Oesophageal physiology

When you receive your results, your team at London Bridge Hospital will provide a comprehensive treatment pathway for you, specifically tailored to your symptoms and needs.  Different results will suggest different kinds of further treatment.

Reflux: Treatments for reflux may include changing the timing and/or dose of any proton pump inhibitor medication you’re taking, taking alginates (medications derived from seaweed that can help with reflux), or changes to your lifestyle, such as what and when you eat. If your reflux symptoms persist, your consultant may recommend surgical or endoscopic options and refer you to one of our Upper GI consultants.

Motility disorders: If your results indicate a motility disorder such as achalasia, spasm, or esophagogastric junction outflow obstruction (EJOO) (which causes chest pain and swallowing problems), your consultant will recommend tailored treatment. This might include botulinum toxin injection to relax overactive muscles, pneumatic dilatation to improve swallowing, or a per-oral endoscopic myotomy (POEM) or laparoscopic Heller myotomy to help ease pressure on your sphincter.

You’ll also be given ongoing access to supportive care including advice about diet, and any speech and language therapy you might need.

It depends on which kind of test(s) your consultant recommends, and which medications you’re taking, but this should give you a good idea:

If we’re testing ‘off therapy’ (meaning we stop your current medication to see if reflux is the cause of your symptoms) you’ll need to stop taking the following medications before your test(s): 

• PPIs such as omeprazole, lansoprazole or esomeprazole 7 days beforehand
• H2-blockers such as famotidine 48 hours beforehand
• Antacids or alginates 24 hours beforehand

If we’re testing ‘on therapy (meaning we’re looking for symptoms that occur despite your current treatment) we’ll ask you to keep taking your reflux medicines as usual. 

For manometry testing, where the pressure in your oesophagus is being measured, we’ll usually suggest you keep taking your reflux medications and advise you about any exceptions. 

It’s important to remember that you should only ever change your medications if we’ve asked you to. Never stop taking essential drugs such as heart or blood pressure medication unless you’ve been given specific medical advice.

Again, this depends on the kind of test(s) you’re having. 

High-resolution manometry involves having a thin tube passes through your nose for 20–30 minutes. You may feel a brief gagging sensation as the tube goes in, and it may also cause your eyes to water, but any discomfort is usually mild and passes after a few moments. You should be able to go right back to your usual activities as soon as it’s over.  

pH-impedance testing means you’ll need to have a catheter inserted through your nose into your stomach, and it will stay in place for 24 hours. You’ll be aware of the small tube in your nose and throat, especially when you swallow, but it shouldn’t be painful. You’ll usually be able to speak and sleep without any problems, and it’s OK to go back to work, but you should avoid strenuous exercise.

Wireless pH monitoring is very safe. Complications are rare, but can include:

• Temporary discomfort in your chest or throat, or a sensation that feels like a lump
• Heartburn or mild pain in the first 24–48 hours
• Capsule detachment delay, where the capsule doesn’t detach in the expected time.  This is very rare, and the capsule usually falls off and passes from your body naturally.
• If your capsule is placed via an endoscopy, it can lead to a sore throat, bleeding, or (very rarely) perforation or aspiration in your throat.

Wireless pH monitoring means you must avoid having an MRI until the capsule has safely detached and passed from your body. That usually happens within a week, but you should avoid any MRIs for 14 days unless an X-ray confirms that the capsule has gone.

If you develop severe chest pain, difficulty swallowing, or black stools after your wireless pH monitoring procedure, contact us immediately or seek urgent care.