Did you know that sometimes a symptom of chest pain may not be related to the heart? Or that a chronic cough may not always stem from a condition in the respiratory system? Or even that post-nasal drip may have nothing to do with a virus or allergies?
It’s true. All of these symptoms can actually signal gastroesophageal reflux disease (GERD), which is one type of a gastrointestinal motility issue.
Gastrointestinal motility is defined as the movement (by muscle and nerves) of food through all parts of the gastrointestinal (GI) tract — from the throat to the rectum. When motility goes awry in the upper GI tract, it can result in issues like GERD (also known as reflux) as well as swallowing disorders like dysphagia. And in the lower GI tract, motility issues like fecal incontinence, pelvic pain and constipation can develop.
More Accurate Diagnoses
Patients with motility issues often suffer without a clear diagnosis, and healthcare providers typically prescribe them medicine or interventions based on their symptoms rather than knowing the exact cause. But as an answer for these tricky-to-pin-down motility diagnoses, Doylestown Health Gastroenterology has started a new testing program to identify them: Manometry testing and 24-hour pH testing.
Esophageal Manometry: Typically used for patients who experience esophageal symptoms like heartburn, GERD, dysphagia (trouble swallowing), chronic cough or chest pain, this test is performed in the gastroenterologist’s office. In this procedure, a nurse feeds a flexible catheter (with a camera attached to it on one end and a computer monitor on the other) from the nose to the stomach. Then that person drinks saline water and swallows. This can reveal any problems with motility of that area.
“During the test, it allows us to see the pressures and function to see if anything is too tight or too lose [in the esophagus] or just not working correctly,” says Karissa Russell, RN, GI motility nurse with Doylestown Health Gastroenterology.
While it might seem daunting to have a catheter placed through the nose, Karissa explains that patients are numbed before the catheters are placed and then it’s over quickly. “Nine times out of 10, patients will admit it’s not as bad as they thought. And they’re ultimately thankful they had the test,” she says.
24-hour pH Testing: This type of testing is also called impedance testing and helps diagnose GERD by determining how much acid is present from the stomach to the esophagus. To do this, the nurse feeds a flexible tube from the patient’s nose to the stomach. At the other end of the tube is a small computer that measures the acid in the GI tract and records what’s happening. The patient then wears the device around the waist for 24 hours at home. Then the next day at the gastroenterologist office, the tube is removed and the computer data is downloaded providing the physician with a clearer picture of the severity of reflux.
“One reason why the pH testing is so helpful is that patients can still be on their GERD medications and have the test,” says Asyia Ahmad, MD, MPH, gastroenterologist with Doylestown Health Gastroenterology. “With a lot of other tests, they can’t. So this not only helps us see the reflux happening but also tests the effectiveness of medicines that patients are on, too.”
Anorectal Manometry: This test is often used for patients with constipation, fecal incontinence or pain to measure the strength of anal muscles and accompanying sensations in the rectum that are necessary to produce normal bowel movements. Also done in the physician’s office, this test uses a catheter that is inserted into the rectum to test the motility of the lower GI tract (with a camera on one end and a computer monitor on the other). That information is rendered into a 3D visual.
“Patients who have anorectal manometry testing will be asked to do exercises like squeezing or pushing and we can actually see how those muscles are working from a motility standpoint. With the 3D capability, it helps us pinpoint the exact areas that are working or not working so they can see a surgeon or physical therapist for treatment,” explains Karissa. “We can also test rectal sensations. Sometimes there’s underlying nerve damage from trauma somewhere in the body and they can’t feel certain pressures and this test helps identify that.”
- For more information on gastrointestinal motility services, call 215.345.6050
About Gastroenterology
Our caring, compassionate gastroenterologists are experts in the diagnosis and treatment of disorders and diseases of the digestive system. Using advanced screening tools, state-of-the-art treatments and innovative technology, our gastroenterology team delivers comprehensive care for conditions of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. The Open Access Colonoscopy Program allows healthy patients the convenience of scheduling a screening colonoscopy without an initial office visit.
