24 hour ph test have any one took it

[MountainReader]

If your doctor recommends you get a 24 hour PH and you are having problems with suspected reflux, I would recommend you get it.

My primary reflux symptoms are belching and a chronic cough. Since January 2002, I have been on taking allergy meds, asthma meds and acid reflux meds to try to get rid of the cough--those are often causes of chronic cough. (When it flares up, the cough is a dry cough that is constant. I can't catch my breath, I sometimes bend over double, I pull stomach muscles and sometimes vomit.) After trying a variety of medication combinations and watching my diet, I ended up on Allegra, Singulair, Flonase, Astelin, Advair 500/50, Albuterol, and Protonix for about 2 years. Last February, my cough really flared up again. Because my lungs sounded ok, my doctor suspected it was the reflux that was the main trigger but wasn't sure because I was already on reflux meds and the symptoms hadn't let up. (By that time, I had used Pepcid AC, Prilosec, Nexium and Protonix.) She finally had me see a GI specialist for an Endoscopy. The test came back clear. I was frustrated because I was worn out by the constant coughing. The next test the doctor recommended was a manometry with the 24Hr. PH. I was glad I went in for it because the test confirmed that yes I did have a problem. My esophageal sphincter was not closing properly and I had reflux in my esophagus about 35% of the day--even though on the day of the test I was still on a diet avoiding the troublesome foods. I have been on Prevacid 2x per day since April and was given 11 refills. I still have some belching, but the cough has improved--really helping my quality of life.

About the test: It wasn't the most pleasant thing I have done, but I expected much worse. I would do it again if I needed to. I went in in the morning after fasting from the night before. They did the manometry first. First they sprayed something in the back of my throat to numb it--it tasted across between bananas and gasoline--then they put a numbing gel in the nostril of choice which should be the least stuffy one. After they had a few minutes to take effect, they took a special sensor tube which was hooked up to a computer and put it up my nose. They had me taking sips of water from a straw to help the tube go down OK. It was a bit uncomfortable, but not too bad. Next they moved the tube up and down my esophagus while swallowing air or water. When they found the esophageal sphincter, they had me swallow at intervals so they could measure how well it was working. When the techincian had the readings they needed, he pulled out the tube. Next was the PH probe. This tube was about 1/3 the size of the first one. It went down the same way but was a bit more uncomfortable as it went down. I asked the tech about it and he said it was a bit stiffer than the first probe. Anyway, it had some marks on it that corresponded to marks on the first tube and told him how far to insert it because he knew where my esophageal sphincter was. Once it was inserted, he wrapped it behind my ear and taped the tube down to my nose and cheek. Then he took the other end of the sensor and attached it to a computer about the diameter of a softball. The computer could be hung around my neck or attached to my belt. When you use the computer, you have to putch a button to indicate if you are upright or laying down. You also have to push a button when you eat. There are numbers on the probe that allow you to see what the PH is throughout the test. The other thing I had to do is to fill out a log every time I ate, took medications or had any symptoms. By the time this was finished, I was very hungry. I stopped on the way to work (they want you to carry on a regular day) and picked up a muffin. The first bite I took was very uncomfortable because it caught on the tube. Everything else I ate during the day--chicken, rice, salad, etc... was good though and it wasn't that uncomfortable. I was worried about sleeping with the wire and computer because I can be a restless sleeper, but I had no difficulties at all. The worst part of it all for me was not being able to shower the next morning. (A sponge bath just isn't the same.) After my 24 hours was up I just had to go back to have it removed. I asked the day before if I needed an appointment, but they said the receptionist would know why I was there when I entered the room. Sure enough, the receptionist called across the room when I entered and asked if I was ready to get it out. It only took a second to remove. I had some difficulty getting the adhesive off my face though. I used alchohol wipes, took a shower, etc.. and still had residue for 2 days. I was worried my nose would continue to be sore from the tube after that, but I didn't have any problems.

I know this is long, but I hope it helped.

[taape]

A few questions come to mind: MountainReader

Can you stay on your regular meds including PPI's during the 24 hr test?
If not, did you get nausea?
What if you have bad allergies and your nostrils are pretty much shut?
Can you still use the Astelin and Flonase in the other nostril?
Are you allowed to exercise during the 24 hours?
Why can't you take a bath and keep your head away from the water?
Are you allowed to brush your teeth?

Wouldn't getting the manometry test be enough that you didn't need to have the tube for 24 hours? You were brave to go to work with the tube.

[MountainReader]

taape,

1. Yes you can stay on your regular medications. They prefer you to have an empty stomach though. If you have to take before the test, they recommend at least 4 hours before the test. I took all my regular meds as soon as they put the tube in--my appointment was first thing in the morning.
2. Nope. No nausea.
3. I am chronically stuffy with year-round allergies. I just picked the one that was the least stuffy. I don't think it really makes a difference though.
4. I kept using the Astelin and Flonase in both nostrils even with the tube in.
5. They want you to follow your regular routine. If that includes exercise, they want you to exercise. You can't get the computer wet though so I guess swimming would be out. I would think aerobic activities might be inconvenient because the computer was about softball size and would bounce around alot. The technician who put the tube in said that if I regularly skydived on Tuesdays that I should skydive so my guess is--anything goes.
6. They don't want you to take chances getting the computer wet and messing up the readings so no bath.
7. You can brush teeth, blow your nose (gently), eat, drink, whatever you would normally do.

