Esophageal Manometry to diagnose IBS symptoms
In mid-May, 2015 I was subjected to every GI patient’s favorite things – an upper and lower endoscopy. This was at least my third (probably my fourth) time going through this prep and it was by far the easiest.
I don’t know if it was because of my overall diet changes the last few years, the different prep plan that this doc gave me or both. The prep this time around included going on a low-residue diet (aka low-fiber diet) for 2 days prior to the liquid diet day. The low-residue diet restricted all raw fruits and veggies, as well as a lot of other things. The only thing that wasn’t restricted was meat. So we went out for dinner to Texas de Brazil.
The liquid diet day wasn’t a party but it wasn’t bad and when I started the prep it was no big deal at all. I was given Supra-Prep, which I think I’ve had before but I can’t quite recall for certain. It’s these two bottles of nasty tasting liquid that you have to mix with water.
I had to drink one at about 6pm the night before the procedures and the second the morning of. When I’ve done this prep in the past I’m in the bathroom all night. Not this time. I was in in and out for about 1-2 hours then I slept well! That was a first for any of these procedures. I woke up early the next morning and did the second round of prep and again less than 2 hours and I was done. So Easy!
Sadly, this wasn’t the only place where this experience veered greatly from earlier scopes. This time they found something. Gastritis in the stomach, a polyp and a healing fissure in the lower intestines.
Given the amount of reflux I’ve had and that the meds they’ve tried haven’t really helped me get past lunchtime even if I avoid anything acidic or gas-inducing, the doc decided to order another test.
The Esophageal Manometry Test
What the heck is an esophageal manometry test you ask? Well, having been through a Rectal Manometry I had an idea, but I googled it anyway just to be sure. My guess was pretty much right on.
They basically stick a tube down your throat to measure the pressure of your Esophagus. Throat isn’t exactly correct, well it is.. but not quite. They actually stick the tube down your nose and then it goes down your throat.
First, they squirt some thick numbing gel into your nose, then they squirt some more. That’s both gross and uncomfortable. Then they attempt to get the tube down your nose and no it’s no small tube. My gag reflex kicked in and she had to spray my throat with a numbing spray (much like you’d buy if you had tonsillitis).
After the spray kicked in she was able to slide the tube down my nose, but just because I’d been numbed didn’t mean it wasn’t really uncomfortable. It was. For the next 10 minutes or so I had to lay on a bed, taking occasional sips of water while she measured my swallowing function.
And the 24 hour pH study….
Once the first part of the test was over, she yanked that tube out and replaced it with a much thinner tube (thankfully) that I would keep for the next 24 hours.
This tube was connected to a little box that measured my Ph levels. For the next 24 hours I had to hit a button when I had any symptoms (belching, reflux, chest pain, heartburn, etc), when I ate, when I took my meds, and when I slept.
Additionally, I had a diary that I had to record all of those things in, along with more info (like what I ate, what specific symptoms, etc). I was actually better at remembering to write things down than I was at pushing the buttons, which she said was OK as she could enter it later.
She told me I should eat and drink normally for the next 24 hours including eating and drinking things I’d been avoiding because of the symptoms (things like carbonated beverages, coffee, tomato, and everything with any sort of spice).
The tube down my throat was not comfortable. It hurt a little when I would turn my head certain directions. It actually felt better when I swallowed than if I wasn’t swallowing.
Overall, the test sucked.
When I returned the next day to get the tube out, I ran into my doctor and I let him know he wasn’t my current favorite person. I also pointed out that I really hoped this test showed something because we have such a great history of tests not giving us good info.
Sadly, when I returned to see him in mid-June I learned that these tests weren’t any better than previous ones and once again we were left with no info. Other than the scopes showing gastritis, we’ve got nothing.
The pH test let us know that I don’t have the worst case of reflux ever. His current line of thought is that we are chasing the wrong rabbit trail so let’s start looking at different things.
First thought is that it’s bile reflux rather than acid reflux (since I don’t have a gall bladder anymore). So, we are trying a med for that. I’d like to say I’m hopeful, but to be honest at this point I’d be more surprised if we found an answer than if we didn’t.
It’s frustrating. He’s now suggesting we may end up doing an elimination diet to try to figure some things out. Heck, I already know that basically everything causes me stomach issues of one kind or another.
On the upside, I now know what an esophageal manometry test is and if they ever suggest a 24 hour pH test I know to run the other way.