Impedance question for Howard
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From: Peter on 15 Apr 2008 19:54 Howard, In your last post to me you said you would see me if I wanted to travel to Minnesota, and if I visited you, that you could "arrange an EGD one day and impedance manometry pH testing the next". I am curious about how the impedance test is combined with the ph testing or is it one and the same (ie how do you do them together in one day). I have had the 24 hour ph nose hose three years ago, immediately after they did a manometry first, the manometry being a short procedure using a bigger nose hose. So I know about those, and I know about the bravo 48 hour test as we have discussed in the past, and I asked you if we could bypass the bravo after the EGD and go right to the impedance test so I could determine if I had acid or basic reflux (ie, I thought there would be no separate pH test, and the impedance test inherently checked for both acid and basic reflux by itself). Here is a site that briefly describes esophageal impedance testing, if you could please take a quick look at it - http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698 . Here is a paragraph quoted from the site, that talks about combining the impedance test with manometry and combining the impedance test with pH (ie, MII-EM and MII-pH) - it is in the last half of the paragraph. "Measuring impedance at multiple sites (multichannel) allows for determination of direction of bolus movement based upon temporal differences in bolus entry and exit (ie, bolus entries progressing from proximal to distal indicate antegrade bolus movement while bolus entries progressing from distal to proximal indicate retrograde bolus movement) (show figure 1). Combined with manometry (multichannel intraluminal impedance and manometry; MII-EM) it provides information about both pressures and bolus transit within the esophagus. Combined with pH (multichannel intraluminal impedance and pH; MII-pH) it permits detection of both acid and non-acid gastroesophageal reflux". I don't understand exactly what they mean by "combined with". I thought the manometry was a separate test by itself and I thought the ph test (whether the 24 hour nose hose or the 48 hour bravo) was a separate test in itself, and the impedance test was a separate test (which is also a 24 hour nose hose like you have said, I believe). So could you please shed some light on this and what does impedance "combined with" manometry and pH exactly mean. And what did you mean when you said you could do the "EGD one day and impedance manometry pH testing the next". I thought that would mean on the second day I might get a manometry first, followed immediately by the impedance nose hose, but I am not sure how the pH ties in because they talk about combining the impedance with pH in the paragraph I quoted, and I would think that would be two separate tests (just like the manometry would be a separate test), and you could not do them in one day unless the pH is part of the impedance test. I hope you see what I am getting at - it is a little confusing to me. Please explain this to me if you would be so kind. It is important to me. Thanks...Pete
From: H McCollister on 15 Apr 2008 22:05 In article <fu3f7i01rl4(a)enews2.newsguy.com>, "Peter" <peter(a)nospam.net> wrote: > Howard, > > In your last post to me you said you would see me if I wanted to travel to > Minnesota, and if I visited you, that you could "arrange an EGD one day and > impedance manometry pH testing the next". I am curious about how the > impedance test is combined with the ph testing or is it one and the same (ie > how do you do them together in one day). I have had the 24 hour ph nose > hose three years ago, immediately after they did a manometry first, the > manometry being a short procedure using a bigger nose hose. So I know about > those, and I know about the bravo 48 hour test as we have discussed in the > past, and I asked you if we could bypass the bravo after the EGD and go > right to the impedance test so I could determine if I had acid or basic > reflux (ie, I thought there would be no separate pH test, and the impedance > test inherently checked for both acid and basic reflux by itself). > > Here is a site that briefly describes esophageal impedance testing, if you > could please take a quick look at it - > http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698 . > > Here is a paragraph quoted from the site, that talks about combining the > impedance test with manometry and combining the impedance test with pH (ie, > MII-EM and MII-pH) - it is in the last half of the paragraph. > > "Measuring impedance at multiple sites (multichannel) allows for > determination of direction of bolus movement based upon temporal differences > in bolus entry and exit (ie, bolus entries progressing from proximal to > distal indicate antegrade bolus movement while bolus entries progressing > from distal to proximal indicate retrograde bolus movement) (show figure 1). > Combined with manometry (multichannel intraluminal impedance and manometry; > MII-EM) it provides information about both pressures and bolus transit > within the esophagus. Combined with pH (multichannel intraluminal impedance > and pH; MII-pH) it permits detection of both acid and non-acid > gastroesophageal reflux". > > I don't understand exactly what they