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Diagnostic Testing

The diagnostic information provided is not for self-diagnosis or self-treatment. Diagnostic testing and physician expertise are required for diagnosing your symptoms. Check with your physician to determine what may be causing your symptoms and the treatment that is right for you.

Esophageal Manometry

An esophageal motility test measures the contractions of the esophagus. It is used to diagnose disorders of esophageal motility such as achalasia. Before the test, the patient must fast for four hours. During the test, a thin flexible catheter is passed into the esophagus through the nose. The patient is then asked to take sips of water to make the esophagus contract. Although placement of the catheter may be temporarily uncomfortable, an esophageal manometry is not a painful test and does not require anesthesia.


An esophagogram is an x-ray study of the esophagus used to diagnose disorders of the esophagus such as achalasia. During the test, the patient is asked to swallow a barium tablet and to drink a liquid barium contrast material. The barium allows the passage of "fluids and solids" through the esophagus to be seen on X-Ray to determine if the esophagus is functioning properly.

24-Hour pH Testing

A 24-hour pH test measures the amount of acid in the esophagus using a special thin catheter which is passed through the nostrils, down the throat, and remains in the distal esophagus for approximately 24 hours. The catheter is attached to a small monitor worn during the study. It is usually used in the diagnosis of gastroesophageal reflux disease (GERD) and to determine the effectiveness of medications that prevent acid reflux.

Impedance pH Testing

Impedance pH is a test to measure the amount of acid and non-acid reflux in the esophagus using a special thin catheter which is passed through the nostrils, down the throat, and remains in the distal esophagus for approximately 24 hours. The catheter is attached to a small monitor worn during the study. It is usually used in the diagnosis of atypical gastroesophageal reflux (GERD) symptoms.

Bravo pH Study

Bravo pH testing involves an upper endoscopy procedure to place a small catheter in the distal esophagus which monitors and records reflux episodes over a 24 hour period. The capsule passes naturally. Readings from the capsule are picked up by a small monitor worn during the study. It is often used to conduct pH testing in patients who do not tolerate the presence of a nasal catheter.

Gastric Emptying Study

A gastric emptying scan allows doctors determine the time it takes food to pass through the stomach. The patient eats a meal that is "labeled" with a radioactive substance. Using a special scanner, the percentage of food that empties from the stomach can be calculated.


The SmartPill is currently used to assess gastric motility. It involves the use of a wireless capsule that is swallowed and passes naturally from the body. The capsule records information about pH, pressure, and temperature throughout the GI tract. It is presently indicated for use in evaluating patients with delayed gastric emptying.

Hydrogen Breath Testing

The hydrogen breath test is used to identify lactose or fructose intolerance, or an abnormal growth of bacteria in the intestine. It is used to diagnose a lactose or fructose intolerance, which is the inability of the body to digest and or absorb lactose, the sugar found in dairy or fructose, the sugar found in a number of foods (fruit, vegetables, soda, etc.). Hydrogen breath testing can also be used to diagnose intestinal bacterial overgrowth. A breath sample will be collected and tested for the presence of hydrogen. To obtain the sample, you will be asked to blow up a balloon-type bag. Normally, very little hydrogen is detected in the breath. You will then be given a lactose, fructose, or lactulose solution to drink. Breath samples are collected every 15 minutes for 2 hours to detect any increase in hydrogen in the breath as the solution is digested. Increased hydrogen breath levels indicate improper digestion. The testing procedure lasts about 3 hours.


Sitzmarks is a diagnostic test used to assess bowel motility. It involves the ingestion of a gelatin capsule that contains 24 radiopaque rings followed by an X-Ray of the abdomen 5 days later. It is often used to evaluate patients with chronic constipation.

Anorectal Manometry

An anorectal manometry is a test that is used to measure the pressures of the anal sphincter and to assess rectal sensation. It involves the insertion of a small flexible catheter into the rectum and often involves expulsion of a 60 cc balloon. It may include pudendal nerve latency testing to evaluate the nerve supply to the pelvic floor. It can be used to evaluate a number of gastroenterologic symptoms including chronic constipation and fecal incontinence.


A Defogram is an X-Ray study that shows how well the rectum and anal canal function when having a bowel movement. It involves insertion of a barium paste into the rectum. Patients being evaluated for chronic constipation and other conditions related to evacuation of feces often undergo a defogram.

Anorectal Biofeedback

Anorectal biofeedback involves the use of sophisticated techniques to retrain and strengthen the muscles of the pelvic floor to improve bowel function. It is generally indicated for patients with chronic constipation related to a dysfunction of the muscles of the pelvic floor and for patients with fecal incontinence.

Contact Information

IBS and Functional Bowel Disorders Program
Digestive Disease Center
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215