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Suggest An Effective Alternative Diagnostic Test To Manometry

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Posted on Thu, 20 Oct 2016
Question: Hello,

I was wondering if there is any other test alternatives to a manometry. I tried doing that test for reflux surgery, and I just can't perform it. I wouldn't want to be half-sedated either! That would be horrible.
doctor
Answered by Dr. Dr.Arnab (27 hours later)
Brief Answer:
yes there are alternatives available..

Detailed Answer:
Hello XXXX, Welcome to HCM,
I've gone through your query and understand your concern,

Yes, since you can't undergo standard esophageal manometry and don't want to be half-sedated, there're alternatives available..

As a part of the pre-operative work-up for anti-reflux surgery, you can opt for a simple old-fashioned Barium Swallow (however it's end results are not so sensitive compared to conventional manometry) or an Endoscopically Assisted Water perfusion Esophageal Manometry (EAM), it's a relatively newer technique, but very effective when performed by an experienced gastroenterologist plus it has the added advantage of minimal sedation (just some local anaesthesia with minimal short acting I.V. sedatives during the procedure)..

So, EAM will be the worthy investigation for you in this regard, however since it's a newer technique, so not every gastroenterologist's perform it in routine basis, so all you need to do is to find out the appropriate clinic/ investigation center and the Gastroenterologist who's experienced in it..

Wish you the very best of health

Do let me know if there's any further queries, I'll be glad to clarify..


Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (16 hours later)
Thank you,

I have a couple of other questions for you since you answered so well!

I have been diagnosed with non-acid reflux, LPR (because of throat symptoms).

I have never felt acid reflux before, until recently, I went on the XXXXXXX XXXXXXX diet, and now, after not eating after 7pm, and staying on a strict, low-fat, low acid diet, now I actually feel the reflux between 4 and 5am.

Do you know why this may be?
I also have had orange, soft stools, for a lot of this time during this mysterious illness!

Thanks for all your help,
XXXXXXX
doctor
Answered by Dr. Dr.Arnab (3 hours later)
Brief Answer:
follow-up consultation..

Detailed Answer:
Hello XXXXXXX Welcome back,
Thanks for following up with these details,

Yes, LPR is a different entity and primarily managed by a team approach of a Gastro-enterologist as well as an ENT specialist and of course you (your effort and motivation towards the management process is extremely important for long term well being too)..

As per your description, initially it could've been LPR alone while afterwards there could've been an underlying element of GERD also (in this case, I'd strongly suggest you to continue the twice daily dose of PPI as your already following)..

Unlike acid reflux, LPR strictly requires 2-6 months of intensive PPI therapy (in some individual it can be even longer based on their symptoms) before observing significant improvement in long term, so please continue with the PPI therapy without any miss..

Well the XXXXXXX Kauffman diet is a well established plan, however there's a huge variety of menus (more than hundreds) so if you feel that 7 pm cut-off is not suiting you, just modify the timings by maintaining the 2-3 hrs interval between each meals and finish off the last meal by 8.30-9 pm, do follow this and observe how you stay (you should also note that the wide range of variable ingredients in the diet plan is there, as, not every ingredient is well tolerated by every individual, thus modifications necessary)..

Another important thing to consider regarding the early morning reflux is the lax lower esophageal sphincter which may be responsible for this, which is why it's time to consider getting done the manometry/ EAM to look in to this further..

Don't worry about the orange soft consistency of the stools (our stool reflects largely what we eat/drink), it's mainly due to high beta-carotene containing foods in the diet (eg. Any food with an artificial yellow or orange coloring eg. Apricots/ Carrots / Cilantro / Collard greens/ Fresh thyme/ Kale/ Sweet potatoes /Spinach/ Turnip greens / Winter squash and several others)..


Let me know how you stay in the due course..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (3 hours later)
If I decided to do the barium swallow instead, would it be able to tell this as well. I've had two endoscopy's already, and I'm trying hard to avoid anymore! What is the accuracy of the barium swallow compared to the manometry? I still worry from what I've read about the EAM that I would be half asleep thinking, I can't do anything with a tube going down. When I had my endoscopy I was in twilight and I remember nothing! This is what I would like!!

Thank you for all your help, XXXXXXX
doctor
Answered by Dr. Dr.Arnab (45 minutes later)
Brief Answer:
follow-up consultation..

Detailed Answer:
Hello XXXXXXX Welcome back,
Thanks for following up with these details,

No, barium swallow is an age old procedure and only give a gross idea about the level of obstruction/narrowing of esophageal tract (if any) and is indicated for just a few anatomical disorders, and reserved as a last resort when manometry is abandoned/failed..

Manometry is the gold standard in this regard, and when experience trouble, then EAM can be safely opted as an alternative (as I've already explained)..barium swallow is not even in the league of comparison..

Yes, I can understand the fear of tube passing through can be really bothersome, but I'm telling you from my personal clinical experience, the sedation in EAM won't be that much compared to conventional esophageal manometry (and a little bit of sedation is extremely necessary to carry out the procedure as it'll keep the gag reflex and body's stress responses minimal too)..

Nobody wants to remember fearful and troublesome experiences during such procedure thus a little bit of those momentary twilight episodes are extremely necessary (remember it's been created in modern aneasthesiology to allay the pain, fear and discomfort during the procedure which is actually necessary for a prompt diagnosis and of course smooth and better post-procedural outcome )..

I hope now your doubts are clear, please don't worry and simply go ahead with the procedure, discuss with the Gastroenterologist regarding the EAM and let him/her take it from there..have faith, it's just a momentary phase which you'll successfully pass without any doubt at all..

My best wishes..let me know how you stay in the due course..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
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Dr. Dr.Arnab

Critical Care Specialist

Practicing since :2012

Answered : 1479 Questions

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Suggest An Effective Alternative Diagnostic Test To Manometry

Brief Answer: yes there are alternatives available.. Detailed Answer: Hello XXXX, Welcome to HCM, I've gone through your query and understand your concern, Yes, since you can't undergo standard esophageal manometry and don't want to be half-sedated, there're alternatives available.. As a part of the pre-operative work-up for anti-reflux surgery, you can opt for a simple old-fashioned Barium Swallow (however it's end results are not so sensitive compared to conventional manometry) or an Endoscopically Assisted Water perfusion Esophageal Manometry (EAM), it's a relatively newer technique, but very effective when performed by an experienced gastroenterologist plus it has the added advantage of minimal sedation (just some local anaesthesia with minimal short acting I.V. sedatives during the procedure).. So, EAM will be the worthy investigation for you in this regard, however since it's a newer technique, so not every gastroenterologist's perform it in routine basis, so all you need to do is to find out the appropriate clinic/ investigation center and the Gastroenterologist who's experienced in it.. Wish you the very best of health Do let me know if there's any further queries, I'll be glad to clarify.. Take Care Kind Regards