Daily pH measurement
The technique of esophageal daily pH-impedancometry was created for the functional diagnosis of the condition of the esophagus. This method is the only examination that can determine impaired function, unlike gastroscopy and computed tomography, which help to identify the disturbed structure. There are also no laboratory tests that can assess the function of the esophagus. Therefore, for patients suffering from reflux disease or suspected of it, the technique of esophageal daily pH-impedance measurement is recognized as the gold standard.
The essence of the method is that a wire equipped with a sensor is placed in the patient's esophagus. The sensor measures the pH level of the esophageal contents at the required level. As a rule, this is the lower third of the esophagus.
Gastroesophageal reflux (GERD) is a common disease associated with the discharge of acidic stomach contents into the overlying digestive and respiratory systems. These casts are recorded by the study, which continues throughout the day. The patient can stay at home in the usual conditions, drink, eat, walk, take medications - the lifestyle is not fundamentally disrupted during this study. Moreover, it is most interesting for specialists to find out what happens in the esophagus in real conditions, and not in artificially created hospital conditions. As a result of daily monitoring of events in the esophagus, the doctor receives information about the discharge of acid, bile, etc
.
Indications for daily pH-impedancometry:
- Confirmation of the diagnosis of gastroesophageal reflux. It is often required in patients with chronic cough and in other cases when ingestion into the esophagus does not cause damage to the esophagus itself, but is associated with other atypical manifestations.
- Monitoring the effectiveness of treatment. When the diagnosis is established, treatment is carried out, but the symptoms persist. It often happens that prescribed medications are processed too quickly by the patient's enzyme systems. About 20% of people have a fast metabolism. And instead of the documented 20 hours, the medicine in such patients can work for 12 or 14, which is clearly not enough. The study makes it possible to identify this phenomenon of drug deficiency and adjust treatment. Differential diagnosis of gastroesophageal reflux and other functional pathologies. Bile is often released in the early morning hours, which the patient either does not feel or cannot relate to anything. Nighttime or early morning symptoms can only be documented and linked using this diagnostic method.
- Preparation for surgical treatment of precancerous conditions such as Barratt's esophagus, which are complications of gastroesophageal reflux disease.
Limitations to the study:
- Inflammation, erosion, or ulcer of the esophagus. In these cases, the study is conducted after basic therapy.
- Active infectious diseases, whether it's sore throat or oropharyngeal or nasopharyngeal disease, which technically burden the placement of the probe.
- Anatomical features or emotional reaction of the patient. In fact, this is not a contraindication, but the need to choose a condition for the placement of the probe. We can perform the study under general sedation with endoscopic control. This will be both comfortable for the patient and safe.
Carrying out pH-impedance measurements for children
Children also suffer from reflux disease. We have all the facilities and equipment for conducting research for children of all ages.
How is the research going
The patient needs to arrive at the clinic on an empty stomach, or 3 hours after eating. The study is carried out in the standard case in the gastroenterologist's office. Anesthesia is not required. The probe installation itself takes about a minute. It takes longer to calibrate the individual probe. The probe tags must be located according to an international protocol. Modern equipment allows you to install the probe in the desired position, depending on the research tasks. There are various techniques: X-ray monitoring and using a pressure gauge. In each specific case, the method is determined by the doctor. After the probe is installed in the desired position, it is fixed to the skin with a Band-Aid.
The device is equipped with buttons that the patient needs to press when eating, changing the body position from vertical to horizontal and vice versa. The device also has the technical capability to register symptoms. The drug intake can also be programmed on the button. We have the opportunity to calculate how long the effect of the drug actually lasts. Sometimes we see that drugs of the old classes do not work in patients.
The result of the study
The study ends in a day. If for some reason the probe needs to be removed sooner or later, this can be done around the clock in the emergency department. The procedure is performed by nurses.
The interpretation of the study implies a description of statistics on the number, duration and quality of injections into the esophagus (acidic, alkaline, mixed). The results are provided as a block of data, graphs, and a doctor's interpretation.
Why do otorhinolaryngologists prescribe a study?
Tells Irakli Yakobashvili, otorhinolaryngologist, PhD:
Previously, it was believed that GERD only leads to diseases of the esophagus and classic symptoms such as heartburn and belching. However, there is evidence that reflux can contribute to the development of many other seemingly unrelated disorders. However, in most cases, there are no symptoms of heartburn and belching. GERD has been proven to promote the development of:
- Chronic cough
- Postnasal congestion syndrome
- Hoarseness of voice
- The feeling of a constant lump in the throat
- Recurrent inflammatory diseases of the pharynx
Studies are being conducted to identify the link between reflux and other diseases of the ENT organs:
- Chronic and recurrent sinusitis
- Chronic and vasomotor rhinitis
- Exudative otitis media
These diseases are often difficult to treat and have a recurrent nature. There are cases when patients decide on surgical treatment, the result of which is not optimal or unsatisfactory.
The need to diagnose reflux disease may come as a surprise to a patient who has been treated, for example, with chronic nasal congestion, especially if he has no symptoms from the gastrointestinal tract. However, it is precisely these studies that can protect him from ineffective repeated courses of therapy.
Knowing about the presence of reflux in a patient allows an otorhinolaryngologist to perform an operation in case of planning surgical treatment, having previously offset the effect of acidic stomach contents on the healing process in the postoperative period.
The diagnosis of chronic and recurrent diseases of the ear, throat and nose cannot be considered complete without assessing the possible effect of gastroesophageal reflux on these organs. This is especially true for patients who are resistant to drug therapy, or who have already received surgical treatment, but without a satisfactory result.
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Doctors
Kanevskaya Svetlana
ЕМС chief physician, head of the internal medicine clinic, Doctor of Medicine, Professor
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Novikova-Anna
Ph.D. of Medical Sciences, Associate Professor
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Georgiy Ekimovskiy
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Evgeniy Avetisov
Director of Medical Development
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Ivan Pozharov
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Maltseva Alina
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Nino Gozalishvili
M.D.
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Loginov Aleksandr
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Zhizhko Natalya
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Parshukova Olga
Senior physician of the inpatient department of the clinic on Shchepkina ul.
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Ostrovskaya Elena
Expert in preventive and anti-age medicine
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Saad Ahmed
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Pshenichnaya Natalya
Doctor of Medicine, Professor
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Fedosina Ekaterina
Ph.D. of Medical Sciences
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Kurbanov Artem
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Kulinkovich Anna
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Davydova Irina
Ph.D. of Medical Sciences
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Chekulaeva Olga
Ph.D. of Medical Sciences
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Canivets Ilya
Ph.D. of Medical Sciences
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Urbanova Ksenia
Specialist in preventive and anti-aging medicine
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Kanevskaya Svetlana
ЕМС chief physician, head of the internal medicine clinic, Doctor of Medicine, Professor
- An expert in the field of internal medicine, preventive and anti-aging medicine, with more than 25 years of clinical and academic experience
Total experience
25 years
Experience in EMC
since 2021
