91034 Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation

Name of the Procedure:

Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis, and interpretation.
Common names: pH Probe Test, 24-hour pH Monitoring

Summary

This procedure measures the pH levels in the esophagus over a 24-hour period to assess acid reflux. A small, thin tube with sensors is inserted through the nose and down into the esophagus, where it monitors acid levels.

Purpose

The procedure is used to diagnose gastroesophageal reflux disease (GERD) and to assess the severity of acid reflux. The goal is to provide detailed information about acid exposure in the esophagus, which helps in tailoring appropriate treatment plans.

Indications

• Symptoms of GERD, such as heartburn, regurgitation, and chest pain
• Persistent cough, hoarseness, or throat irritation
• Evaluating effectiveness of previously prescribed GERD medications
• Pre-operative assessment before anti-reflux surgery

Preparation

• Fast for at least 6 hours before the procedure.
• Avoid certain medications, such as antacids, proton pump inhibitors, and H2 blockers, for a specified period as directed by the physician.
• Complete any required diagnostic tests, such as an endoscopy, beforehand.

Procedure Description

1. The patient is seated, and a local anesthetic is applied to the nasal passage.
2. A thin, flexible tube with a pH sensor is gently inserted through the nose and guided into the esophagus.
3. The tube is secured externally, and a recording device is attached to the sensor.
4. The patient carries on with normal activities for the next 24 hours, recording meals, symptoms, and sleep periods.
5. After 24 hours, the patient returns to the clinic for tube removal.
6. The recorded pH data is analyzed and interpreted by a healthcare professional.

Duration

The tube placement takes about 10-15 minutes. The recording period lasts for 24 hours.

Setting

The procedure is performed in an outpatient clinic or an endoscopy center.

Personnel

• Gastroenterologist or trained physician
• Nurse or medical assistant

Risks and Complications

• Minor discomfort or gagging during tube insertion
• Nasal or throat irritation
• Rarely, nosebleeds or sinus irritation
• Dislodgement of the tube

Benefits

• Accurate assessment of acid reflux patterns
• Helps in diagnosing GERD and related conditions
• Informs more effective treatment plans
• Allows evaluation of treatment efficacy

Recovery

• Follow doctor’s instructions on resuming normal activities post-removal.
• No specific recovery time needed; patients can usually return to daily activities immediately after tube removal.
• Schedule follow-up appointments to discuss the results and further treatment.

Alternatives

• Bravo capsule pH monitoring: less intrusive but may require an endoscopic procedure to attach the capsule.
• Esophageal manometry: measures pressure but not pH levels.
• Empirical treatment with medications: can be tried but might delay accurate diagnosis.

Patient Experience

During the procedure, the patient may feel a sensation of gagging or slight discomfort as the tube is placed. Throughout the monitoring period, they may feel the presence of the tube, which could cause minor throat irritation. Proper pain management and comfort measures, such as lozenges or numbing sprays, can be used to alleviate discomfort.