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more articles by West, Carl , MD  |  author's bio

Major Breakthrough in Diagnosing Chronic Heartburn

Major Breakthrough in Diagnosing Chronic Heartburn

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 treat GERD?


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 and medication.


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 System work?


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 percent.


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.


Dr. 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.


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