Tests offered at GCC

The following Motility tests are available at The Motility Center at the GCC:

24 Hour pH Test (Catheter Study)

GERD (Gastro esophageal Reflux Disease) is a common disorder of the esophagus and the most common symptom is heartburn. The diagnosis is usually made based on the presence of typical symptoms. However, a medical provider may order a pH study in a patient who has GERD symptoms in order to confirm the diagnosis. Acid blocking medications should be stopped for one week prior to pH testing.

The test is performed in two ways – 1). by placing an esophageal catheter which is left in place for 24 hours or 2). by attaching a recording device to the lining of the esophagus during an upper endoscopy. The catheter test or 24 hour pH test is performed by placing a catheter into the esophagus by way of the nostril. This catheter is usually placed following an esophageal manometry [see esophageal manometry].

The catheter has a sensor which is able to measure the acidity (or pH) of the esophageal contents. The information obtained by the sensor is recorded on a device which is kept close to the patient during testing.

The patient is urged to eat and drink normally during testing. It is necessary to keep a diary and record symptoms, meals, rest and medications taken during testing. The information recorded by the sensor is then interpreted by a physician and a report is generated.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include infection, bleeding, making a small hole or tear.

Anorectal Manometry

Chronic constipation and fecal incontinence are conditions which affect many people in our population. These abnormalities can develop as a result of abnormalities of the rectum, anal sphincter and pelvic floor muscles. Anorectal manometry is a test used to evaluate the motor function, sensory function and coordination of these areas.

The test is usually performed by a technician or a nurse. The preparation includes consuming a light breakfast and administrating of an enema prior to arrival for the test. The patient is required to lie on his left side with his hips and knees flexed for the test duration.

A lubricated probe is inserted into the rectum. The probe has sensors which measure pressure produced by the muscles in the rectum, anal sphincter and pelvic floor. This probe is connected to a monitor.

The patient is asked to squeeze, bear down and relax at different times during testing in order to fully assess function. A balloon at the end of the probe will also be inflated during the test to evaluate nerve function. The patient is asked to simulate a bowel movement by attempting to expel a balloon from the rectum while sitting on a commode. This last portion of the test is performed in patients with constipation and is timed. Anorectal manometry takes approximately 20 minutes.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include infection, bleeding, making a small hole or tear.

Watch a video on the procedure

Bravo pH

GERD (Gastro Esophageal Reflux Disease) is a common disorder of the esophagus and the most common symptom is heartburn. The diagnosis is usually made based on the presence of typical symptoms. However, a medical provider may order a pH study in a patient who has GERD symptoms in order to confirm the diagnosis. Acid blocking medications should be stopped for one week prior to pH testing.

The test is performed in two ways – 1). by placing an esophageal catheter which is left in place for 24 hours or 2). by attaching a recording device to the lining of the esophagus during an upper endoscopy [See EGD or upper endoscopy].

The Bravo esophageal pH device is able to detect and measure the acidity (or pH) of the esophageal fluid contents. The pH data is captured on a wireless device which is approximately the size of a beeper. This recording device must be close to the patient during testing. Data is usually recorded for approximately 48 hours.

The recorded data is later analyzed by a physician and a report is generated. Fasting is required for this test and patients are not allowed to have an MRI for 30 days after the Bravo device is placed.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include adverse reactions to anesthesia, infection, bleeding, making a small hole or tear.

Colonoscopy

A colonoscopy is an endoscopic test used to examine the lining of the large intestine or colon. The instrument used is called a colonoscope. It is a thin, flexible tube with a light and camera on one end. The images from the camera are transmitted to a monitor that allows the physician to see the entire length of the colon.

A colonoscopy may be ordered for the evaluation and/or treatment of many conditions including abdominal pain, chronic diarrhea, and chronic constipation, and anemia, blood in the stools and for colon cancer screening.

A colonoscopy offers the opportunity to obtain tissue samples and treat abnormalities. Polyps or abnormal growths arising from the lining of the colon can be removed or biopsied during colonoscopy.

The colonoscopy is performed in an endoscopy center which may be in a hospital or gastroenterology office. Fasting is required in addition to discontinuing or adjusting medications a few days prior to testing.

A special bowel cleanse is needed in order to empty the colon and allow for a thorough examination of the colonic lining. The preparation includes a clear liquid diet the day prior to the procedure in addition to a laxative solution.

Sedative medications are given intravenously during the procedure and most patients are fully asleep. Sedation is administered by an anesthesiologist or a supervised nurse anesthetist. Vital signs are monitored throughout the procedure.

Your physician will tell you the results of the colonoscopy following your procedure. Biopsy results are usually available several days after the procedure.

Most patients are able to resume their usual diets following a colonoscopy. Driving is prohibited following the procedure and so patients are asked to have a designated driver to take them home.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include adverse reactions to anesthesia, infection, bleeding, making a small hole or tear.

