Specialist upper GI diagnostics · UK
Oesophageal physiology, in a proper specialist lab.
High-resolution manometry, 24-hour pH-impedance, Bravo capsule and EndoFLIP - the specialist tests that separate reflux from achalasia, from spasm, from a hiatus hernia, and that decide whether medical therapy, endoscopy or surgery is the next step.
Why patients choose us
- 01
A specialist physiology lab, not a general endoscopy list
Oesophageal physiology sits between gastroenterology and upper GI surgery. We arrange it in a proper physiology lab with a specialist gastroenterologist and a GI physiologist - not tacked onto a general endoscopy slot.
- 02
The right test, in the right order
HRM, pH-impedance, Bravo, EndoFLIP and barium studies each answer a different question. We line them up in the order that will actually change your management - and skip the ones that won’t.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private oesophageal physiology costs in the UK.
Indicative ranges across our partner physiology labs. Send the details and we quote firm figures across two or three options - including the full pre-anti-reflux-surgery workup as a bundle.
In short
HRM plus 24-hour pH-impedance in our network: £1,300–£2,400, reported within two weeks.
| Test | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| High-resolution manometry (HRM) | £600–£1,100 | 15–20 min | 1–2 weeks |
| 24-hour pH-impedance monitoring | £700–£1,300 | 24 h ambulatory | 1–2 weeks |
| Bravo wireless pH capsule (48–96 h) | £900–£1,600 | OGD + 48–96 h | 1–2 weeks |
| EndoFLIP (add-on to OGD) | £600–£1,000 | During OGD | Same visit |
| Videofluoroscopy (VFSS) with SLT | £450–£900 | 20–30 min | Same day |
| FEES with SLT | £350–£700 | 20–30 min | Same day |
| Barium swallow / timed barium | £300–£600 | 15–30 min | 1–3 days |
| Full pre-anti-reflux surgery workup | £1,500–£2,600 | 2 visits | 2–3 weeks |
Prices vary by lab, by whether an OGD is bundled in (needed for Bravo and EndoFLIP), and by whether the report includes upper GI MDT discussion. We confirm a firm quote within one working day.
The problem
The right test, in the right order, in a proper lab.
Oesophageal physiology is done properly in only a handful of tertiary UK centres. Elsewhere it gets tacked onto a general endoscopy list, reported without Chicago v4.0, and the wrong test is done for the wrong question. We fix all three before you book.
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Reflux that hasn’t settled?
A 24-hour pH-impedance study on and off PPIs works out whether reflux is really the driver - before another prescription is changed.
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Facing anti-reflux surgery?
HRM excludes achalasia and pH-impedance confirms pathological reflux. Skipping this is why fundoplications fail.
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Difficulty swallowing?
HRM plus barium or EndoFLIP separates achalasia, EGJ outflow obstruction, spasm and stricture - each treated very differently.
The journey
From enquiry to MDT report - what happens, in order.
One clinician from first message to MDT discussion - including how the result changes your treatment plan.
Phase 1 · Before your test
Concierge, off-stage for you
Phase 2 · At the lab
A short visit, or 24 hours ambulatory
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Reflux, chest pain, dysphagia, regurgitation, chronic cough - and what has already been tried.
- 02
Before
We come back with a recommendation
Within one working day: which physiology tests you actually need (HRM, pH-impedance, Bravo, EndoFLIP), in which order, and an indicative price.
- 03
Before
We arrange the appointment
Usually within one to two weeks at a tertiary physiology lab (UCLH, Kings, Guys, Manchester, Nottingham, Sheffield, Bristol, Oxford). PPIs are stopped 7 days before pH studies where safe.
- 04
At the lab
Arrival at the physiology lab
A short chat with the GI physiologist. Local anaesthetic spray to the nose and throat for catheter tests. EndoFLIP is done during an OGD under sedation.
- 05
At the lab
The test itself
HRM: 15–20 minutes with a thin catheter and ten swallows. pH-impedance: catheter placed then 24 hours ambulatory. Bravo: capsule clipped during OGD, then 48–96 hours at home.
