Gastroenterology

Motility & Physiology Lab (619) 543-2347 http://health.ucsd.edu/specialties/gastro/

ESOPHAGEAL MANOMETRY IMPEDANCE & 24 HOUR PH RECORDING WHILE TAKING ACID REDUCTION (STOMACH) MEDICATIONS Patient Name:

Date:

Check-in Time:

Appointment Time:

If you arrive more than 15 minutes late to your appointment, you may have to reschedule. Check-in Information and Address of Test Site: UCSD Thornton Hospital in La Jolla: 9300 Campus Point Drive, La Jolla, CA 92037. Check in at the admissions/patient access reception desk on the 1st floor. There is no free parking. Please check-in 30 minutes prior to appointment. Cancellations: A 72 HOUR NOTICE IS REQUIRED. Call 619-543-2347 and leave a cancellation message. Please include your name, medical record number (MRN) and message. Emergency questions: After hours or weekends call (619) 543-6737 and ask for the G.I. fellow on-call for emergency questions. PREPARATION INSTRUCTIONS Keep taking acid reduction (stomach) medications. Three Days Before the Procedure: 1) Stop taking Reglan (Metoclopramide) Two Days Before the Procedure: 1) Stop taking Cardiac Calcium Channel Blockers including the following medications Procardia, Norvasc, Adalat, Cardizem, Vascor, Calan, Verapamil, Nifedipine, Diltiazem, Amlodipine. Please contact your prescribing doctor about not taking these medications. The Day of the Procedure: 1) Do not eat or drink 6 hours before the test. 2) Take your usual medications with a small sip of water. 3) Bring the completed esophageal questionnaire, medication reconciliation form, and this packet with you to the lab. 4) You will get numbing medication in a gel and/or spray form. 5) The test will take about 1 hour. For more information go to http://health.ucsd.edu/specialties/gastro/motility/procedures, or call 619543-2347. PH CATHETER REMOVAL INSTRUCTIONS 1) The day after the test, you will need get the pH catheter removed. 2) Please return to UCSD Thornton Hospital, ICU waiting room at the time appointed by the RN. PH802 (R 8/10)

3) Bring your completed diary.

24 Hour pH Diary – ON Patient Instructions  Bring this packet to your appointment for how to use the diary.  The purpose of pH monitoring is to measure the frequency and duration of gastroesophageal reflux during a normal day.  It is important that you eat, drink, work, and exercise as you normally would.  Without carrying out your normal day, the test results may not reflect an accurate picture of your esophageal pH exposure.  Personal hygiene and bathing should be limited to a "sponge bath" only. Showers and tub baths are not permitted during the study period. Water will severely damage the inner parts of the computer and the tube where it attaches, and all data entered to that point will be lost. The cost of replacement of the entire device is greater than $10,000. Using the Buttons Button

Activity All symptoms Sleep, rest & laying down Upright, sitting, standing, & walking Eating or drinking (Start) Not eating or drinking (Stop)

  

Record symptoms (Heartburn, Regurgitation, Chest Pain) by pressing the yellow symptom button on the receiver. Use the slide button on the receiver when sleeping, resting, or laying down and when upright, sitting, standing, or walking. Use the slide button on the receiver when eating or drinking and when not eating or drinking.

Using the Diary  Record events (i.e. meals, snacks, drinks, lying down and sleep) in the patient diary using the time on the Receiver’s display. (i.e. 12:30 – 12:55…Meal, 21:00 – 07:00…Sleep)  Record the name of your medication and the exact times when you take your medication  Remember to record the times from the receiver. For example: Start Time

End Time

13:05

13:45

13:45

13:46

14:18

Heartburn

Regurg.

Chest Pain

Meal

Sleep/Rest

Medications

Comments

X

Orange Juice, Chicken Sandwich on white bread with mayo, French fries and ketchup. Spironolactone 50 MG

X

X

15:16

15:20

21:39

7:07

X

Glass of water X

Page 3 of 5

24 Hour pH Diary – ON Day 1 ___ / ___ 20__ Start Time

End Time

Heartburn

Regurg.

Chest Pain

Cough

Belch

Hiccups

Page 4 of 5

Difficult Swallow

Meal

Sleep/Rest

Medications

Comments

24 Hour pH Diary – ON Day 2 ___ / ___ 20__ Start Time

End Time

Heartburn

Regurg.

Chest Pain

Cough

Belch

Hiccups

Page 5 of 5

Difficult Swallow

Meal

Sleep/Rest

Medications

Comments