The Esophageal Disease and Motility Center is located at North Shore University Hospital, 300 Community Drive, Levitt Building, 4th Floor, Manhasset, NY 11030. You can reach us by telephone at (516) 562-4281 or fax at (516) 562-2683.

The Center offers several high-quality diagnostic tests to accurately evaluate the symptoms of patients with acid reflux or motility disorder. We are a fully modern facility, performing reliable, individualized tests for a large number of patients. Diagnostic services provided include:

Twenty-four- or 48-hour esophageal pH monitoring Esophageal manometry Anorectal manometry

Twenty-four- or 48-hour ambulatory pH monitoring is considered the “gold standard” for diagnosing gastroesophageal reflux. More recently, a catheter-free, temporarily-implanted device (Bravo pH monitoring system, Medtronic) has been approved by the U.S. Food and Drug Administration (FDA) for the purposes of esophageal monitoring. Using endoscopic or manometric guidance, the capsule is temporarily implanted in the esophageal mucosa using a pin. The capsule records pH levels for up to forty-eight hours and transmits them via radio frequency telemetry to a receiver worn in the patient’s belt. Data from the recorder are uploaded to a computer for analysis by a nurse or technician.

Twenty-four- or 48-hour esophageal pH monitoring may be considered medically necessary for one of the following clinical indications in adults:

1. Evaluation of refractory reflux in patients with chest pain after cardiac evaluation and after a one month trial of proton pump inhibitor therapy
2. Evaluation of suspected otolaryngologic manifestations of GERD (i.e., laryngitis, pharyngitis, chronic cough) that have failed to respond to at least four weeks of proton pump inhibitor therapy
3. Evaluation of concomitant GERD in an adult-onset, non-allergic asthmatic suspected of having reflux-induced asthma
4. Documentation of abnormal acid exposure in endoscopy-negative patients being considered for surgical anti-reflux repair
5. Evaluation of patients after anti-reflux surgery who are suspected to have ongoing abnormal reflux
6. Evaluation of patients with either normal or equivocal endoscopic findings and reflux symptoms that are refractory to proton pump inhibitor therapy

Esophageal manometry measures the muscular contractions in the esophagus, including the swallowing mechanism and the lower esophageal sphincter. It is the test-of-choice for diagnosing motility disorders that cause difficulty swallowing. This test takes approximately 30 to 60 minutes to perform. A thin catheter (tube) is placed through the nose and positioned in the esophagus. Pressure measurements of the Lower Esophageal Sphincter (LES), the body of the esophagus and the upper esophageal sphincter are then recorded and processed by a computer. Esophageal Manometry may be considered medically necessary in one of the following clinical indications:

1. To diagnose dysmotility in dysphagia without mechanical obstruction
2. To guide the placement of intraluminal devices such as pH probes
3. For the preoperative assessment of patients being considered for anti-reflux surgery if there is any question of an alternative diagnosis, especially achalasia
4. For the preoperative assessment of peristaltic function in patients for anti-reflux surgery
5. For patients with dysphagia post anti-reflux surgery
6. For patients with dysphagia post treatment of achalasia

Anorectal Manometry
Anorectal disorders occur fairly regularly in the U.S. Currently 3% of the U.S. population suffer from constipation, and according to Nelson, et al., 2.2% suffer from fecal incontinence. Roberts, et al., found a prevalence of fecal incontinence ranging from 3-17% among institutionalized older persons. Furthermore, Gordon, et al., found that the true prevalence of fecal incontinence is mostly likely underestimated. These statistics suggest that fecal incontinence is under-diagnosed in the primary care setting and therefore the majority of patients with anorectal disorders do not get the treatment required to maintain a normal lifestyle. Anorectal manometry provides information the pressures generated in the rectum and anal canal. The internal anal sphincter generates approximately 85% of the resting anal coanal pressure, whereas the external anal sphincter is solely responsible for the voluntary squeeze pressure.

Anorectal manometry can define functional weakness of one or both sphincter muscles by providing information on resting pressure, squeezing pressure, high-pressure zone (HPZ) and RAIR.

Indications for anorectal manometry:

1. Constipation (in absence of an anatomic abnormality and failure of high fiber and fluids)
2. Fecal incontinence
3. Pelvic floor dysynergia
4. Hirschsprung’s Disease

For further information, please contact Dr. Tai Ping Lee at the Digestive Disease Institute of the Division of Gastroenterology at (516) 562-4281.