Any info on Impedance study/PH study?

[Smiley2000]

Hi there,

I had a consult with a Surgeon (telephonically) after my GI referred me.  Long story and long history with uncontrolled GERD and now Barrets and upcoming surgery (Nissen Fund.)  

I had a 24hr PH study/Impedance study done in Oct. 2010 and I got the results from the Doc who did it and guess what?  the Surgeon can not use it as the study was done WHILE I WAS ON PPI medication!  Worse of all is that the GI doc that performed the study INSTRUCTED me to take my Nexium and to just make a note of it in the Diary they give you.

So now I have to repeat the test (horrible horrible test)!!!

Can any of you share your info on such a study that was done on you?  My previous study said that I had 23 non-acid related reflux episodes.  Is that normal???  and ofcourse 0 acid-related because I was on the PPI's.

I am just so frustrated with Doctors and really confused.  any help?

[Smiley2000]

Hi there,

I had my consult and waiting for date of surgery.  They did not repeat the impedance study as it is diagnostic test to determine of you have GERD and I have Barrets, so that is enough proof that I have reflux problem.  

I was horrified when I read that you've had 3 surgeries and still have such a big hernia and going for a 4th time!  I would definitely say change Surgeons!

The Impedance study is much more accurate than the Bravo-capsule.  The tube and water swallow-test is called Manomatric study.  That is necessary to measure peristalsis and LES, UES function.

You asked about the Impedance study:  I was also under sedation (they did the Gastroscope and then inserted the tube) and when I woke up I had the tube in.  It is uncomfortable and it pulls when you swallow or eat.  You can eat basically everything that you would normally eat - the idea of the test is to see how much reflux you get from whatever you eat and drink - so they incourage you to eat normally.  This test measures reflux from acid, alkaline, pepsic and all non-acid materials from your tummy.  You have a monitor attached to it all (can not bath or shower for that period) and you have to highlight when you sit down, eat, sleep and keep a diary of your diet and symptoms.

Let me know if you have any more questions.

[LindaSueBob]

Hi, can you tell me how the test was done and what you had to do and how was it for you. I am having one done on January 12th in San Francisco three hours from home and have to stay in a hotel and go back on Friday 13th to have tube taken out. They are putting it in via Esophagogastroduodenoscopy or egd so when I wake up there will be a tube out my nose taped to my cheek they say. Dr thinks they won't be able to get past my hernia and that is why the EGD which I sure don't want but have no choice. Could you feel the tube or did it make you gag. Did you eat okay? Two months ago I had the other test with the tube and water swallows, that was horrible, I threw up and gagged through the whole thing for nothing as she could not get the tip past my hernia. That first morning I am also having to eat the radioactive toast eggs and something else at 8 am and the egd at 3 pm for the nose tube thing. I have had three fundoplications with the third being an open which put me on the couch for a whole month. All three have failed and all three were within 18 month period by the same surgeon. Changing surgeons. Not looking forward to a fourth which surgeon says is quite possible. I have no idea why they are even doing the 24 hour test as last year I had the bravo capsule which showed a horribly high demester score. Any help appreciated. So sorry you have to do this test again. ugh.

[Flycaster305]

I had the Nissen Fundoplication procedure  1 1/2 years ago, and I had both a HH as well as LES dysfunction.  The hiatel hernia has been a problem for a number of years.  The LES problem began after I became extremely ill with a bowel obstruction and had some very violent retching sessions, and it is thought my LES was damaged at that time.  Shortly afterward, my vocal cords were damaged by acid and the enamel started eroding off my teeth.  I've assumed the Barretts's Esophagus was caused by long term damage due to the Hiatel Hernia, however.

[Smiley2000]

ah no!  I am so sorry that you have the Dysplasia going on!  

When did you have your Nissen Fund?  did you have a Hiatus Hernia or the LES dysfunction?  that seems to be the main reason for Barrets?  am I correct?

[Flycaster305]

My report mentioned Dysplasia.  I have to have a yearly Endoscopy. I think your report means you have cell changes, but the core cell changes aren't to the point that they are pre-cancerous.  That being said,you are very young and given years of acid reflux, you probably will get a dysplasia report if you don't have an intervention.  
I'm glad they are happy with the Manomatry study, Smiley, that is not an easy test.
Keep us informed.  

[Smiley2000]

Thanks!  I feel the same way!  I have all these alarm symptoms (the GI Prof said ENT related symptoms are alarms going off that the reflux is uncontrolable) and yet they STILL want to repeat the Impedance study and want more info on how many episodes and how much and how long.

One thing I could get from the previous Imp study:  23 episodes of non-acidic nature.  0 acid episodes, because of the PPI that they gave me.

23 episodes!  that is a lot, isn't it?

Now I've learned about:  metaplasia or dysplasia.  On my reports it says:  no Dysplasia.

Can you see from any of your reports if your Barrets had "metaplasia" or "dysplasia"?

Atleast they are happy with the Manomatry that was done and would not be repeating that.

[Flycaster305]

Smiley, I think you got really bad advice from the GI doctor.  You can't take any kind of antacid/PPI before those tests. I agree with you, the test is terrible, I've been through it,  but I'm betting you will be asked to repeat the test when not taking nexium, any antacids. Sorry... that being said,  
The fact that you already have Barrett's E. proves you have an acid issue.  I'd think we would just have to have the motility test to move forward for the surgery.  I'd ask that question, and be a bulldog.  Those of us with Barrett's E. have it from an excess of acid, so why are acid tests necessary?

[selmaS]

  Hi, we had a member that had this testing done....I will give u a link so u can  read the older threads and possibly sende the member a PM as he is not active but does respond to PM's.
http://www.medhelp.org/forums/search/333?utf8=%26%23x2713%3B&query=gnorb

Hope this is helpful to u and wish u luck in having to go thru all that again.

    "selma"