Reflux – Required Diagnostic Testing
There are many questions concerning what is necessary to best characterize the extent of your reflux in order to have a precise understanding of the specific type and factors affecting your disease. We have a number of tools that we use. In particular, we may use a probe to measure the amount of reflux that comes up into your throat or into your esophagus, known as a pH Probe study. This helps gauge the severity of your reflux and what type of contents may be effecting your disease and how we may better treat it.
Another important tool is esophageal motility, which is usually measured by a small catheter placed through your nostril, which you then swallow into the esophagus. This gives us the opportunity to measure the sphincter pressures as well as to measure the disorder of swallowing. The most important thing about esophageal motility is to make sure you do not have another condition, which is actually the opposite of reflux known as Achalasia. In this particular case, the sphincter muscle is actually too tight, and we wouldn’t want to try and correct your reflux, but rather fix the problem of an overly tight sphincter muscle leading to retention in the esophagus and simulating reflux type symptoms.
Other tests that are very important, because the weakened lower esophageal sphincter can be overcome by the gastric pressure, include studies of gastric motility or gastric emptying. In the case of gastric emptying, you may be asked to eat an egg preparation, and this is measured leaving your stomach over a four hour period of time. We’re looking for a condition known as gastroparesis, which is present in 40 to 45% patients with reflux disease.
Another very important test is the electrogastrogram. This is a test that measures electrical activity and motility. Approximately 20-25% of patients will have a problem with the emptying of their stomach caused by a faulty sphincter at the bottom of the stomach, known as the pylorus. Very often in these cases we can improve the pyloric sphincter function at the bottom of the stomach, which will make the reflux either disappear or come under better control.