EGD

EGD or esophagogastroduodenoscopy is an endoscopic test used to evaluate the lining of the esophagus, stomach and beginning of the small intestine (or duodenum). It is also known as an upper endoscopy. The instrument used is called a gastroscope. It is a thin, flexible tube with a light and camera on one end. The images from the camera are transmitted to a monitor.

An EGD may be ordered for the evaluation and/or treatment of many conditions including GERD, difficulty swallowing, painful swallowing, nausea, vomiting, abdominal pain, bloating, diarrhea, anemia and blood in the stools.

An EGD offers the opportunity to obtain tissue samples and treat abnormalities. Certain conditions such as an esophageal stricture or narrowing can be widened during an EGD by doing a dilation. Bleeding ulcers can be treated during an EGD by burning or cauterizing the bleeding blood vessel.

A special device for measuring esophageal acid called the Bravo pH device (see Bravo pH above) can be placed during an EGD. Testing and treatment are performed by passing special tools through the accessory channel of the instrument.

The EGD is performed in an endoscopy center which may be in a hospital or gastroenterology office. Fasting is required in addition to discontinuing certain medications a few days prior to testing.

Sedative medications are given intravenously during the procedure and most patients are fully asleep. Sedation is administered by an anesthesiologist or a supervised nurse anesthetist. Vital signs are monitored throughout the procedure.

Your physician will tell you the results of the EGD following your procedure. Biopsy results are usually available several days after the procedure.

Most patients are able to resume their diets following the procedure. Driving is prohibited following the procedure. Patients are asked to have a designated driver to take them home.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include adverse reactions to anesthesia, infection, bleeding, making a small hole or tear.

Esophageal Manometry with pH Impedance

The esophagus or food pipe works to move liquids and food from the mouth into the stomach. Symptoms of esophageal disorders include heartburn, difficulty swallowing, painful swallowing and chest pain. Esophageal manometry is a test used to assess esophageal muscle function. It is usually performed by a nurse or technician. The test is performed with the patient in a semi-reclined position. A thin catheter is passed into the esophagus by way of the nostrils after the nasal passage is numbed.

This catheter has pressure sensors which measure the strength of the esophageal muscles. The catheter is connected to a monitor and information from the sensors is recorded. The patient is asked to take several swallows of sterile water during the test and so no sedation is given. This test takes approximately 20 minutes and requires fasting. The information recorded by the sensors is interpreted by a physician following the test and a report is generated.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include infection, bleeding, making a small hole or tear.

Hydrogen Breath Tests

Hydrogen breath tests are used to diagnose conditions in which carbohydrates are not absorbed properly as well as small intestinal bacterial overgrowth. Examples of such carbohydrates or sugars include lactose and fructose. Symptoms of these conditions include bloating, diarrhea and flatulence (passing large amounts of gas).

Hydrogen is normally produced by colonic bacteria. This hydrogen is absorbed into the blood stream and is detectable on the exhaled breath. The conditions mentioned above cause abnormal amounts of hydrogen production by intestinal bacteria.

Colonic bacteria produce abnormal amounts of bacteria when they are exposed to large amounts of undigested carbohydrates. This may occur in people who do not have the enzymes or proteins needed to break down carbohydrates such as the enzyme lactase needed to break down lactose.

Large amounts of undigested carbohydrates also reach the colon in conditions which cause rapid intestinal transit. Small intestinal bacterial overgrowth occurs when colonic bacteria move backward into the small intestine.

Hydrogen breath tests are performed following a 12 hour fast. A baseline breath sample is obtained after which the patient is given a drink containing a sugar such as lactose, fructose or lactulose. The choice of sugar depends on the condition being evaluated.

Breath samples are obtained every 15 minutes and the amounts of hydrogen exhaled are measured. The test can last up to 3 hours.

In-office Hemorrhoidal Band Ligation

Many people are affected by symptoms caused by internal hemorrhoids. These symptoms usually include bleeding, itching and difficulty cleaning the bottom following a bowel movement. Constipation and pregnancy are common risk factors. There are several different ways to treat hemorrhoids. One of these ways includes in-office hemorrhoidal rubber band ligation.

This procedure is performed in a doctor’s office following an examination. There is no bowel preparation, fasting or anesthesia required for this procedure.

During the procedure a small, hand-held device is used to gently pull in the internal hemorrhoid by applying suction. Following this, a small rubber band is placed around the base of the hemorrhoid. The band is placed in an area which does not have nerve endings and cuts off the blood supply to the hemorrhoid. The hemorrhoid then shrinks and the band falls off within a few days. The procedure takes about 1 minute and is usually more than 95% effective. Additional sessions are sometimes needed.

Risks: the procedure is safe with a low risk of potential complications. Possible complications include infection, bleeding and discomfort in the anus or rectum.