoms as they occur and patients are also required to keep a journal to record when food is consumed and when they are in the supine position. Upon completion of the 24 hour monitoring period, the catheter is removed by the patient or the motility nurse. The data is collected through the monitor and the journal is collected to be analyzed. It usually takes between 1-2 weeks for the data to be appropriately analyzed.
Wireless Bravo pH testing
Bravo pH testing is used to diagnosis the causes of heartburn and to provide more specific information regarding gastroesophageal reflux disease. The Bravo pH testing procedure involves placing a small pH capsule in the esophagus 6 centimeters above the lower esophageal sphincter endoscopically. The pH capsule measures the pH in the esophagus and transmits the information to a receiver worn by the patient for 48 hours after the pH capsule has been placed. The receiver is returned to the endoscopy suite upon completion of the 48 hours of data collection, and is downloaded to a computer. This data will then be analyzed. The pH capsule naturally falls off of the wall of the esophagus and passes through the digestive tract to be eliminated through the feces within several days after the test is completed.
Wireless Bravo pH testing is not recommended in patients with pacemakers, implantable defibrillators or neurostimulators, history of bleeding diatheses, strictures, severe esophagitis, severe varices, or obstructions.
The Esophageal Disease Program offers a specialized motility lab for evaluating patients experiencing severe constipation and/or fecal incontinence through anal manometry.