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Restech Dx-pH 24 hour testing for LPR

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Posted 10/12/2012 12:24 AM (GMT 0)
Has anyone received a 24 hour pH study using the Restech Dx-pH system?

If so, what results did you receive, what was your RYAN score? And was it fairly easy to live with for a day?

If you previously had regular PH or Ph/Impedance testing, how did that result compare to the Dx-pH result?

www.restech-corp.com/Oropharyngeal-pH-Probe.aspx

This is a PH probe better designed to measure LPR and aerosolized reflux compared to standard PH catheters that are better for people with typical GERD symptoms like heartburn. The test is analyzed using different criteria, since the throat is affected differently than the esophagus by various pH levels, than the standard PH testing.

I am considering asking for the Dx-pH probe to be done to help solidy my diagnosis of LPR. In Northern California, there are very few doctors who have this particular system. I spoke to Restech and they said it was increasingly common on the east coast, but California and some other locations on the west coast are slower to adopt.

Thanks.
Posted 10/12/2012 3:11 AM (GMT 0)
Hi,
I'm getting mine done Monday , I will have to travel a bit as there are no docs in my area. I received the paperwork and I am scheduled to get a manometry test first and then the Restech will be placed along WITh the regular dual probe catheter. So two tubes going down the nose. I am a little freaked out and hope I can handle it. The nurse said this is how they do it, because I've never had the ph test previously. Has anyone had the two together? I am very nervous.
Posted 10/12/2012 3:15 AM (GMT 0)
Hi Georgi. What kind of symptoms are you having? Did your doctor recommend the dx ph or did you ask for it?

From looking at the dx ph, it looks pretty light compared to the regular catheter. It claims to not impact swallowing, which I found the regular ph catheter did to some extent. So hopefully you will not notice the dx ph much, but the regular catheter was somewhat annoying to me. I found if I turned my head when swallowing, it wasn't as noticeable.
Posted 10/13/2012 2:45 AM (GMT 0)
Hi
My doctor didn't recommend me for the Restech . I called on my own to set it up. Originally I thought I was just going to get the Restech test and any other tests with my doctor, but they sent back the paper with these other tests too. I hesitated, but figured I might as well get it over with. I'm sure I'll have to take them anyway at some point.
My symptoms can fluctuate, but basically they are chest pains, shortness of breath , sore throat, sinus and ear trouble., strangling tight throat, GLOBUS with pain. Sometimes trouble swallowing and food feeling like it gets stuck, or goes down slow. Did you have a manometry? Any hints on how to deal with that? I haven't been formally diagnosed with LPR that's why I wanted the Restech to prove or disprove acid in the airways.
Posted 10/13/2012 3:22 AM (GMT 0)
Yes I had manometry.. and my main symptom off PPI was very tight throat and excessive swallowing. It was a bad symptom to have during the manometry test when they want swallows at very specific times.

Do you feel you swallow excessively? If so, the tube in the throat during the testing will probably increase the feeling of the need to swallow, especially if you've been off PPIs for a week.

But the best way to deal with it is to focus on something else, anything to keep your mind off it. The nurse who did my manometry did not have a good technique.. between the time that I swallow and then I'm supposed to NOT swallow, she would say "Don't swallow. It's very important that you DON'T SWALLOW". All the while I'm trying to get my mind off swallowing. So I did have inadvertent swallows, which she scolded me for, saying that there were other people scheduled to come in and we had to get this test over with.

I explained to her that I'm not making a CHOICE to swallow, and I told her "Stop telling me NOT to swallow, I know I'm not supposed to swallow. Say it once and I'll do my best". That seemed to work and she stopped constantly yapping about swallowing.

It was very tough for me since that was my main symptom.. tightness and the body telling me that I needed to swallow for relief, and by that point I had been off PPIs for a week and off zantac for a few days. When I am on PPI, it relieves the tightness a good 90% but now I have other symptoms such as sour reflux in my throat.

Good luck. Thankfully the manometry is a short test so even if it's as bad as it was for me, it's over fairly quickly.

Post Edited (drtinsac) : 10/12/2012 9:26:43 PM (GMT-6)

Posted 10/14/2012 3:33 AM (GMT 0)
Thanks! Trying not to think too much about it. What about the 24 hour probe? Is it a constant annoyance? Painful?
Posted 10/16/2012 11:39 PM (GMT 0)
Dr

I paid a visit to an ENT who specializes in LPR. He has read Dr. Koufman's book and is a firm believer in her research. I've finally been 'unofficially' diagnosed with it. He mentioned the majority (95%) of his patients are "Acid LPR'ers". The other 5% of "non-Acid LPR'ers" are mostly singers. He even brought up the topic of pepsin. I mentioned the RDBiomed Peptest but he had not heard of it so I'm going to print out some info from their website and bring it to him tomorrow. We were talking surgery and even though the majority of his patients who follow the strict lifestyle/diet/med regimen do show dramatic improvement over time, the one's who don't are having a hard time obtaining Fundo approval through their insurance plans. He wasn't aware of the Linx but seemed very intrigued and was going to look into it tonight.

