South Tyneside NHS Foundation Trust Having an Oesophageal Manometry and 24-hour ph Test (a guide to the test) GI Services Endoscopy Day Ward Outpatients Department Providing a range of NHS services in Gateshead, South Tyneside and Sunderland.
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Oesophageal Manometry and 24-hour ph test Following your appointment with the doctor, you have been advised that you need an oesophageal manometry and 24- hour ph test (procedure to measure the co-ordination and pressure activity within your oesophagus and the amount of acid regurgitation into your oesophagus). This will be carried out in the Endoscopy Day Ward, which is situated on the Outpatients Department, South Tyneside District Hospital. Please read the instructions in this booklet ON RECEIPT OF YOUR APPOINTMENT and bring it with you when you come for your appointment. Blood-thinning tablets It is not necessary to stop blood-thinning tablets. Diabetics If you are an insulin or tablet-controlled diabetic do not fast. Continue your normal medication and diet. Ambulance transport If you require hospital transport to and from the hospital you should book this with your GP or ask the endoscopy booking clerk to book this for you in advance. Special arrangements Please let us know before your visit if there are any arrangements we can make for you, e.g. an interpreter or sign guide to help you during your appointment. Please contact the Endoscopy day Ward on the telephone number given and we will arrange for someone to be with you. Some frequently asked questions This information leaflet will help you to understand what happens when you have an oesophageal manometry and 24- hour ph test. 3
What is oesophageal manometry? This test measures the pressures and co-ordination of activity within your oesophagus when you swallow. From this we can make an assessment of its functioning and determine if your symptoms are due to certain disorders of the oesophagus. The test is also required before anti-reflux surgery to make sure the oesophagus is working well enough for you to have the operation. What is 24-hour ph test? This test measures the amount of reflux that wells up from your stomach into your oesophagus and will help to find if your symptoms are caused by reflux What are the risks of having an oesophageal manometry? A sore throat after the test is very common and should resolve after a few hours. There is a small risk of: entrapment of catheter a nose bleed feeling faint a very small risk of perforation of the oesophagus. Will I need to fast? You should not eat anything for at least 6 hours before the appointment time. You can drink water until 2 hours before your appointment time. HOWEVER, if you are diabetic continue normal diet. Do I keep taking my tablets? You must keep taking any essential prescribed tablets, e.g. heart tablets, blood pressure tablets, diabetic medication, etc., which you can take with a sip of water. 4
However, stop taking indigestion medication before the test. A list of medications to be stopped and when to stop will be sent to you with your appointment booklet. Will I be asleep for my test? You will not be put to sleep or sedated in any way since you should feel only slight discomfort from this. Do I need to bring someone with me? You do not need to bring anyone with you. However, you may like someone to accompany you however they will have to wait about an hour. What happens when I arrive for my test? The nurse will explain the procedure to you and ask for your consent form. This is to ensure that you understand the test and its implications. You will be made comfortable on the couch. The nurse will then pass a tube, with pressure sensors, through your nose and into your oesophagus. During the test period we ask you to lie as quietly as possible as talking can interfere with the measurement. We will give you 10 small amounts of water to swallow so that we can observe the muscle contractions in the oesophagus. This test takes about 30 minutes. The tube will then be removed. After the manometry test, the nurse will then pass a fine 24- hour measuring tube through your nose and back of your throat into the oesophagus. The catheter remains in place for the duration of the test (about 24 hours) and is attached to a small recording machine, which is worn on a belt around the waist. When you go home you will be asked to keep a complete diary during the period of your test to record when you eat, sleep or have symptoms. 5
Will I be able to feel the catheter? You will be aware of the catheter in the back of your throat throughout the test but most patients find they become less aware of it with time. Will I be able to eat food and drink? We especially want you to continue with your normal diet throughout the test as we need to see what happens during a normal day. Please do not chew gum. The catheter may move very slightly as you eat and it may feel strange but we would like you to persevere as it is important to know what happens after mealtimes. What happens if I need to cough, vomit or blow my nose? The catheter will be securely taped to your cheek and behind your ear and it is not likely to move on these occasions. Very rarely the catheter can be vomited back up into your mouth and in this situation you have to remove it. To do this, untape the catheter from your face, take a deep breath in and pull it out from your nose. Then place all the equipment in a plastic bag and return as arranged. May I take any medicine for indigestion during the test? Please do not take any indigestion medication during the test as this affects the amount of reflux and therefore will give us an inaccurate result. Will I be able to go to work? If possible, follow your normal daily routine. However, if you feel it inappropriate to remain at work, do be as active as you normally would be. 6
