Major Breakthrough in Diagnosing
By Carl West, MD
Physicians at Cayuga Medical Center
are using a new monitoring system with a wireless pH sensor to collect data
about acid levels in a patient’s esophagus (the canal that runs from the back
of the throat to the stomach). This is an easy, painless way to capture the
information needed to make an accurate diagnosis of gastroesophageal reflux
disease (GERD), or what most people call chronic heartburn.
Why is it important to diagnose and
Chronic acid reflux damages the
esophagus and can cause serious medical problems, among them swallowing
difficulties and Barrett’s esophagus, which can lead to cancer of the
esophagus. Fortunately most patients with GERD respond well to lifestyle changes
How is GERD diagnosed?
If a patient has symptoms of
heartburn but we can see no damage in the esophagus, we need to determine if
the cause of the symptoms is acid reflux or another problem, such as heart
disease. We do this by measuring the pH in the esophagus over a 48-hour period
of normal activity.
The pH level will naturally dip
down during and after meals, as the stomach produces acid to digest food.
However, if the pH dips down and stays down, there’s probably an acid reflux
problem. The patient keeps a diary to record activities during the day. This
way we can correlate fluctuations in pH to heartburn symptoms and check the
diary for activities such as eating, bending over, and lying down, which
typically bring on these symptoms. This provides us with objective findings on
which to base a diagnosis of acid reflux.
How does the Bravo pH Monitoring
Since the 1980s, we’ve measured
esophageal pH by placing a recording electrode in the esophagus, attached to a
plastic wire that comes out of the nose and is taped to the cheek. This wire is
connected to a data recorder worn on the belt. Most patients find it socially
unacceptable to be in public this way, and there is the added disadvantage that
the wire and electrode could inadvertently be tugged out of place.
By contrast, the new Bravo pH
Monitoring System is wireless, making it easier for patients to tolerate. The
patient comes into the medical center and is mildly sedated. Using a very thin
tube we go down the back of the throat and attach a small capsule to the wall
of the esophagus, just above the juncture of the esophagus and the stomach. It
only takes a few minutes.
Two tiny probes on the capsule
measure the pH and a transmitter inside sends the information to a small
portable receiver (about the size of a pager) usually worn on the belt. When
the patient showers or sleeps, the receiver sits on a nearby table. After 48
hours, the patient returns the receiver to the medical center and we download
the information onto a computer, which produces a graph indicating levels of pH
at different times of the day and night. Within a couple of days the capsule
drops off the wall of the esophagus, travels through the digestive tract, and
is flushed down the toilet.
How is GERD treated?
The first line of defense is
lifestyle change. This includes losing weight; consuming smaller, more frequent
meals; avoiding highly acidic foods like tomatoes, vinegar, and coffee; and
quitting smoking. Some people find it helpful to raise the head of the bed by
putting the top legs up on blocks. Antacids such as Rolaids and Tums can also
help control symptoms.
The next line of defense includes
acid reducers, which are available over-the-counter. These medications go by
brand names such as Zantac, Pepcid, Axid, and Tagamet. If symptoms persist,
your doctor will probably recommend an acid-blocker, such as Prilosec OTC,
Prevacid, Aciphex, or Nexium. These medications reduce stomach acid by up to 95
If these measures do not ameliorate
GERD symptoms, you may want to consider surgery to strengthen the lower
esophageal sphincter and stop the flow of acid from the stomach up into the
esophagus. This procedure, which is called laparoscopic fundoplication, is
performed by local surgeons.
West is board certified in gastroenterology and is a member of the medical
staff at Cayuga Medical Center. He is in practice with Gastroenterology
Associates of Ithaca, where he can be reached at (607) 272-5011.