mean by "combined with". I thought the > manometry was a separate test by itself and I thought the ph test (whether > the 24 hour nose hose or the 48 hour bravo) was a separate test in itself, > and the impedance test was a separate test (which is also a 24 hour nose > hose like you have said, I believe). > > So could you please shed some light on this and what does impedance > "combined with" manometry and pH exactly mean. And what did you mean when > you said you could do the "EGD one day and impedance manometry pH testing > the next". I thought that would mean on the second day I might get a > manometry first, followed immediately by the impedance nose hose, but I am > not sure how the pH ties in because they talk about combining the impedance > with pH in the paragraph I quoted, and I would think that would be two > separate tests (just like the manometry would be a separate test), and you > could not do them in one day unless the pH is part of the impedance test. I > hope you see what I am getting at - it is a little confusing to me. > > Please explain this to me if you would be so kind. It is important to me. > Thanks...Pete > > EGD one day. Next day, impedance manometry with the manometry catheter. Takes about 20 minutes. Manometry catheter removed, replaced with the much smaller impedance pH catheter which is down for 24 hours. HMc
From: Peter on 16 Apr 2008 15:49 H McCollister wrote: > In article <fu3f7i01rl4(a)enews2.newsguy.com>, "Peter" > <peter(a)nospam.net> wrote: > >> Howard, >> >> In your last post to me you said you would see me if I wanted to >> travel to Minnesota, and if I visited you, that you could "arrange >> an EGD one day and impedance manometry pH testing the next". I am >> curious about how the impedance test is combined with the ph testing >> or is it one and the same (ie how do you do them together in one >> day). I have had the 24 hour ph nose hose three years ago, >> immediately after they did a manometry first, the manometry being a >> short procedure using a bigger nose hose. So I know about those, >> and I know about the bravo 48 hour test as we have discussed in the >> past, and I asked you if we could bypass the bravo after the EGD and >> go right to the impedance test so I could determine if I had acid or >> basic reflux (ie, I thought there would be no separate pH test, and >> the impedance test inherently checked for both acid and basic reflux >> by itself). >> >> Here is a site that briefly describes esophageal impedance testing, >> if you could please take a quick look at it - >> http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698 >> . >> >> Here is a paragraph quoted from the site, that talks about combining >> the impedance test with manometry and combining the impedance test >> with pH (ie, MII-EM and MII-pH) - it is in the last half of the >> paragraph. >> >> "Measuring impedance at multiple sites (multichannel) allows for >> determination of direction of bolus movement based upon temporal >> differences in bolus entry and exit (ie, bolus entries progressing >> from proximal to distal indicate antegrade bolus movement while >> bolus entries progressing from distal to proximal indicate >> retrograde bolus movement) (show figure 1). Combined with manometry >> (multichannel intraluminal impedance and manometry; MII-EM) it >> provides information about both pressures and bolus transit within >> the esophagus. Combined with pH (multichannel intraluminal impedance >> and pH; MII-pH) it permits detection of both acid and non-acid >> gastroesophageal reflux". >> >> I don't understand exactly what they mean by "combined with". I >> thought the manometry was a separate test by itself and I thought >> the ph test (whether the 24 hour nose hose or the 48 hour bravo) was >> a separate test in itself, and the impedance test was a separate >> test (which is also a 24 hour nose hose like you have said, I >> believe). >> >> So could you please shed some light on this and what does impedance >> "combined with" manometry and pH exactly mean. And what did you >> mean when you said you could do the "EGD one day and impedance >> manometry pH testing the next". I thought that would mean on the >> second day I might get a manometry first, followed immediately by >> the impedance nose hose, but I am not sure how the pH ties in >> because they talk about combining the impedance with pH in the >> paragraph I quoted, and I would think that would be two separate >> tests (just like the manometry would be a separate test), and you >> could not do them in one day unless the pH is part of the impedance >> test. I hope you see what I am getting at - it is a little >> confusing to me. >> >> Please explain this to me if you would be so kind. It is important >> to me. Thanks...Pete >> >> > > > EGD one day. Next day, impedance manometry with the manometry > catheter. Takes about 20 minutes. Manometry catheter removed, > replaced with the much smaller impedance pH catheter which is down > for 24 hours. > > HMc Thanks Howard...That was very straightforward and to the point. So the impedance pH catheter inherently does the pH also - but I think the site I posted was a bit confusing about the "combining stuff" if you read it. What is different about the "impedance manometry" versus the "plain manometry". Why would you (or any facility that had impedance capability) even bother doing a bravo test (or the old 24 pH test which I think you stopped doing), if the impedance pH catheter is better and is all inclusive (ie it tests for both acid and bile reflux). I would think if a facility has the capability for impedance testing, they should just do that first, and not even mess with the bravo. Do you agree. Thanks...Pete