Will I be able to take a bath or shower? No, the recorder must not get wet. You may bathe with care. Can I damage the equipment? Yes - the equipment is expensive and we ask you to treat it with care. What should I do if I cannot tolerate the catheter? In this unlikely event, you can remove the catheter yourself. To do this, untape the catheter from your face, take a deep breath and pull it out from your nose. After removing the catheter, place all the equipment in a plastic bag and return for your appointment, as arranged. Obviously, if this happens, we gain less information about your condition. What should I expect when I return to have the catheter removed? The appointment takes only 5-10 minutes. The recorder is stopped and the catheter removed. Removing the catheter only takes 2-3 minutes and is not usually uncomfortable. When will I get my results? The information is downloaded and the results printed. The printout needs to be analysed and you will get the results at your next out-patient appointment at the hospital. Discharge instructions If you have any concerns contact the Endoscopy Day Ward on 0191 404 1000 ext. 2247 between 9.00 a.m. and 5.00 p.m. or attend Accident and Emergency or contact your GP. 7
Notes or questions: About the consent form Before a doctor or other health professional examines or treats you, they need your consent. Sometimes you can simply tell them whether you agree with their suggestions. However, sometimes a written record of your decision is helpful for example if your treatment involves sedation or general anaesthesia. You ll then be asked to sign a consent form. If you later change your mind, you re entitled to withdraw consent even after signing. 8
What should I know before deciding? Health professionals must ensure you know enough to enable you to decide about treatment. They will write information on the consent form and offer you a copy to keep, as well as discussing the choices of treatment with you. Although they may well recommend a particular option, you re free to choose another. People s attitudes vary on things like the amount of risk or pain they re prepared to accept. That goes for the amount of information, too. If you d rather not know about certain aspects, discuss your worries with whoever is treating you. Should I ask questions? Always ask anything you want. As a reminder, you can write your questions down. The person you ask should do his or her best to answer, but if they don t know they should find someone who is able to discuss your concerns. To support you and prompt questions, you might like to bring a friend or relative. Ask if you d like someone independent to speak up for you. Is there anything I should tell people? If there s any procedure you don t want to happen you should tell the people treating you. It s important for them to know about any illnesses or allergies you may have or have suffered from in the past. Can I find out more about giving consent? The Department of Health leaflet Consent what you have a right to expect is a detailed guide on consent in versions for adults, children, parents, carers / relatives and people with learning disabilities. Ask for one from your clinic, order from the NHS Response line (0870 155 455) or read it on the website: www.doh.gov.uk/consent Who is treating me? 9
Amongst the health professionals treating you may be a doctor / nurse in training, medically qualified, but now doing more specialised training. They will only carry out procedures for which they have been appropriately trained. Someone senior will supervise either in person accompanying a less experienced doctor in training or available to advise someone more experienced. Photographs and videos As part of your treatment some kind of photographic record or video may be made. The photograph or recording will be kept with your notes and will be held in confidence as part of your medical record. This means that it will normally be seen only by those involved in providing you with care or those who need to check the quality of care you have received. The use of photographs and recording is also extremely important for other NHS work, such as teaching or medical research. However, we will not use yours in a way that might allow you to be indentified or recognised, without your express permission. What if things don t go as expected? Amongst the many procedures taking place every day, sometimes things don t go as as they should. Although the doctor / nurse involved should inform you and your family, often the patient is the first to notice something is amiss. If you re worried for example about the after-effects of a procedure continuing much longer than you were told to expect tell a health professional right away. Speak to your GP or contact the clinic the phone number should be on your appointment card, letter or consent form. 10
What are the key things to remember? It s your decision! It s up to you to choose whether or not to consent to what s being proposed. Ask as many questions as you like, and remember to tell the team about anything that concerns you or about any medication, allergies or past history which might affect your general health. Questions to ask health professionals As well as giving you information, health professionals must listen and do their best to answer questions. Before your next appointment, you can write some down. Questions may be about the treatment itself, for example: What are the main treatment options? What are the benefits of each of the options? What are the risks, if any, of each option? What are the risks if I decide to do nothing for the time being? How can I expect to feel after the procedure? When am I likely to be able to get back to work? 11
Healthcare professionals should welcome your views and discuss any issues so they can work in partnership with you for the best outcome. South Tyneside District Hospital Harton Lane South Shields Tyne & Wear NE34 0PL Tel: (0191) 404 1051 This leaflet gives a general description of a medical or diagnostic procedure. It may help you to understand it better. It does not necessarily describe your problem exactly or take the place of a consultation. All questions and concerns should be addressed directly to a Doctor, or health advisor. We are committed to raising the standard of written information for patients, their carers, people who use the NHS and the general public. This information can be made available in another format or language on request. For further copies of this leaflet please contact on telephone numbers above. Production date: October 2016 Author: GI Services Code: 1016/442 Review date: October 2019