The manometry was able to say the sphincter wasn't closing properly. The 24hr. PH was able to let monitor what times throughout the day I had reflux and what activities/ food/ meds, etc...triggered the reflux and how bad the reflux was. This information helped my doctor tailor my treatment. For example, he would have been able to see if any medications I was on was aggrevating the reflux. I guess if you really had a concern about the 24 hour probe, a manometry would be better than nothing.

Thanks, I wasn't happy to go to work with the thing in but I was desperate for some answers. I work in a public service job in a school/community service building and interact with several hundred people regularly every day--I was constantly telling people I wasn't contagious. I did tell those I see the most about the test ahead of time though. I wouldn't say anyone was really surprised I was having a test done. They have been listening to me cough for years. That particular flare-up had lasted constantly over 3 months and they always knew when was coming down the hall before they saw me. I am sure they are all relieved to have some silence when I got the cough under some control.

[taape]

Thanks for all your answers to my questions. I know someone who had a similar test where a sensor or something was actually placed in the stomach or near there for 72 hours and they wore a computer type device that whole time. They had to keep track of their activities and record it. Have you heard of a test like this? It apparently measured the acid in the stomach area during eat, activities, etc.,

[aswander]

Hi Taappe,

Before I was diagnosed, the allergy-like and asthma-like symptoms very very confusing. The thought that I might have reflux never crossed my mind, and I was almost "holding onto" the idea that my problems were allergy or asthma related only because that's what all the local doctors were suggesting. Even though treatment for the A & A smptoms was totally ineffective, it was even worse to think that noone actually knew what the real problem was. As such, I was overmedicating myself with allergy and asthma drugs, and completely treating the wrong problem.

I even had a doctor suggest that I had "some reflux", but he wasn't familiar with the 2 dosage a day protocol and only prescribed me 1 dose a day of Nexium, which was ineffective at that level. Since that doctor didn't say anything beyond "some reflux may be complicating things", (in other words, he didn't hammer the idea into my head that reflux was the primary cause), it went in one ear and out the other. Perhaps if I had listened to him a little more closely, I would have done some research on reflux-related coughing, discovered more info on PPIs, and gotten better a whole lot earlier. Instead, I begrudgingly went to a doctor at Yale recommended by my envirnonmental health doctor (another concept I was clinging to was living in a toxic household). When I went to the Yale doctor, she diagnosed me using just the RSI (a reflux symptoms index), explained everything clearly, and gave me a copy of the article "LPR - It's not GERD". There in the office, she had me take a double dose of Nexium, and I stopped coughing 30 minutes later. She also told me to lay of the allergy and asthma medications immediately so I could be fully aware of the effect of the PPIs. And guess what? I didn't need them at all.

Since that time, I have been very successfully treated and have never needed those allergy or asthma medications again, and it's been 4 years.

So if you're concerned about walking around for 24 hours with a tube down your nose, just remember, it's your choice. If you are determined to see for yourself that your LES isn't closing properly, that's your choice, but you should know that the medical community does not see these kinds of tests as necessary for managing and diagnosing LPR. The protocol is for the LPR patient to be given "high dosage" PPIs at the 2 time per day level (BID) for 4 months. If, ond only if, there is little-no improvement after 4 months, are the invasive tests warranted.

Just a quick search at Pubmed or "LPR" and diagnosis turns up these citations that support this idea:

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=12803789&query_hl=20&i tool=pubmed_docsum[/url]

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=16189367&query_hl=1&it ool=pubmed_docsum[/url]

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=16319603&query_hl=1&it ool=pubmed_docsum[/url]

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=16598989&query_hl=1&it ool=pubmed_docsum[/url]

[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=A bstract&list_uids=16846931&query_hl=1&it ool=pubmed_docsum[/url]

So while I'm not sure what treatment you are currently on, I just wanted to be sure that you have consistently been on a high dosage, 2 time per day (BID) PPI regimen for at least 4 months. It would be even better if you were using Prevacid, Nexium or Aciphex, which based on board feedback, seem to have the best LPR response.

While I suspect that Mountainreader, is like I was, "holding on" to those other symptoms and not fully embracing the "reflux as primary cause" paradigm. Her posts seem to suggsest that she is still on the asthma and allergy meds and has only been on a 2x daily dose of Prevacid since April 2006. But she says that her cough has dramatically improved since April, which is the most important thing.

If it's direct proof that you want, and mentally need - go for it. It won't physically harm you. But if you can settle for indirect proof via the drug regimen, you do have a choice. I know my LES and UES aren't functioning properly - but it's treatable, so I'm content with that.

On a different note, I was recently wondering if I needed to schedule a 2nd endoscopy, as my last (and first one) was done over 2 years ago. My UPENN doctor, David Katz, who did the first endoscopy, is very conservative, and told me not to bother with a 2nd endoscopy, even though he could have made some money doing so as he performs them himself. He said that since the initial endoscopy showed little damage (I had been on BID PPI therapy for 6 months at that point), there was no reason to do another - because the PPIs were clearly still having a positive effect. Being almost symptom free was, in his mind, proof positive that my esophogous looked good without having to stick sedate me and stick a tube down my throat. (However, I still let my ENT scope me last month - as long as it's ambulatory, doesn't involve sedation or my having to walk around with it all day).