They're scheduling the Restech out three months but I lucked out. While I was in the office, they just happened to have a cancellation for tomorrow. My follow-up isn't until November 6th but I'll be sure to share my experience and grab a copy of my report.

Post Edited (rockhopper) : 10/16/2012 5:48:54 PM (GMT-6)

Posted 10/17/2012 2:55 AM (GMT 0)
Hi Rock! Sweet, nice how things work out like that sometimes. I'll be looking forward to the results.
Posted 10/17/2012 10:13 PM (GMT 0)
DR

Fitting for the Restech this morning was a breeze. Walked into the doctor's office and sat down in the chair. While he was calibrating the wireless monitor, he gave me the Restech daily diary to review. Basically the same as the 24hr esoph test. Day, time symptom(s) occurred, time ended and explanation. I was in and out of there within 30 minutes.

7 buttons on the monitor. I only need to be concerned with 4. "burp"; "heartburn (used for other symptoms such as throat clearing, etc); "meal"; "bed". The others are "escape" and up/down.

The monitor has a belt clip so it's easy to attach. Much better than the 24hr Ph "purse" I had to carry around. The wireless range is 15 feet but I was told to keep it in close proximity.

It shows realtime ph levels so I know if/when my ph drops. He said anything under 5.5 is considered an acid reflux event and any 10% drop from baseline is considered an event.

Post Edited (rockhopper) : 10/17/2012 4:16:17 PM (GMT-6)

Posted 10/18/2012 3:12 AM (GMT 0)
Hi All,
Just had my Restech yesterday along with the 24 hour probe and a manometry. I was having a "better day" and I didn't have many symptoms during the 24 hour period. And no shortness of breath. I hope it was able to detect something. I wasn't able to eat much because it was pretty uncomfortable. I will get my results in a week so I'll let you know. Also, Rockhopper, I couldn't see on mine any ph numbers. Any idea why not?
Posted 10/18/2012 1:57 PM (GMT 0)
georgi

Did you have one unit for both the 24hr and Restech? If so then maybe it's a different model? Maybe the until can be programmed to hide the data from the LCD display? Both my 24hr esophageal and Restech units displayed the current ph.
Posted 11/7/2012 1:10 AM (GMT 0)
Hey DR,

Received my Restech results today. I sure do have aerosolized reflux. This is night and day compared to my 24 hour pH test. My upright RYAN score was 18.85 with a normal value below 9.41. Supine RYAN was 12.85 with a normal value below 6.80.

To my surprise, the majority of my events are supine related. I thought I was strictly an upright refluxer. Median pH 6.2876 - Minimum pH 4.139 - Number of pH events 26 (21 supine)

Compare this to my 24 hour pH:

Acid reflux: 0 normal below 55
Weakly acidic reflux: 10 normal below 26
Nonacid reflux: 0 normal below 1
Upright: 0
Supine: 0
DeMeester: .2 Yup, there's a dot before the 2

For whatever reason, this test made me burp almost as often as the 24hr pH. I'm assuming I just kept swallowing air..? I'm not sure if this could have altered the results. I'm thinking the more air being swallowed the more burps being produced. More burps equals more aerosolized reflux? Of course I forgot to ask the doc at the follow up.

If and when the time comes to consider surgical options, I sure hope they don't base their decisions soley on my 24hr pH results or I'm screwed. Doc said some of his patient's Ryan scores are well into the 90's. If you want to see the test results with charts I can scan them tomorrow.

I highly recommend this test to anyone with LPR symptoms who do not score high on the 24hr pH study.
Posted 11/7/2012 4:55 AM (GMT 0)

rockhopper said...
Hey DR,

Received my Restech results today. I sure do have aerosolized reflux. This is night and day compared to my 24 hour pH test. My upright RYAN score was 18.85 with a normal value below 9.41. Supine RYAN was 12.85 with a normal value below 6.80.

To my surprise, the majority of my events are supine related. I thought I was strictly an upright refluxer. Median pH 6.2876 - Minimum pH 4.139 - Number of pH events 26 (21 supine)

Compare this to my 24 hour pH:

Acid reflux: 0 normal below 55
Weakly acidic reflux: 10 normal below 26
Nonacid reflux: 0 normal below 1
Upright: 0
Supine: 0
DeMeester: .2 Yup, there's a dot before the 2

For whatever reason, this test made me burp almost as often as the 24hr pH. I'm assuming I just kept swallowing air..? I'm not sure if this could have altered the results. I'm thinking the more air being swallowed the more burps being produced. More burps equals more aerosolized reflux? Of course I forgot to ask the doc at the follow up.

