Gastrointestinal Motility Disorders | Gastroenterology and Hepatology | Department of Internal Medicine | UC Davis Health

Patient instructions for esophageal manometry study

You are scheduled for an esophageal manometry study. Esophageal manometry is a test which measures how well the muscles in your esophagus (food pipe) work to push food and liquids from your mouth into your stomach. The procedure takes approximately one hour. At the start of the test, you will be sitting upright. One nostril is numbed with a numbing lubricant. A thin, soft catheter is passed through your nostril, down the back of your throat, and into your esophagus and stomach as you swallow. With the catheter in your esophagus, you will lie on your back with your head up. During the test you will be asked to swallow small sips of water. While you are swallowing, the strength of your esophageal muscles will be measured. The esophagus consists of three main parts:  the upper sphincter (throat), the middle esophagus (food pipe), and the lower sphincter. After the test is complete, you may resume your normal diet and medications.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS CAREFULLY AND COMPLETELY:

• Do NOT eat or drink anything six hours before the test.
• Only take medications that need to be taken regularly, such as blood pressure and heart medication with a sip of water on the morning of your test.
• If you have diabetes, skipping breakfast may affect your need for diabetic medication. Check with your primary care provider to ask how much medication should be taken when fasting.
• Certain medications affect the muscles of your esophagus and should not be taken the day of the procedure, but may be taken immediately after the test. These medications include all pain medications, sedatives, tranquilizers, antispasmodics and promotility medications.

Patient instructions for 24-hour pH study

You are scheduled for a 24-hour pH study. This is a test to evaluate gastroesophageal reflux. Heartburn, chest pain and indigestion are symptoms of gastroesophageal reflux disease (GERD). Reflux occurs when the contents in the stomach regurgitate back into the esophagus. Your doctor may want to evaluate you for GERD before or after prescribing medication or performing surgery to relieve GERD.

A small catheter (pH catheter) will be passed through one side of your nose. The catheter will be advanced into the esophagus. The catheter will remain in place for 24 hours. The catheter will be attached to a small recording device which may be secured around the waist or over the shoulder.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS COMPLETELY AND CAREFULLY.

For adults:

• Wear loose comfortable clothing that buttons up in front.
• Do not eat or drink anything six hours before pH catheter placement.
• No proton pump inhibitors for at least seven days (e.g. Prevacid, Prilosec, Aciphex, Nexium, Protonix)
• No H-2 blockers for 48 hours (Axid, Pepcid, Tagment, Cimetidine, Zantac).
• No antacids 24 hours before catheter placement (Maalox, Mylanta, Tums, Gaviscon)
• No x-rays while the catheter is in place.
• You may not shower or tub bathe while catheter is in place. Sponge bathe only.
• Do not operate a microwave while probe is in place.

If esophageal pH study is being performed to test effectiveness of medicine, the patient should continue their normal medication.

Patient instructions for 48-hour Bravo pH study

You are scheduled for a 48-hour Bravo pH study. The Bravo pH monitoring system is used for gastroesophageal pH measurements and monitoring of gastric reflux. The study involves a pH capsule, approximately the size of a gelcap that is attached to your esophagus. During the study, the Bravo capsule measures the pH in the esophagus and transmits this information to a small receiver worn on your belt or waistband. You will be given a diary to write down the times when you have reflux symptoms (e.g. coughing, heartburn, chest pain, regurgitation), and when you eat or lie down. After the study is completed, you need to return the diary and the Bravo receiver to the lab (room 3016). Several days after the study, the capsule naturally falls off the digestive tract and is eliminated from the body.

