High-tech devices help physicians pinpoint causes of some digestive conditions

BY PAULA RASICH & EMMA V. CHAMBERS

or people who live with unexplained chest pain, difficulty swallowing, heartburn or a persistent feeling like something is stuck in their throat, obtaining an accurate diagnosis can be challenging. But in the last two years, two high-tech breakthroughs for the most common esophageal tests — manometry and pH monitoring — have made it easier for doctors to pinpoint the precise cause of some digestive conditions.

“ManoScan technology gives us the ability to obtain a clear picture of the muscle movement of the esophagus, helping us to determine if the cause of the patient’s discomfort is muscular,” said Dr. Gulchin Ergun, clinical chief of the Digestive Disease Section at The Methodist Hospital.

“We can look into the esophagus with X-ray or endoscopes, but the only way to evaluate the wave patterns of the esophagus is with manometry,” she said. Esophageal manometry measures and records muscle pressure within the esophagus, the muscular tube that connects the throat to the stomach. ManoScan, which uses high resolution manometry, delivers a reconstructed topographic map of the pressures obtained during that recording.

The ManoScan measures whether or not peristalsis (successive waves of involuntary contraction) or sequential contraction is actually occurring, whether or not there

is enough vim and vigor to the squeeze to push food through, and whether or not the muscle that separates the esophagus from the stomach relaxes appropriately when you eat.

Prior to high resolution manometry, standard manometry was used, but it was limited because it only measured pressure from a few points inside the esophagus. ManoScan’s advanced technology, which collects measurements from 36 different locations, alerts physicians to what is triggering a patient’s symptoms, enabling them to choose the best possible therapy. It decreases the chances of misdiagnoses, inappropriate treatments and technical mishaps. “If you don’t go this extra step, a patient could be mistreated,” Ergun said.

During a two-hour procedure, in which the patient sits or lies on his side, the physician threads a catheter through the nose into the esophagus. Then the patient is instructed to swallow saliva or water. Sensors on the catheter then record, transmit and translate information to a contour map image shown on a computer screen.

The ManoScan collects the measurements and assembles that information to create a topographic contour of the esophagus during swallowing. This test is faster and more comfortable than standard manometry and allows doctors to collect all information about the squeeze of the swallow in one picture.

Patients can’t eat or drink for eight hours prior to the test but can eat and resume normal activities immediately following the test.

GOING WIRELESS

or the 15 million Americans who experience the common symptoms of gastroesophageal reflux disease — heartburn and acid indigestion — a new less cumbersome testing method increases patient comfort and allows physicians to gather more information.

Instead of checking for acid exposure in the esophagus with burdensome monitoring equipment, doctors now can track esophageal pH (acid) levels by clipping an acid-sensing capsule, the size of a pencil eraser, to the inside of the esophagus.

The capsule, which contains an acid sensing probe, battery and transmitter, is attached to a catheter and threaded through the nose or mouth into the esophagus where it is attached to the lining. The catheter is then removed. The patient goes home and eats, sleeps and works normally.

Doctors can capture the pH contents of the esophagus every six seconds for up to 48 hours. The information is recorded through a receiver the patient wears on a belt. A low pH for long periods indicates frequent abnormal backflow (reflux) of stomach acid into the esophagus or gastroesophageal reflux disease.

The capsule transmits for two days and the battery dies. Five to seven days later, the capsule detaches from the esophagus and is passed through the patient’s stool.

“The beauty of this wireless capsule is that patients are much more comfortable and you get 48 hours worth of data instead of 24,” Ergun said. “Because there is a longer study interval, it allows you to gather more information to discover the underlying problem.”

Esophageal acid measurement helps determine if chest pain is being caused by acid reflux. “When you insert a pH sensing device, you can see if a patient has an abnormal amount of acid, and if so, you can be confident about performing surgery,” she said.

People with unexplained chest pain may benefit most from these tests. “These days we have more and more ways to assess how the body functions beyond X-ray or endoscopy. These advances give us great tools to determine whether a patient’s symptoms are a result of an esophageal muscle dysfunction or abnormal acid contact,” Ergun said.

HIS ADVANCED

TECHNOLOGY ALERTS

PHYSICIANS TO WHAT

IS TRIGGERING A

PATIENT’S SYMPTOMS,

ENABLING THEM TO CHOOSE THE BEST POSSIBLE THERAPY.

To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.