From: H McCollister on 16 Apr 2008 16:43 In article <fu5l8k020jl(a)enews2.newsguy.com>, "Peter" <peter(a)nospam.net> wrote: > H McCollister wrote: > > In article <fu3f7i01rl4(a)enews2.newsguy.com>, "Peter" > > <peter(a)nospam.net> wrote: > > > >> Howard, > >> > >> In your last post to me you said you would see me if I wanted to > >> travel to Minnesota, and if I visited you, that you could "arrange > >> an EGD one day and impedance manometry pH testing the next". I am > >> curious about how the impedance test is combined with the ph testing > >> or is it one and the same (ie how do you do them together in one > >> day). I have had the 24 hour ph nose hose three years ago, > >> immediately after they did a manometry first, the manometry being a > >> short procedure using a bigger nose hose. So I know about those, > >> and I know about the bravo 48 hour test as we have discussed in the > >> past, and I asked you if we could bypass the bravo after the EGD and > >> go right to the impedance test so I could determine if I had acid or > >> basic reflux (ie, I thought there would be no separate pH test, and > >> the impedance test inherently checked for both acid and basic reflux > >> by itself). > >> > >> Here is a site that briefly describes esophageal impedance testing, > >> if you could please take a quick look at it - > >> http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698 > >> . > >> > >> Here is a paragraph quoted from the site, that talks about combining > >> the impedance test with manometry and combining the impedance test > >> with pH (ie, MII-EM and MII-pH) - it is in the last half of the > >> paragraph. > >> > >> "Measuring impedance at multiple sites (multichannel) allows for > >> determination of direction of bolus movement based upon temporal > >> differences in bolus entry and exit (ie, bolus entries progressing > >> from proximal to distal indicate antegrade bolus movement while > >> bolus entries progressing from distal to proximal indicate > >> retrograde bolus movement) (show figure 1). Combined with manometry > >> (multichannel intraluminal impedance and manometry; MII-EM) it > >> provides information about both pressures and bolus transit within > >> the esophagus. Combined with pH (multichannel intraluminal impedance > >> and pH; MII-pH) it permits detection of both acid and non-acid > >> gastroesophageal reflux". > >> > >> I don't understand exactly what they mean by "combined with". I > >> thought the manometry was a separate test by itself and I thought > >> the ph test (whether the 24 hour nose hose or the 48 hour bravo) was > >> a separate test in itself, and the impedance test was a separate > >> test (which is also a 24 hour nose hose like you have said, I > >> believe). > >> > >> So could you please shed some light on this and what does impedance > >> "combined with" manometry and pH exactly mean. And what did you > >> mean when you said you could do the "EGD one day and impedance > >> manometry pH testing the next". I thought that would mean on the > >> second day I might get a manometry first, followed immediately by > >> the impedance nose hose, but I am not sure how the pH ties in > >> because they talk about combining the impedance with pH in the > >> paragraph I quoted, and I would think that would be two separate > >> tests (just like the manometry would be a separate test), and you > >> could not do them in one day unless the pH is part of the impedance > >> test. I hope you see what I am getting at - it is a little > >> confusing to me. > >> > >> Please explain this to me if you would be so kind. It is important > >> to me. Thanks...Pete > >> > >> > > > > > > EGD one day. Next day, impedance manometry with the manometry > > catheter. Takes about 20 minutes. Manometry catheter removed, > > replaced with the much smaller impedance pH catheter which is down > > for 24 hours. > > > > HMc > > Thanks Howard...That was very straightforward and to the point. So the > impedance pH catheter inherently does the pH also - but I think the site I > posted was a bit confusing about the "combining stuff" if you read it. What > is different about the "impedance manometry" versus the "plain manometry". > > Why would you (or any facility that had impedance capability) even bother > doing a bravo test (or the old 24 pH test which I think you stopped doing), > if the impedance pH catheter is better and is all inclusive (ie it tests for > both acid and bile reflux). I would think if a facility has the capability > for impedance testing, they should just do that first, and not even mess > with the bravo. Do you agree. > > Thanks...Pete Bravo is fine for acid reflux - people who respond to PPI's. It's accurate because it's 48 hours, and it's more comfortable because it doesn't involve a transnasal catheter. Impedance pH testing is helpful in determining what's going up or down the esophagus. The impedance manometry catheter measure pressure conventionally, and its ability to measure impedance gives information about bolus transit. HMc