Please arrive 30 minutes prior to your appointment. If you are unable to keep your appointment, you must cancel at least 48 hours in advance, or you will be referred back to  your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS COMPLETELY AND CAREFULLY:

• Wear loose comfortable clothing.
• Do NOT eat or drink anything six hours prior to capsule insertion.
• Discontinue all proton pump inhibitors (Prevacid, Prilosec, Aciphex, Nexium) for seven days prior to the study.
• Discontinue all other medications known to interfere with gastric function (Propulsid, Reglan, Axid, Pepcid, Tagmet, Zantac) 72 hours prior to the study.
• Discontinue all antacids (Maalox, Mylanta, Tums, Rolaids, Amphogel, Gaviscon) 24 hours before study.
• You will be able to drive to and from your appointment unless an upper endoscopy (EGD) is required for Bravo capsule insertion. That procedure requires sedation and you MUST have someone drive you home after the procedure.
• You can NOT have an MRI study done for 30 days after having the Bravo procedure.

If the esophageal study is being performed to test the effectiveness of medicine, patients should continue their normal medication.

Patient instructions for esophageal impedance study

Multichannel intraluminal impedance (MII) is a new technique that measures gas or liquid reflux into the esophagus. It is useful in patients who have reflux of substances which are not acidic and therefore would not be detected by the pH study or the Bravo capsule. It may be used alone or in combination with the pH study. As in the standard pH study, the impedance study also uses a small catheter passed through the nose into the esophagus. The catheter is attached to the waist recorder, and the patient is asked to perform his or her regular daily activities.

A small catheter (pH catheter) will be passed through one side of your nose. The catheter will be advanced into the esophagus. The catheter will remain in place for 24 hours. The catheter will be attached to a small recording device which may be secured around the waist or over the shoulder.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS COMPLETELY AND CAREFULLY.

• Wear loose comfortable clothing that buttons up in front.
• Do not eat or drink anything six hours before pH catheter placement.
• No proton pump inhibitors for at least seven days (e.g. Prevacid, Prilosec, Aciphex, Nexium, Protonix)
• No H-2 blockers for 48 hours (Axid, Pepcid, Tagment, Cimetidine, Zantac).
• No antacids 24 hours before catheter placement (Maalox, Mylanta, Tums, Gaviscon)
• No x-rays while the catheter is in place.
• You may not shower or tub bathe while catheter is in place. Sponge bathe only.
• Do not operate a microwave while probe is in place.

If this study is being performed to test effectiveness of medicine, the patient should continue their normal medication.

Patient instructions for gastric emptying study

Gastric emptying study is performed by the nuclear medicine department at UC Davis Health. For the study, the patient eats a meal in which a solid component of the meal, a liquid component of the meal, or both, are mixed with a small amount of radioactive material. A scanner is placed over the patient’s stomach to monitor the amount of radioactivity in the stomach for several hours after the test meal is eaten. The rate at which the radioactivity leaves the stomach reflects the rate at which food is emptying from the stomach

Before the examination, you should tell your physician if you are pregnant or nursing. You should not eat or drink anything for six hours prior to the study. Check with your physician to see which medications should be withheld and for how long before this study, as many medications may affect gastric emptying.

Patient instructions for SmartPill test

You are scheduled for a SmartPill test. The SmartPill capsule is slightly larger than a multivitamin. The SmartPill capsule measures pressure, pH and temperature from within the entire gastrointestinal tract to determine gastric emptying time, combined small and large bowel transit time and total transit time.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

DO NOT eat or drink anything prior to your appointment. You must bring the following items the morning of your procedure. There are no substitutions to this standard meal:

• 1/2 cup egg substitute (e.g. Egg Beaters)
• 2 slices of bread
• 1 1/2 tablespoon of strawberry jam
• 1 can of nutritional drink (e.g. Ensure)

Motility altering medications such as cisapride, domperidone, metoclopramide, macrolides (e.g. Erythromycin, Zithromycin), 5HT4 partial antagonist (Zelnorm), antiemetics, anticholinergics (e.g. Phenergan, Compazine), and 5HT3 antagonists (e.g. Zofran, Kytril) should be stopped 48 hours before the test.

The following medications may alter gastric pH:

• Proton pump inhibitors should be stopped seven days before test.
• Histamine blockers, cimetidine (Tagament HB), famotidine (Pepcid AC), ranitidine hydrochloride (Zantac) should be stopped two days before test.