If and when the time comes to consider surgical options, I sure hope they don't base their decisions soley on my 24hr pH results or I'm screwed. Doc said some of his patient's Ryan scores are well into the 90's. If you want to see the test results with charts I can scan them tomorrow.

I highly recommend this test to anyone with LPR symptoms who do not score high on the 24hr pH study.

One thing to consider is that even though you have aerosol reflux, it might not be causing any throat issues.

Something can appear to be the cause, but it does not necessarily be the case.
Posted 11/7/2012 4:19 PM (GMT 0)
Thanks for posting that Rockhopper, that is great info and I'm glad it finally showed that you have a reflux problem.

Right now I have an ENT appt. coming up, and how that visit goes will determine what I do next. If I can convince the ENT to do a fundo, which seems very unlikely based on my past experience, then I'll just get that. But if not (most likely) then I'm going to try to see a doc with the Restech sometime in January after I've switched my health insurance to a PPO where I can go anywhere without a referral, regardless of what medical group the doctor is associated with.

So what is next for you in your treatment, now that you have the Restech #s?

Posted 11/8/2012 12:18 AM (GMT 0)
Hi All
Well went to see Dr. Peters today to go over my Restech and ph and manometry. Seems I don't have acid reflux from these findings...My restech Ryan score was a 8. demeester 2. He said my ph test showed I was even lower than normal acid. He said to me "you don't have acid reflux" Leaving the manometry which he said shows that my LES is tight. So, I'm not sure where to go from here? I still have the feeling of aerosol type vapors in my mouth and throat, constriction feeling in neck and throat , shortness of breath, occasional acid in throat, chest pains. He explains the shortness of breath coming from a signal that is sent to the brain and my lungs are not being affected? I don't know.. I also have soreness of my lungs at times which I forgot to tell him. He believes my condition and says its a newer thing they are finding with the tight LES bringing on these symptoms. He went on to describe the treatments that are used for Achalasia, botox, dilation, or cutting. He said to sit tight for a while and see if anything changes...Also, he did an endoscopy and I'm awaitng results on that.
I'm a bit frustrated. He said I don't have to take the Zantac anymore or antacids. I did tell him these help me at times..so I'm a little confused. I don't think I asked enough questions, but he was pretty certain in the way he told me I don't have Acid reflux. According to my tests no..but could I still?
Posted 11/8/2012 2:02 AM (GMT 0)
DR

So you don't think Linx will ever be an option for you or are you just tired of living with it?

Since I have slightly improved since this all hit me back in July, I'll have to go the same route as everyone else. Stick with the Koufman diet and Prilosec regimen of 40mg in the morning, 20mg evening and Pepcid before bed. Doc wants to see me in two months. If there's improvement we'll stick with this for up to the six month course. If I become worse, he'll probably up my dosage though I highly doubt an extra 20mg's of Prilosec will do any good. Besides, even if the Prilosec worked, I'd prefer surgery over long term PPI use.

Funny thing happened over the weekend. My birthday was last Friday and I was feeling a little frustrated with this condition so I broke down and ate quite a few "birthday" cupcakes. Even had a large meal for the first time in months. You'd think I'd be a hurting unit the next day but it ended up being one of my better days. Makes no sense sometimes.

The doc did mention trying Elavil at some point. Maybe after my two month follow up. We discussed the Linx and Fundo options and although he's definitely not against surgery, he did mention how it may not help PPI resistant LPR. Of course we've all heard this before. Since I've only been struggling for four months now and I don't seem (yet) to be getting progressively worse, surgery isn't in my very near future. I'm still going to remain positive and hope I'll improve over time. Going to try chiropractic and acupuncture as well.

georgi,

Since your scores are good, maybe you would be a candidate for a trial of Elavil? Check out the link below. DR gave it whirl but I believe it didn't work out for him.

https://www.healingwell.com/community/default.aspx?f=45&m=2184357
Posted 11/8/2012 3:06 PM (GMT 0)
Hi Rockhopper. The reason I'm thinking of going fundo (if I can get it), is because that is the operation used to relieve symptoms in the particular type of patient that I am according to journal articles. All the LINX research I've read so far is for people that have typical symptoms and a positive/high DeMeester score.

It would also be cheaper since insurance would cover it. But if my ENT doesn't agree on fundo, then I pursue other tests and at that point I'd be switched to a PPO and could go meet with any number of LINX surgeons to see if that is a viable option considering my symptoms and that group of patients like me who were relieved by fundo.
Posted 11/24/2012 7:47 PM (GMT 0)
Georgi,

You mind sharing a little info. On the insurance situation regarding the Restech test? Since it wasn't formally recommended by a doctor you were already seeing, did insurance still treat it as a covered test and pay their share? How about the pepsin test? If anyone else has anything to contribute, please also feel free. Thanks in advance. To an eventual LPR-free holiday.

