Joy McCann Culverhouse Center for Swallowing Disorders

About Your Procedure - Gastroenterology

High-Resolution Esophageal Manometry (HREM)

High-resolution Esophageal manometry (HREM) is a test that measures the pressures generated and the coordination of muscle contraction in the esophagus when you swallow. It evaluates how the esophagus transports food and liquid from the mouth to the stomach. HREM is important in the diagnosis of many diseases like achalasia, esophageal spasm, and difficulty swallowing. It is helpful in the evaluation of acid reflux disease, especially prior to surgery.

HREM involves the placement of a small tube or catheter through the nose into the esophagus. An anesthetic (numbing) gel may be used to reduce the sensitivity of the nose and throat. The tube is slowly advanced into the esophagus as you sip and swallow water from a straw at specific intervals. The tube has 32 sensors that measure the amount of pressure generated within the esophagus each time you swallow. You may resume your normal daily activities, diet and medications. following your test. Since there is no sedation required, you may drive yourself home after the procedure.

The data produced by the HREM study is reviewed by our staff physician(s) and a report is sent to your physician. You must arrange follow-up with your physician for the results of this study.


Ambulatory esophageal pH monitoring

Esophageal pH monitoring is a test which measures the amount of acid or non-acid refluxing back into the esophagus from the stomach. Gastro-esophageal reflux disease (GERD) is a common condition and has a range of symptoms including heartburn, regurgitation, dysphagia (difficulty swallowing), belching, throat pain, hoarseness, cough, asthma, and occasionally chest and upper abdomen discomfort. Test results can help your physician determine:

  1. Whether or not your symptoms are related to GERD
  2. How your GERD symptoms respond to your current therapy
  3. If your stomach acid is reduced enough to control your present symptoms
  4. Whether your upper respiratory symptoms are related to acid exposure
  5. Whether or not you are a candidate for alternative medical or surgical management.

There are two methods to perform esophageal pH testing:

  1. Transnasal pH catheter: A small tube, the size of a spaghetti noodle, is placed into the esophagus through the nose after applying an anesthetic gel to decrease the discomfort. You will be asked to sip water from a straw to help the tube advance through the esophagus to a predetermined position. Once in place, the tube is secured to the nose and face with a small strip of tape. The exposed end of the tube is connected to a small recorder which is the size of a small wallet. It records all acid reflux as well as non-acid episodes over the 24 hour period. You are required to return to the Swallowing Center the next day to remove the catheter. The results are then analyzed by our physician(s) and a report is sent to your referring physician.
  2. Bravo 48 hour pH capsule: This device attaches to the esophagus while you are sedated and undergoing an endoscopy. There are no visible wires and it permits more normal activity (eating, sleeping, exercising or working). The pH capsule measures acid reflux for 48-96 hours. A small pager like device is worn on a waist belt to collect the information. Bravo pH capsule studies are only accurate when performed off PPIs or H2Ra such as Tagamet, Zantac or Pepcid. The device is usually painless and passes out of your digestive system in about 7 days.

Upper GI endoscopy

The procedure is also known as esophagogastroduodenoscopy (EGD). It is a procedure that allows your physician to examine the lining of your upper GI tract including the esophagus, stomach and part of the small intestine. A flexible tube with a light and camera is passed through your mouth into your GI tract. You are given IV medication by an anesthisiologist so you will have no discomfort and will not remember the test. Depending on the purpose of your procedure, biopsies may be taken and sent to a pathologist to make an accurate diagnosis. Biopsies are small pieces of tissue that are removed and viewed under a microscope by a specially trained doctor. Biopsies enable tissue to be analyzed and are used to detect various disorders including Barrett esophagus, dysplasia, and cancer.


Barium Esophagram

A barium esophagram is a test that evaluates the esophagus using x-ray. You will drink several ounces of barium liquid while the physician or technician takes x-rays as the liquid passes through your esophagus. Barium is a contrast material that is thin, white, and may be artificially sweetened and flavored. Barium rarely causes any problems and passes through the digestive tract. It may be helpful to drink extra liquid after the study to help clear it and prevent constipation.

Preparing for the test (or put in section with instructions)

  • No solid foods 4 hours prior to procedure. Adult patients may be on a clear liquid diet 2 hours prior to the procedure. Take medications at the regular times with a small sip of water.
  • Wear clothing that you can remove from the waist up. You will be given a gown to wear.
  • The esophagram uses x-rays and anyone who is pregnant cannot be in the room during the x-ray.

Timed Barium Emptying Study (TBES)

A Timed Barium Emptying Study (TBES) is an x-ray exam that evaluates the time it takes for 8 oz. of barium liquid to pass from your mouth to your stomach. It is a useful test to evaluate how quickly your esophagus empties. X-ray images are taken 1 minute and 5 minutes after swallowing barium. Then a 13-mm barium tablet is swallowed and its transit time is also measured.