Center for Motility and Functional Gastrointestinal Disorders

This procedure is used to find out how well your child's esophagus is working by measuring the pressure and coordination of the esophageal muscles. The procedure also is done to find out if acid from the stomach is coming up into the esophagus.

Why is it necessary?
A pH Motility study is necessary to find the cause of your child's symptoms, such as difficulty swallowing, chest pain, or gastroesophageal reflux. How should I prepare my child?

Your child must have an empty stomach for the procedure. No solid food should be eaten for eight hours before the procedure. A member of the GI (gastroenterology) or endoscopy staff will tell you how long before the procedure your child must stop eating and drinking.

It is very important that your child not take any medicines that reduce the amount of acid made in the stomach for at least 48 hours before the test. These medicines are:

• Omeprazole (Prilosec®)
• Cimetidine (Tagamet®)
• Ranitidine (Zantac®)
• Axid®
• Prevacid®
• Pepcid®
• Nexium
• Protonix
• Reglan
• Antacids (such as Maalox®, Tums® or Gelusil®)

Your child will need to remain still during the procedure. If you feel your child may have difficulty cooperating with the test, please let us know. Some children may require medication to help them relax.

The tube may cause your child to feel some pressure and discomfort as it passes through the nose. Your child may cough, sneeze or gag as the tube is passed.

Be open and honest with your child about the procedure. Explain in simple terms why it is needed and what will happen. To help comfort your child, tell him or her that he or she may bring a favorite toy, blanket, music tape or CD and that you will stay with him or her during the test.

Please do not bring other children to the procedure. If you must bring other children, please bring another adult with you to care for them.

When you arrive at the Endoscopy Unit, you will meet with a nurse, who will explain the procedure and answer your questions. If your child needs medicine to make him or her relaxed, you will be asked to sign the consent form. You must be your childs legal guardian to sign the consent form.

What happens during the test?

• Your child will need to sit upright on the bed for the procedure.
• If your child is given medicine to make him/her relaxed for the procedure, he or she will wear a heart and oxygen monitor. Usually this medication is given by mouth, but occasionally it is given by IV (intravenously).
• Depending on your child's age, he or she may be given a numbing medicine inside his or her nose.
• A flexible tube will be inserted into the nose and passed into the esophagus. The tube is attached to a computer that measures the pressure and coordination of the esophageal muscles.
• During the procedure, your child will be given sips of water.
• The tube will slowly be repositioned in the esophagus. Your child will be asked to swallow sips of water and measurements will be taken at each level of the esophagus. This motility portion of the procedure usually takes about 30 minutes.
• Occasionally an x-ray in needed to verify the placement of the tube.
• The tube will then be taped in place for the pH portion of the study, which may last 18-24 hours. This portion of the study determines if acid is coming from the stomach into the esophagus. The end of the tube is attached to a small recording machine. This recorder has a belt that may be buckled around your childs waist or over a shoulder. Younger patients are usually admitted to the hospital after the tube is inserted. Occasionally, older children can go home with the tube in place.
• You will be asked to write down what your child is doing while the tube is in place, such as eating, sleeping, walking and coughing. Your child's physician or nurse will explain exactly what needs to be written down to help with the study. The doctor will use the diary to compare the computer reading with your childs activity.
• The tube will be removed the next day by a member of the GI staff. Removing the tube takes less than a minute and does not hurt. Some children cough or sneeze.

If your child did receive sedation, the nurse will move him or her to the Recovery Area. You will be directed to the Family Waiting Area. From there, a nurse will bring you to the Recovery Area to be with your child. We ask that you do not bring siblings or other young children into the Recovery Area. Children may wait with another adult in the Family Waiting Area.

In the Recovery Area, the nurse will stay with your child and carefully observe him or her during the entire recovery time. When your child is fully awake, he or she may have clear liquids to drink. Generally, children are able to go home or to the inpatient floor about one hour after the test is done. The recovery room nurse will review all instructions with you before you leave.

Patients who receive sedation and are going home must have a responsible adult with them when they leave the hospital. Since your child may still be sleepy or unsteady, please arrange to have private transportation to go home. Do not plan to take a bus or the MBTA. If a ride has not been arranged, the procedure may be canceled.

How will we be informed of the results?
Your child's doctor will speak with you as soon as the motility portion of the procedure is done. After the tube is removed, the information in the recorder is put into a computer. A Children's GI doctor will interpret the results and give them to your child's primary doctor. Call your child's primary doctor one week after the study for the results.

When to call your child's doctor or nurse
If you have any questions about the procedure, call the GI/Endoscopy Unit at 617-355-6172 between 7 a.m. and 4 p.m. Ask to speak to one of the nurses. For emergencies, you can call a GI doctor 24 hours a day. Call the hospital page operator at 617-355-6369 and ask for the GI fellow on call.