96-hour oesophageal pH monitoring with a wireless capsule
96-hour wireless oesophageal pH monitoring is a long-term examination that allows for an objective assessment of acid exposure in the oesophagus and determines whether the patient's symptoms are related to acid reflux.
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How to prepare
What does the patient gain?
Accurate and long-term acid reflux diagnostics
96-hour wireless oesophageal pH monitoring is a long-term examination that allows for an objective assessment of acid exposure in the oesophagus and determines whether the patient’s symptoms are related to acid reflux.
Unlike traditional 24-hour pH monitoring with a catheter inserted through the nose, this examination uses a small wireless pH capsule that is attached to the oesophageal mucosa during an upper endoscopy. The capsule continuously measures the pH in the oesophagus and wirelessly transmits the data to a small recording device worn by the patient.
Measurements can be taken for up to 96 hours or four days. A longer observation period allows for the evaluation of reflux fluctuations on different days and provides more extensive information than a single-day measurement.
What can be determined with 96-hour pH monitoring?
The examination helps to objectively determine:
- what portion of the day the oesophagus is exposed to acid (acid exposure time – AET)
- the frequency and duration of acid reflux episodes
- reflux changes during the day and night
- the correlation between reflux episodes and the patient’s symptoms
- whether objective findings correspond to gastro-oesophageal reflux disease (GORD)
- in specific clinical situations – the effectiveness of acid-suppression therapy
Wireless pH monitoring is particularly valuable in situations where the patient has symptoms characteristic of reflux, but gastroscopy shows no convincing signs of GORD or the diagnosis otherwise remains unclear.
How is the examination performed?
At the beginning of the examination, an upper endoscopy or gastroscopy is performed under sedation.
During the endoscopy, the doctor evaluates the oesophagus, stomach, and duodenum and determines the exact placement for the capsule. The small disposable pH capsule is attached to the oesophageal mucosa.
After the procedure, the patient receives a portable data recorder that captures the pH measurements transmitted by the capsule for the next 96 hours.
The patient is instructed on how to record significant events, such as meals, sleep/lying in a horizontal position, or any symptoms.
This is very important because, after the examination, the doctor can analyse not only the acid exposure but also its potential correlation with symptoms.
What happens during these four days?
After the procedure, the patient goes home and, following the restrictions set after sedation, tries to live as normal a daily life as possible. This is precisely what is essential for the quality of the examination.
When allowed to resume eating after the procedure, you should not specifically switch to a gentle diet or avoid all products that usually cause symptoms. The goal is to obtain information about reflux in the patient’s real daily conditions.
What happens to the capsule after the examination?
The capsule does not need to be removed after 96 hours.
It is temporarily attached to the oesophageal mucosa and spontaneously detaches after several days, moves through the digestive tract, and is excreted naturally with a bowel movement. Most patients do not notice the detachment or excretion of the capsule.
The patient returns the recording device to the clinic after the 96-hour measurement. The data is downloaded and analysed, and the gastroenterologist prepares the examination report.
How to prepare for 96-hour pH monitoring
7 days before the examination
If the examination is intended to be without acid-reducing therapy (OFF-PPI), the use of proton pump inhibitors must usually be stopped 7 days before the examination, for example:
omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole, etc.
Important: do not stop medications on your own if the doctor has given other instructions.
In certain situations, pH monitoring is intentionally performed during PPI therapy (ON-PPI), so the final decision on stopping therapy is made by the gastroenterologist according to the purpose of the examination.
3 days before the examination
If the examination is intended to be without acid-reducing therapy, H₂ receptor blockers, such as famotidine, are also usually stopped. Likewise, the use of antacids, alginates, and blood-thinning preparations is stopped.
The day before the examination
No special diet is required.
It is not necessary to preventatively stop probiotics, magnesium, or fibre just for the sake of pH monitoring, unless the doctor has given other individual instructions.
Since the capsule insertion is performed during gastroscopy under sedation, you must arrive for the procedure on an empty stomach; the use of blood-thinning medications must be stopped 3 days before the examination.
On the day of the examination
You must arrive for the procedure on an empty stomach – you must not eat or drink for at least 6 hours. Blood-thinning medications must not be used for 3 days before the examination!
After the capsule insertion, a magnetic resonance imaging (MRI) scan must not be performed!!!
The capsule contains metallic/magnetic components. The manufacturer’s safety information states that an MRI must not be performed for 30 days after the start of the wireless pH capsule examination.
Before the procedure, inform your doctor if you have:
oesophageal narrowing (stricture); oesophageal varices; severe oesophagitis; swallowing disorders; bleeding risk or use of medications affecting blood clotting; an implanted cardiac rhythm device; known sensitivity/allergy to metals.
For this specific wireless capsule system, the manufacturer mentions several contraindications and precautionary situations, including strictures, oesophageal varices, severe oesophagitis, a tendency to bleed, and certain implantable cardiac devices.
Is the examination unpleasant?
Most patients tolerate the capsule well. Some may experience the following in the first few days:
a foreign body sensation, discomfort when swallowing, mild pain, or a feeling of pressure behind the breastbone
In rare cases, more pronounced symptoms or failure of the capsule to detach may occur, and medical or endoscopic assistance may be required.
If severe or increasing pain in the chest or abdomen, repeated vomiting, swallowing disorders, bleeding, or other severe symptoms occur, contact the clinic or seek emergency medical help.
After the 96 hours of recording, the gastroenterologist analyses the pH recording and prepares a full report regarding oesophageal acid exposure and its correlation with the patient’s symptoms.
Four days allow for the observation of how reflux behaves in the patient’s real daily life. Prolonged wireless pH monitoring is particularly valuable because acid exposure can fluctuate significantly from day to day.
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We specialise specifically in the care of gastroenterology patients, combining our expertise in the stomach, liver, pancreas, intestines, and the microbiome.
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We have gastroenterologists, hepatologists, endocrinologists, psychologists, nutritionists, neurologists, and other specialists who work together to provide a holistic approach to health.
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We will develop a personalised treatment plan that includes both medication and dietary and lifestyle changes.
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You will receive accurate diagnosis and treatment based on the latest international guidelines and research, using state-of-the-art technology.
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The clinic offers a comfortable, peaceful, and welcoming environment that helps ease any anxiety you may feel before your examination. The thoughtfully designed interior, the professional attitude of our staff, and our compassionate communication will help you feel safe and supported.
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