24HR pH/Impedance and Motility Testing

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What is 24HR pH/Impedance and Motility Testing?

24HR pH/Impedance Testing is a diagnostic procedure to measure the amount of acid and non-acid reflux into the part of the digestive tract between the mouth and the stomach, which is known as the oesophagus, over a period of 24 hours.

Motility Testing, also known as oesophageal manometry, is a procedure where a small tube called a manometer catheter is passed through your nose and into the oesophagus to test the muscle function of the oesophagus.

Indication for 24HR pH, Impedance / Motility Testing

Generally, 24HR pH/Impedance and motility testing is used to diagnose gastroesophageal reflux disorder(GERD). GERD is a common condition which occurs when stomach acid repeatedly flows back into the esophagus. This backflow (acid reflux) can irritate the lining of your esophagus when it happens repeatedly over time.

Common signs and symptoms of GERD include:

A burning sensation in your chest, especially in the middle part, known as heartburn. You might experience it after eating. The condition may worsen at night or while lying down.
Backflow (regurgitation) of food or sour liquid into the throat
Upper abdominal or chest pain
Difficulty swallowing (dysphagia)
Sensation of a heaviness in your throat and chest
Repeated belching
Frequent hiccups

Motility testing may also be ordered to rule out problems of the oesophagus such as:

Diffuse oesophageal spasm, characterised by multiple, poorly coordinated, forceful oesophageal contractions.
Achalasia, characterised by incomplete relaxation of the lower oesophageal sphincter muscles which prevents food from entering the stomach.
Oesophageal Scleroderma, which is a rare disease in which the lower oesophageal muscles progressively stop functioning.

Preparation for 24HR pH/Impedance and Motility Testing

Preparation for 24HR pH/Impedance and Motility Testing will include the following:

Discuss your medication and past medical history with your doctor.
Your doctor will explain the procedure in detail including associated risks and complications prior to obtaining an informed consent from you.
You will be asked to not eat or drink anything for 4-6 hours prior to the procedure.

Procedure of 24HR pH/Impedance and Motility Testing

The 24HR pH/Impedance and Motility Testing process involves following steps:

You will be asked to lay or sit down comfortably and tilt your head back to easily pass the manometry catheter through your nose into the oesophagus.
Your doctor will use local or topical anesthetic spray to minimize the irritation experienced in your nose and throat during catheter insertion
Later, the manometry catheter which contains multiple pressure sensors is guided down your nose and throat into the oesophagus.
The catheter sensors evaluate the strength and coordination of your upper GI tract muscle contractions and also the strength and relaxation function of the lower esophageal sphincter during various swallowing tasks and the readings are recorded on a computer.
The manometry catheter is then withdrawn and a catheter which measures pH and impedance is threaded through the nose into the upper GI tract. Once the catheter is in place, the doctor secures the other end of the catheter over your face with a piece of tape, and loops the catheter behind your ear. This catheter is left in place for 24 hours.
You will be given a smartphone size monitor to wear at the waist level. It notes down the information from the acid-sensitive tip of the catheter inserted inside your upper GI tract.
You will be observed for a while and once you feel totally comfortable with the catheter in place, you will be able to leave the office and resume your daily activities, eating and drinking as you normally would.
You should keep a diary of your meals and activities, and any symptoms you experience.
The catheter records the amount and time of reflux into your oesophagus. It transmits this information to the computer monitor for correlating the information with your symptoms.
You should return to the doctor’s office the next day after completing 24 hours. The doctor removes the catheter, downloads the data from the computer and analyzes the changes in acid levels throughout the 24-hour period.
If the data from the test result shows that you have GERD or another reflux problem, your doctor will recommend the appropriate treatment option.

Risks of 24HR pH/Impedance and Motility Testing?

24HR pH/Impedance and Motility Testing is a safe procedure with a few possible risks which include:

Nasal and throat irritation due to catheter placement.
Irritation to the inner lining of the upper GI(gastrointestinal) tube due to insertion and removal of catheter.
Infection and inflammation.
Some people may not be able to tolerate the procedure due to gag reflex (muscular contraction of the back of the throat evoked by touching the roof of the mouth and surrounding parts).
Rarely oesophageal abrasions and bleeding.