General

Synonym/Acronym:
Esophageal function study, esophageal acid study (Tuttle test), acid reflux test, Bernstein test (acid perfusion), esophageal motility study.

Rationale
To evaluate potential ineffectiveness of the esophageal muscle and structure in swallowing, vomiting, and regurgitation in diseases such as scleroderma, infection, and gastric esophageal reflux. Additional testing commonly performed in conjunction with esophageal manometry has reduced the frequency of requests for more invasive and time-consuming studies involving aspiration of gastric contents. (NOTE: Despite decreased use, gastric analysis and gastric acid stimulation remain the gold standard for measurement of gastric acid secretion.)

Patient Preparation
There are no activity restrictions unless by medical direction. Under medical direction, the patient should withhold medications for 24 hr before the study. Instruct the patient to fast and restrict fluids for 6 hr prior to the procedure to reduce the risk of aspiration related to nausea and vomiting. Patient may be required to be NPO after midnight. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.

Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Protocols may vary among facilities.

Normal Findings

• Acid reflux (EM study): No regurgitation (reflux) into the esophagus
• Esophageal sphincter pressure (EM study): 10 to 20 mm Hg
• Esophageal secretions: pH 5 to 6
• Acid perfusion (Bernstein test): Negative (no discomfort or pain following instillation of hydrochloric acid)
• Acid clearing (Tuttle test): Fewer than 10 swallows

Critical Findings and Potential Interventions
N/A