All antacids should be stopped one day before test.

Patient instructions for hydrogen breath test

Hydrogen breath test may be used to diagnose the malabsorption of specific carbohydrates. Sugars malabsorbed in the small bowel are metabolised by colonic bacteria with the production of hydrogen, which diffuses rapidly across the colonic mucosa into the blood and can be measured in the breath. Patients drink a solution of lactose, fructose, sucrose or glucose in water. After drinking the solution, patients are asked to breathe into a plastic bag; breath samples are obtained every 30 minutes and analyzed for hydrogen content to determine if there is a proper break down of lactose or sucrose, or if there is evidence of bacteria overgrowth.

You must be off antibiotics and Pepto-Bismol for two weeks. On the evening before your test, you may have the usual amounts of meat and vegetables from dinner time until midnight. Please consume only small amounts of sugar and starch. After midnight, have nothing to eat or drink until your examination is completed.

Patient instructions for rectal manometry

You are scheduled for a rectal manometry test. Rectal manometry is a test used to measure and assess pressure, reflex and sensation in the rectum. The test also evaluates the efficiency of the anal sphincter. The procedure will help your doctor evaluate the cause and determine the correct treatment of fecal incontinence or constipation.  While lying on your left side, a thin flexible catheter with a small uninflated balloon at the tip is passed through the anus and into the rectum. The catheter is slowly withdrawn while numerous pressure measurements are recorded. You will also be asked to push and squeeze your anal muscles at certain times. You will also be asked to indicate when you experience a feeling of fullness or distension in the rectum, upon inflation of a small balloon at the end of the catheter.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS COMPLETELY AND CAREFULLY:

• Do NOT take smooth muscle relaxants (Valium, Flexeril or narcotic pain medications) 24 hours prior to your appointment time.
• Obtain a Fleet enema from your local pharmacy and use ONE hour prior to your appointment time.

This is a very easily tolerated procedure. The procedure lasts approximately 20 to 30 minutes. You will be able to return to work afterwards.

Patient instructions for neuromuscular retraining

Neuromuscular retraining is used to teach patients correct use of muscles in the anorectum. It has no associated risk factors or medical complications, and has a high success rate for treating patients with elimination problems.

In neuromuscular retraining, a specialized anorectal probe is used. With the probe in place, the patient is instructed to perform specific relaxation and squeeze maneuvers while observing his or her own manometric tracings. The patient compares these tracings to those of a normal subject. During the training session, the patient practices performing the maneuver, with feedback from his or her own manometric tracings, until he or she is able to consistently elicit a normal tracing. The patient is also given exercises to perform at home.

Please arrive 30 minutes prior to your appointment. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.

PLEASE FOLLOW THESE INSTRUCTIONS COMPLETELY AND CAREFULLY:

• Purchase one Fleet enema.
• Administer enema one hour prior to your appointment.

Patient instructions for pudendal nerve latency test

The pudendal nerve is a nerve which innervates the sphincters involved in the continence of stool and urine.  Malfunction of this nerve usually leads to incontinence with symptoms of involuntary leakage and soiling of stool and/or urine. During this test you will be required to use an enema preparation before your appointment. You will be requested to undress and wear a gown, and lie down on your left side in a fetal position. The doctor will perform a rectal digital exam with a stimulation electrode attached to the index finger. He will locate the electrode in the path of the pudendal nerve both on the right and left side of the pathway of the nerve. While applying small painless electrical stimulus on the path of the nerve, a computer will record a quantitative assessment of the speed of the impulse transmission. This assessment allows for determination of possible malfunction of the nerve. In general, the procedure feels like a prolonged rectal exam which lasts approximately 20 minutes.

Please administer the enema 30 minutes prior to your appointment.

Please arrive 30 minutes prior to your appointment for registration. If you are unable to keep your appointment, you must cancel at least 48 hours in advance or you will be referred back to your primary care physician.