Wireless capsules for esophageal pH monitoring: are we placing them correctly?

BACKGROUND: Recommended Bravo capsule placement is 6 cm proximal to the squamocolumnar junction. This is because the junction resides 1 cm distal to the lower esophageal sphincter. AIM: To determine the positional accuracy of capsule placement compared with the ideal location in symptomatic patients. METHODS: Retrospective analysis of consecutive symptomatic outpatients undergoing both capsule placement and esophageal manometry on the same day. Error in capsule placement (ECP) was calculated as the actual capsule position (ACP) minus the ideal capsule position (ICP) based on manometry results. An error in positioning < or =3 cm was deemed an accurate placement. RESULTS: Accurate placement of the capsule occurred in 91/147 (62%) patients. In patients with inaccurate placement, 92.9% were placed >3 cm proximal to the ICP. Only longer esophageal length correlated with the severity of proximal misplacement. There was no relationship between severity of ECP and whether the study demonstrated acid reflux. CONCLUSIONS: Our results suggest that endoscopic misplacement of Bravo capsules is common. Capsule misplacement proximally occurred far more frequently than distal misplacement. Capsule misplacement was not associated with pH study results.

Egg labeling methods for gastric emptying scintigraphy are not equivalent in producing a stable solid meal.

UNLABELLED: A wide range of radiolabeled test meals have been used for gastric emptying scintigraphy. The purpose of this study was to test whether (99m)Tc-sulfur colloid-labeled liquid egg white is as stable as 2 fresh whole eggs labeled with (99m)Tc-sulfur colloid and whether the cooking method is important. METHODS: Whole eggs and liquid egg white were mixed with (99m)Tc-sulfur colloid and cooked by either microwaving or frying on a griddle. The cooked eggs were tested for breakdown after 2 and 4 h of incubation in gastric fluid or HCl. RESULTS: Labeled liquid egg white, prepared by either method of cooking, exhibited less breakdown in gastric fluid than whole eggs. Whole eggs cooked in the microwave exhibited significantly more breakdown than liquid egg white. CONCLUSION: (99m)Tc-Sulfur colloid binds better to egg whites compared with whole eggs. These results emphasize the need to evaluate the stability of new radiolabeled test meal preparations, including the method of cooking.

Regional postprandial differences in pH within the stomach and gastroesophageal junction.

Our objective was to determine regional differences in intragastric pH after different types of meals. Ten normal subjects underwent 27-hr esophagogastric pH monitoring using a four-probe pH catheter. Meals were a spicy lunch, a high-fat dinner, and a typical bland breakfast. The fatty dinner had the highest postprandial buffering effect, elevating proximal and mid/distal gastric pH to 4.9 +/- 0.4 and 4.0 +/- 0.4, respectively, significantly (P < 0.05) higher compared to 4.2 +/- 0.3 and 3.0 +/- 0.4 for the spicy lunch and 3.0 +/- 0.3 and 2.5 +/- 0.8 for the breakfast. The buffering effect of the high-volume fatty meal to pH > 4 was also longer (150 min) compared to that of the spicy lunch (45 min) and the bland breakfast, which did not increase gastric pH to > 4 at any time. Proximal gastric acid pockets were seen between 15 and 90 min postprandially. These were located 3.4 +/- 0.8 cm below the proximal LES border, extending for a length of 2.3 +/- 0.8 cm, with a drop in mean pH from 4.7 +/- 0.4 to 1.5 +/- 0.9. Acid pockets were seen equally after the spicy lunch and fatty dinner but less frequently after the bland breakfast. We conclude that a high-volume fatty meal has the highest buffering effect on gastric pH compared to a spicy lunch or a bland breakfast. Buffering effects of meals are significantly higher in the proximal than in the mid/distal stomach. Despite the intragastric buffering effect of meals, focal areas of acidity were observed in the region of the cardia-gastroesophageal junction during the postprandial period.