Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Esophageal pH monitoring is used to diagnose GERD, to determine the effectiveness of medications that are given to prevent acid reflux, and to determine if episodes of acidic reflux are causing episodes of chest pain. Monitoring esophageal pH also can be used to determine if acid is reaching the pharynx (lower throat) and is possibly responsible for such symptoms as cough, hoarseness, and sore throat.
Esophageal pH monitoring is performed by passing a thin plastic catheter a sixteenth of an inch in diameter through one nostril, down the back of the throat, and into the esophagus as the patient swallows. The tip of the catheter contains a sensor that senses acid. The sensor is positioned in the esophagus so that it is just above the lower esophageal sphincter, a specialized area of esophageal muscle that lies at the junction of the esophagus and stomach and prevents acid from refluxing back up into the esophagus. In this position the sensor records each reflux of acid. The catheter protruding from the nose is connected to a recorder that registers each reflux of acid.
The patient is sent home with the catheter and recorder in place and returns the next day to have them removed. During the 24 hours that the catheter is in place, the patient goes about his or her usual activities, for example, eating, sleeping, and working. Meals, periods of sleep, and symptoms are recorded by the patient in a diary and/or by pushing buttons on the recorder. After the catheter is removed, the recorder is attached to a computer so that the data it has gathered can be downloaded into the computer where it is analyzed and put into graphic form. The procedure can be modified by placing the sensor in the upper esophagus or pharynx to determine if refluxed acid is reaching the pharynx.
The most recently-developed device for monitoring esophageal pH uses a capsule also known as the Bravo Capsule. The capsule contains an acid sensing probe, a battery, and a transmitter. The probe monitors the acid in the esophagus and transmits the information to a recorder that is worn by the patient on a belt. The capsule is introduced into the esophagus on a catheter through the nose or mouth and is attached to the lining of the esophagus with a clip. The catheter then is detached from the capsule and removed. Thus, there is no catheter protruding from the nose. The capsule transmits for two days or three days, and then the battery dies. Five to seven days later, the capsule falls off the esophageal lining and is passed in the stool as the capsule is not reusable.
The advantages of the capsule device are related to the absence of a catheter connecting the probe to the recorder. There is greater comfort without a catheter in the back of the throat, and patients are more likely to go to work and do more of their normal activities without feeling self-conscious about the appearance of the catheter to others. The disadvantages of the capsule are that it cannot be used in the pharynx (where it would be impossibly uncomfortable) and, so far, it has not been used in the stomach.