91035 Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation

Name of the Procedure:

Esophagus, Gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis, and interpretation
Common Name(s): Esophageal pH Monitoring, 24-hour pH Test, Ambulatory Esophageal pH Test

Summary

This procedure involves placing a special pH-sensitive probe inside the esophagus to monitor acid levels over a 24-hour period. The data collected helps in diagnosing gastroesophageal reflux disease (GERD) by identifying abnormal acid exposure in the esophagus.

Purpose

This test is primarily used to diagnose GERD, a condition where stomach acid frequently flows back into the esophagus. The goal is to determine the frequency and duration of acid reflux episodes and to correlate these with the patient’s symptoms.

Indications

• Persistent heartburn
• Acid regurgitation
• Chronic cough or hoarseness
• Unresponsive symptoms despite treatment
• Atypical chest pain

Preparation

• Patients are often instructed to fast for at least 4-6 hours prior to the procedure.
• Certain medications, particularly those affecting stomach acid, may need to be discontinued ahead of time as advised by the healthcare provider.
• A pre-procedure assessment usually includes a review of the patient's medical history and current symptoms.

Procedure Description

1. The patient is seated comfortably.
2. A thin, flexible catheter with a pH-sensitive probe is gently inserted through the nose and placed into the esophagus.
3. The probe is positioned above the lower esophageal sphincter and secured in place.
4. The external end of the catheter is connected to a small portable device that records the pH levels over 24 hours.
5. The patient goes about their daily activities, recording symptoms, meals, and body position changes in a diary.

6. After 24 hours, the catheter is removed, and the recorded data is analyzed by a healthcare professional.

   Duration

   The placement of the probe takes about 10-15 minutes. The monitoring period lasts 24 hours.

Setting

Typically performed in an outpatient clinic or a hospital setting.

Personnel

• Gastroenterologist or trained nurse specialist
• Medical assistant
• Technical staff responsible for data analysis

Risks and Complications

• Discomfort or gagging during the insertion
• Nosebleed or nasal irritation
• Sore throat
• Very rare chances of more serious complications like esophageal perforation

Benefits

• Accurate diagnosis of GERD and other acid-related disorders.
• Identification of the correlation between acid reflux and symptoms.
• Information to guide effective treatment strategies.

Recovery

• Minimal recovery needed; patients can usually resume normal activities immediately after the probe is removed.
• Specific instructions might include avoiding certain foods or activities immediately after the procedure.
• Follow-up appointment to discuss results and treatment plan.

Alternatives

• Empiric trial of acid-suppressing medications.
• Esophagogastroduodenoscopy (EGD).
• Bravo pH Monitoring System (wireless pH testing).
• Barium swallow test.

Pros and Cons Compared to Alternatives:

• pH monitoring is more accurate for diagnosing reflux compared to medication trials.
• EGD provides visual examination but less direct correlation with symptoms.
• Wireless pH testing is less intrusive but more expensive.

Patient Experience

During the insertion, patients might experience mild discomfort and a gagging sensation. Over the 24 hours, they might feel conscious of the catheter but generally can go about usual activities. Post-procedure, there may be minimal throat discomfort, easily managed with mild pain relievers such as acetaminophen.