DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Rule out gastroesophageal reflux disease.
POSTOPERATIVE DIAGNOSIS: Normal study on Prevacid.
PROCEDURE PERFORMED: Ambulatory 24 hour pH study.
PROCEDURE AND FINDINGS: The patient was brought in to the ambulatory endoscopy center and had the pH catheter passed transnasally into the esophagus. It was then attached to the ambulatory computer and the patient was discharged and returned the following day. The catheter was withdrawn. The patient tolerated the procedure uneventfully. Reading the patient’s printout, the distal channel, composite score was 15.6, normal is less than 22. The patient had a total of 136 episodes of reflux, normal should be less than 50. Total time refluxing was 3.2% which is within range. The longest episode was 2.3 minutes, which is within range. In the proximal channel, the patient had a composite score of 5.5, within normal range, with 48 episodes of reflux, normal should be less than 50. Total time refluxing in the proximal channel was 0.8%.
IMPRESSION: Essentially normal study with the proviso that there is an increased number of reflux episodes in the distal channel, but the patient’s DeMeester score remains normal.
DATE OF PROCEDURE: MM/DD/YYYY
PROCEDURE PERFORMED: A 48-hour Bravo pH study.
PROCEDURE FINDINGS: Normal DeMeester scores are less than 14.6. On day 1, he had a DeMeester score of 37.4, and on day 2, he did a little bit better with 26.2, but the patient’s total DeMeester score was still abnormal at 33. This reflects significant reflux. Although the patient’s main indicator for the pH study was cough, he really did not complain of any cough during the course of the procedure. The patient had episodes of chest pain which may have been secondary to the Bravo. He had episodes of regurgitation and episodes of heartburn. The regurgitation symptoms sometimes correlated with acid and sometimes did not, raising the question of possibly alkaline reflux; although, there is certainly no way that this can be measured. Indeed, most of the episodes of regurgitation did not appear to be associated with a pH of less than 4.
The patient did have significant heartburn and even chest pain, and the chest pain did seem to correlate with pH of less than 4. There were 4 discrete episodes at about 6:00, the probe was positioned, and these episodes did appear to correlate with a pH down to about 2. No other chest pain was recorded during the course of the procedure. The heartburn symptomatology on occasion was associated with a pH of greater than 4, but would estimate that probably at least two-thirds of the time, the heartburn symptoms did appear to be correlating with a pH of less than 4. As mentioned, no cough was recorded.
During the course of the night, there was no significant acid reflux, even though the patient did have some symptoms. Indeed, the patient complained of heartburn on the second night at about 7:00 to 8:00 in the morning, and on that occasion, the pH was 5. This would suggest that his heartburn symptomatology may not be completely on the basis of acid, but he clearly does have significant acid and does have regurgitation-type symptoms, both when acid is present and when it is not.
IMPRESSION: Significant acid reflux with DeMeester scores being higher than normal. Correlation of heartburn and some chest pain symptomatology with acid reflux.