-MGDawg
Posted 1/3/2013 8:15 PM (GMT 0)
I got my Restech test two weeks ago in Georgia. I'd agree with most of what Rockhopper said. The pH probe itself is fairly small and placing the unit did not take long, nor was it painful. While it is smaller than the "traditional probe", I'd still say it's quite a nuisance... at least for me personally. Word to the wise: don't try to eat anything thick/sticky while it's in. I tried to have some peanut butter as a snack (dumb I know), and the wire is so light it got pulled down my throat when I swallowed and took a painful second or two to get back to normal... other than that, fairly uneventful 24 hours.

The nurse who called me said I had "mild to moderate reflux". She couldn't answer any of my additional questions so I'm having the report faxed to me in its entirety.

Rockhopper, how are things going with you? Better I hope...? Any tips on what your next steps were?

I'll update my personal journal as soon as I get complete results from the Restech probe.

-MG
Posted 1/4/2013 1:17 AM (GMT 0)
MGDawg,

The Restech certainly wasn't a pleasant experience but I think it pales in comparison to the 24-HR dual channel pH/impedance test. I must have been swallowing tons of air because I couldn't stop burping. I'd be interested in reading your results.

My ENT follows the Koufman low acid protocol. Since I wasn't really seeing much improvement, he suggested I try to up my Prilosec dose to 40mg in the morning and 20mg in the evening, along with 20mg pepcid before bed. Increasing my Prilosec dose seemed to cause a rash and made me feel just awful. It was like having the flu without the fever.

Now I'm trying the "Fast Tract" diet by Dr. Norm Robillard. His theories do make sense and I've got nothing to lose at this point. I'm slowly weaning off of the Prilosec while starting this diet.

I'm about seven months into my LPR symptoms so I think I still have lots of things to try before considering surgery.
Posted 1/14/2013 8:46 PM (GMT 0)
Finally got a copy of my medical records.

However my demeester score is 2.4 my ryan score supine is 32 and upright 4.57.

This test showed that I had 144 events while supine.

Supine score 32.45
-Events 144
-Below baseline 46% of time. Assuming baseline is 5.5 ph
-Longest event 29mins

Upright score 4.57
- Event 1
-Lowest ph was 5.9
-longest event 16 secs.

Although my demeester score is well withing normal, it appears my ryan score while supine is positive.

I think it's important for anyone having problems with their throat to have this done compared to just getting a bravo capsule study done. I maybe normal to a GI doctor, but in reality the throat is much different then the esophagus. The study appears to have a different means of measurement with the ryan score compared to the demeester score. The demeester score I believe takes in account of the events below a ph of 4 while the ryan score is 5.5 up right and possibly 5.0 supine.
Posted 1/14/2013 9:21 PM (GMT 0)
I finally got my results via fax for the Restech test as well. I presented 5 pH events that ranged from 5.87-6.17 with 4 Supine episodes and 1 Upright event. RYAN score was a 2.12 in upright positioning (Normal <9.41) and 2.12 in supine positioning (Normal <6.80).

While nothing has really amazed me throughout this multi-month diagnostic process, I'm just about in shock at these results... especially given the commentary from others who have had normal traditional pH-probe results, but then the Restech was much higher. I honestly don't get it.

Does anyone know if they calibrate these things themselves? I was pretty skeptical of the presiding nurse who was reading over the booklet instructions in real-time as she put the probe in my throat and "calibrated" it in different color liquids (I'm guessing one was basic and one was acidic). I don't want to be too paranoid, but figured I'd at least ask since the forum often has great inside information on the tests themselves.

The impression was that I suffer from "Mild to Moderate reflux with most sever episodes during supine positioning". What was the wording of the diagnosis from those that had the higher scores, Rockhopper? Sixness?

Not really sure where to turn next - will keep everyone posted.

MGD
Posted 1/16/2013 2:01 AM (GMT 0)
My doctor wrote down that I had significant laryngeal pharyngeal reflux. He told me to start taking prilosec once a day. As for the calibration, I can't remember if they calibrated it in front of me or not.
Posted 1/18/2013 7:31 PM (GMT 0)
My device was calibrated by one of the staff ENT's though he didn't require an instruction manual. :)

Diagnosed with Moderate LPR. Recommended increasing Prilosec dosage and to continue the Koufman diet. Didn't work out so I'm weaning off the Prilosec and going low carb.
Posted 4/10/2013 2:32 PM (GMT 0)
I am post Linx for 12 weeks now and going to get testing done as I am still refluxing. I want to get proper LPR tests done, figuring out how high and far the reflux is reaching.

Is Restech the way to go?
If I don't get access to Restech, is Multi channel Impedance based testing good enough ?

Any recommendations/suggestions are appreciated.

Thanks,
GH
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