Howard,
In your last post to me you said you would see me if I wanted to travel to
Minnesota, and if I visited you, that you could "arrange an EGD one day
and
impedance manometry pH testing the next". I am curious about how the
impedance test is combined with the ph testing or is it one and the same
(ie
how do you do them together in one day). I have had the 24 hour ph nose
hose three years ago, immediately after they did a manometry first, the
manometry being a short procedure using a bigger nose hose. So I know
about
those, and I know about the bravo 48 hour test as we have discussed in the
past, and I asked you if we could bypass the bravo after the EGD and go
right to the impedance test so I could determine if I had acid or basic
reflux (ie, I thought there would be no separate pH test, and the
impedance
test inherently checked for both acid and basic reflux by itself).
Here is a site that briefly describes esophageal impedance testing, if you
could please take a quick look at it -
http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698
.
Here is a paragraph quoted from the site, that talks about combining the
impedance test with manometry and combining the impedance test with pH
(ie,
MII-EM and MII-pH) - it is in the last half of the paragraph.
"Measuring impedance at multiple sites (multichannel) allows for
determination of direction of bolus movement based upon tem****al
differences
in bolus entry and exit (ie, bolus entries progressing from proximal to
distal indicate antegrade bolus movement while bolus entries progressing
from distal to proximal indicate retrograde bolus movement) (show figure
1).
Combined with manometry (multichannel intraluminal impedance and
manometry;
MII-EM) it provides information about both pressures and bolus transit
within the esophagus. Combined with pH (multichannel intraluminal
impedance
and pH; MII-pH) it permits detection of both acid and non-acid
gastroesophageal reflux".
I don't understand exactly what they mean by "combined with". I thought
the
manometry was a separate test by itself and I thought the ph test (whether
the 24 hour nose hose or the 48 hour bravo) was a separate test in itself,
and the impedance test was a separate test (which is also a 24 hour nose
hose like you have said, I believe).
So could you please shed some light on this and what does impedance
"combined with" manometry and pH exactly mean. And what did you mean when
you said you could do the "EGD one day and impedance manometry pH testing
the next". I thought that would mean on the second day I might get a
manometry first, followed immediately by the impedance nose hose, but I am
not sure how the pH ties in because they talk about combining the
impedance
with pH in the paragraph I quoted, and I would think that would be two
separate tests (just like the manometry would be a separate test), and you
could not do them in one day unless the pH is part of the impedance test.
I
hope you see what I am getting at - it is a little confusing to me.
Please explain this to me if you would be so kind. It is im****tant to me.
Thanks...Pete
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