From: Peter on 16 Apr 2008 22:10
H McCollister wrote: > In article <fu5l8k020jl(a)enews2.newsguy.com>, "Peter" > <peter(a)nospam.net> wrote: > >> H McCollister wrote: >>> In article <fu3f7i01rl4(a)enews2.newsguy.com>, "Peter" >>> <peter(a)nospam.net> wrote: >>> >>>> Howard, >>>> >>>> In your last post to me you said you would see me if I wanted to >>>> travel to Minnesota, and if I visited you, that you could "arrange >>>> an EGD one day and impedance manometry pH testing the next". I am >>>> curious about how the impedance test is combined with the ph >>>> testing or is it one and the same (ie how do you do them together >>>> in one day). I have had the 24 hour ph nose hose three years ago, >>>> immediately after they did a manometry first, the manometry being a >>>> short procedure using a bigger nose hose. So I know about those, >>>> and I know about the bravo 48 hour test as we have discussed in the >>>> past, and I asked you if we could bypass the bravo after the EGD >>>> and go right to the impedance test so I could determine if I had >>>> acid or basic reflux (ie, I thought there would be no separate pH >>>> test, and the impedance test inherently checked for both acid and >>>> basic reflux by itself). >>>> >>>> Here is a site that briefly describes esophageal impedance testing, >>>> if you could please take a quick look at it - >>>> http://www.uptodate.com/patients/content/topic.do?topicKey=eso_dis/13698 >>>> . >>>> >>>> Here is a paragraph quoted from the site, that talks about >>>> combining the impedance test with manometry and combining the >>>> impedance test with pH (ie, MII-EM and MII-pH) - it is in the >>>> last half of the paragraph. >>>> >>>> "Measuring impedance at multiple sites (multichannel) allows for >>>> determination of direction of bolus movement based upon temporal >>>> differences in bolus entry and exit (ie, bolus entries progressing >>>> from proximal to distal indicate antegrade bolus movement while >>>> bolus entries progressing from distal to proximal indicate >>>> retrograde bolus movement) (show figure 1). Combined with manometry >>>> (multichannel intraluminal impedance and manometry; MII-EM) it >>>> provides information about both pressures and bolus transit within >>>> the esophagus. Combined with pH (multichannel intraluminal >>>> impedance and pH; MII-pH) it permits detection of both acid and >>>> non-acid gastroesophageal reflux". >>>> >>>> I don't understand exactly what they mean by "combined with". I >>>> thought the manometry was a separate test by itself and I thought >>>> the ph test (whether the 24 hour nose hose or the 48 hour bravo) >>>> was a separate test in itself, and the impedance test was a >>>> separate test (which is also a 24 hour nose hose like you have >>>> said, I believe). >>>> >>>> So could you please shed some light on this and what does impedance >>>> "combined with" manometry and pH exactly mean. And what did you >>>> mean when you said you could do the "EGD one day and impedance >>>> manometry pH testing the next". I thought that would mean on the >>>> second day I might get a manometry first, followed immediately by >>>> the impedance nose hose, but I am not sure how the pH ties in >>>> because they talk about combining the impedance with pH in the >>>> paragraph I quoted, and I would think that would be two separate >>>> tests (just like the manometry would be a separate test), and you >>>> could not do them in one day unless the pH is part of the impedance >>>> test. I hope you see what I am getting at - it is a little >>>> confusing to me. >>>> >>>> Please explain this to me if you would be so kind. It is important >>>> to me. Thanks...Pete >>>> >>>> >>> >>> >>> EGD one day. Next day, impedance manometry with the manometry >>> catheter. Takes about 20 minutes. Manometry catheter removed, >>> replaced with the much smaller impedance pH catheter which is down >>> for 24 hours. >>> >>> HMc >> >> Thanks Howard...That was very straightforward and to the point. So >> the impedance pH catheter inherently does the pH also - but I think >> the site I posted was a bit confusing about the "combining stuff" if >> you read it. What is different about the "impedance manometry" >> versus the "plain manometry". >> >> Why would you (or any facility that had impedance capability) even >> bother doing a bravo test (or the old 24 pH test which I think you >> stopped doing), if the impedance pH catheter is better and is all >> inclusive (ie it tests for both acid and bile reflux). I would >> think if a facility has the capability for impedance testing, they >> should just do that first, and not even mess with the bravo. Do you >> agree. >> >> Thanks...Pete > > Bravo is fine for acid reflux - people who respond to PPI's. It's > accurate because it's 48 hours, and it's more comfortable because it > doesn't involve a transnasal catheter. Impedance pH testing is helpful > in determining what's going up or down the esophagus. > > The impedance manometry catheter measure pressure conventionally, and > its ability to measure impedance gives information about bolus > transit. > > HMc Thanks again Howard...I understand that Bravo only checks for acid reflux, but if impedance testing checks for both acid AND bile reflux, than why bother ever doing the bravo, and just always go right to the impedance testing, if the facility has the impedance testing capability....Pete |