Gastroenterology - Oesophageal Manometry and 24hr pH/ Impedance Study (off medication)

This leaflet has 3 aims:

1. To help you become better informed and more involved in your care.
2. To explain what happens on the day of the procedure.
3. To answer some of the questions commonly asked about the procedure.

If you have any questions, access or communication needs such as an interpreter please contact the department stated on your appointment letter.

Reasonable adjustments will be considered for all disabled users of this service.

Please make sure that you read all the following information CAREFULLY, which includes what you must do prior to coming for your appointment.

Your doctor has referred you for oesophageal manometry and 24hr pH/Impedance study because you are experiencing problems with your gullet (oesophagus). The 2 most common complaints for referral for this test are acid reflux/heartburn or difficulty swallowing.

When you come for your appointment, it would be helpful to us if you could bring with you a list of your medications.

If you have any heart or breathing problems/conditions, we would appreciate it if you could notify us of these conditions before you attend for your appointment.

What is oesophageal manometry and 24hr pH/Impedance study?

Oesophageal manometry provides us with information on the strength and function of the muscles in your gullet (peristalsis), as well as assessing the effectiveness of the valve at the bottom of your gullet. The 24hr pH/Impedance study shows us how much time acid is in the gullet, and what happens when you have a symptom over a 24hr period.

What will happen during the test?

After we have asked you questions about your symptoms and obtained your consent you will be asked to sit on the couch. The physiologist will explain what they would like you to do in order to successfully insert the tube via your nose. Once the tube is in position the physiologist will ask you to lie down on your back. The physiologist will secure the tube to your nose to hold it in place (with medical tape); this is to enable the physiologist to take accurate measurements whilst you swallow some water as well as some food swallows, which will either be bread or biscuit (we may ask you to bring some bread with you). Once this has been done the tube is removed.

The 24hr pH/Impedance study involves a tube being placed in the gullet via the nose, which will remain in position until the following day. You will be asked to sit, and the tube will be inserted in to position, and taped to your cheek and neck to keep it in place. The catheter will be connected to a recorder which you will carry around with you in a pouch. If the recorder has been covered with a plastic bag, please DO NOT remove this bag. The physiologist will discuss the diary card that you need to complete or which buttons to press during the study. You may be asked to sign a form that states you will look after and return the equipment at the end of the study. Once you leave the department you will carry on with your normal activities and will return the following day at a pre-arranged time to have the catheter and recorder removed. You will also need to bring your diary card with you.

Is the test painful?

The test should not cause you any pain. We can use a local anaesthetic to numb your nose (Xylocaine) if you would prefer. We are not able to offer sedation for this test for safety reasons. Please be assured that oesophageal manometry and the 24hr studies are well-tolerated tests.

How long will the test take?

You will be with us for around 45 minutes. However, the tests themselves take around 30 minutes.

What do I need to do before the test?

You will need to stop certain medications (see list below), prior to the test. We also ask that you do not eat or drink anything 4 hours prior to your test.

7 days prior to the test: Omeprazole (Losec, Pyrocalm, Mezzopram); Esomeprazole (Nexium, Emozul, Guardium, Ventra); Lansoprazole (Zoton, Prevacid); Pantoprazole (Protium, Pantoloc); Rabeprazole (Pariet)

3 days prior to the test: Cimetidine (Tagamet); Nizatidine (Axid); Famotidine (Pepcid); Domperidone (Motilium);; Metoclopramide (Maxolon); Ondansetron; Alverine; Baclofen (Lioresal), Mebeverine (Colofac); Peppermint Oil (Colpermin, Mintec,), Merbentyl (diclomine, Bentyl), Hyoscine (Buscapan), Pro- Banthine, Spasmanol, Colesevalam, Prucalopride

24hrs before the test: Altacite; Gaviscon; Gaviscon Advance, Maalox; Mucogel, Alu-cap, Co-magaldrox, Asilone; Mucaine; Rennies; Settlers; Algicon Bisodol, Acidex, Peptac, Gastrocote, Pepto-Bismol

If you are taking:

• any regular pain medication such as codeine, tramadol, fentanyl or any other morphine/opiate-based medication
• any medication for angina or high blood pressure such as nifedipine, verapamil or diltiazem etc

Please contact the department prior to your appointment. The department contact details are on your appointment letter.

Please continue with all other medications.

Will I be able to ask questions?

You can ask questions at any time prior to, during the test and after the tests.

When will I get the results?

The results of your test will be sent to your hospital consultant or specialist nurse, and you should hear from them directly.

Benefits and Risks

The benefit of having this test is that it will help your doctor determine the problem with your gullet. It can help them manage your symptoms and, in some cases, decide which medication to give you. It will also help them to decide on your future management.

People who are anxious sometimes have difficulty with this test due to the tube being inserted via the nose, but please discuss with us if this is a problem for you. If you have oesophageal varices (prominent veins in your gullet) we would not go ahead with this test. Some people experience discomfort due to stopping their medication, this is quite normal. There are no known significant risks associated with oesophageal manometry. Occasionally nose bleeds may occur but these are rare. There is a risk of perforation, however this is very small and as far as is known has not been associated with this test.

There is no equivalent alternative to this investigation other than not going ahead with this investigation. Occasionally a barium swallow is performed as an alternative, but this test does not give the same accuracy as oesophageal manometry and 24hr pH/ impedance study.
 
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