Your doctor may recommend Ambulatory Esophageal Reflux Testing (pH-Z monitoring).  This is a catheter-based test using a combination of pH and impedance sensors for the identification of both acid and non-acid reflux (that may be contributing to PPI Refractory Reflux Disease). It can evaluate the number of reflux events, the acid content of each event and how long each event lasted. This enables your physician to improve management of Gastroesophageal Reflux Disease (GERD) and develop the best care plan.

How is pH-Z done?

You will first require an esophageal manometry test to locate the upper border of the lower esophageal sphincter (LES) for proper placement of the Ambulatory Reflux testing probe.

Patient must fast for at least 6 hours prior to the test.

You will be instructed whether to hold or continue anti-secretory medications e.g. Omeprazole/Prilosec, Lansoprazole/Prevacid,Pantoprazole/Protonix, Pepcid, Zantac etc.

A small diameter, soft and flexible catheter is inserted gently through the nose after numbing the area and guided into the esophagus. The catheter is taped in position and connected to a monitoring device which is carried by the patient for 24 hours. During the 24 hours, you should continue all your daily activities.

You will be instructed to write entries in a diary and MUST note when you eat, take medications, lay down, upright position or when experiencing any symptoms.

  • Wear loose clothes for the procedure.
  • Do not plan any social activities since you will have instruments in your food pipe.
  • Continue your regular diet but avoid drinking citrus (orange, grapefruit) juice, tomato juice and soft drinks (with caffeine) other than at meal times.
  • Do not use hard candy or gum while the tube is in your nose.
  • It is critical that you keep an accurate diary of events to get the best results from the test. Use the buttons only as instructed and remember to write in the start and end time for each of the categories at the top of your diary. Use the time displayed on the data recorder on your diary to record any event.
  • Please be very careful with the equipment. Do not let the equipment get wet at any time.  Avoid bath or shower while the equipment is attached.

After 24 hours of test period, you will return to the Endoscopy unit where the recording device/diary are collected and the nasal catheter will be removed.

PREP INSTRUCTIONS:

  • Wear loose comfortable clothing.
  • Do NOT eat or drink anything after midnight  or at least 6 hours prior to test.
  • Discontinue all proton pump inhibitors e.g. Omeprazole (Prilosec), Lansoprazole (Prevacid), Rabeprazole (Aciphex), Pantoprazole (Protonix), Zegrid, Esomeprazole (Nexium), Dexlansoprazole (Dexilant) for seven days prior to the study
  • Discontinue all other medications known to interfere with gastric function (Reglan, Axid, Pepcid, Tagamet, Zantac) 72 hours prior to the study
  • Discontinue all antacids (Maalox, Mylanta, Tums, Rolaids, Amphojel, Gaviscon) 24 hours before study
  • You will not receive any sedation therefore will be able to drive to and from your appointment