- 06
At the lab
Home the same day
You go home after HRM or Bravo placement. pH-impedance catheters come out at the lab 24 hours later. EndoFLIP-during-OGD needs someone to collect you.
- 07
After
Report and MDT discussion
A Chicago v4.0 motility report and DeMeester score within one to two weeks, discussed at the upper GI MDT - this is what guides medical vs surgical management.
Typical end-to-end: 2–3 weeks from enquiry to reported study. Full pre-surgery workup: 3–4 weeks.
When it helps
When oesophageal physiology changes management.
The situations we see most, plus the red flag that means a two-week wait OGD first rather than a physiology booking.
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Reflux that hasn’t settled on PPIs
Persistent heartburn, regurgitation or acid taste despite twice-daily PPI - pH-impedance confirms whether reflux is really the problem.
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Dysphagia (difficulty swallowing)
Food sticking, slow swallowing, or a sense of blockage - HRM plus barium or EndoFLIP work out whether it’s achalasia, a stricture or dysmotility.
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Non-cardiac chest pain
Cardiology has cleared the heart. HRM and pH-impedance look for oesophageal spasm, hypercontractile oesophagus or reflux-related pain.
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Regurgitation of undigested food
Classic for achalasia or a large hiatus hernia - HRM plus timed barium swallow is the diagnostic combination.
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Chronic cough of unclear cause
ENT and respiratory have looked. pH-impedance picks up non-acid reflux that PPIs and standard tests miss.
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Pre-anti-reflux surgery workup
Essential before Nissen, Toupet or LINX - HRM excludes achalasia, pH-impedance confirms pathological reflux. Skipping this is why some fundoplications fail.
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Persistent post-surgery dysphagia
Difficulty swallowing after fundoplication or LINX - HRM and EndoFLIP assess whether the wrap or ring is too tight.
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Red flag: dysphagia + weight loss
Progressive difficulty swallowing with weight loss needs a two-week wait OGD first - not a physiology lab booking.
The tests
The physiology toolkit, explained.
What each test actually measures - and which question it answers.
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High-resolution manometry (HRM)
A thin catheter with 36 pressure sensors measures oesophageal muscle contractions during ten swallows. Reported using Chicago Classification v4.0 - achalasia I/II/III, EGJ outflow obstruction, spasm, hypercontractile oesophagus, ineffective motility, or normal.
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24-hour pH-impedance monitoring
A thin nasal catheter sits in the lower oesophagus for 24 hours. Measures acid (pH) and non-acid (impedance) reflux. A DeMeester score above 14.7 confirms pathological reflux.
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Bravo wireless pH capsule (48–96 h)
A pH capsule is clipped to the oesophageal wall during an OGD. No nasal catheter, so you eat and sleep normally for 48–96 hours. The capsule falls off within seven days and passes through the gut.
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EndoFLIP
A balloon-tipped probe measures lumen distensibility and cross-sectional area at the oesophagogastric junction during an OGD. Used for EGJ outflow obstruction, achalasia phenotyping, EoE assessment and intraoperatively during Heller myotomy or POEM.
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Videofluoroscopic swallow study (VFSS)
A modified barium swallow - dynamic X-ray imaging led by a Speech and Language Therapist. First-line for oropharyngeal dysphagia, aspiration risk, post-stroke or post-head-and-neck-surgery swallowing.
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FEES
Fibreoptic Endoscopic Evaluation of Swallowing - an SLT-led nasal endoscopy that watches you swallow food and fluids of different consistencies. Complementary to VFSS, and portable to the bedside.
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Barium swallow
A contrast fluoroscopy study of oesophageal anatomy. Picks up strictures, hiatus hernia, the classic “bird’s beak” of achalasia, epiphrenic diverticulum, or a mass.
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Timed barium swallow
A quantitative version used to grade achalasia and monitor response to Heller myotomy, POEM or pneumatic dilatation.
Our vetted UK network
A small panel of tertiary labs, we picked them.
Specialist upper GI physiology labs in London, Manchester, Nottingham, Sheffield, Bristol and Oxford. Not listed publicly - introductions are made privately, once we understand your case.
Selection criteria
How we choose every lab in our network.
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Specialist gastroenterologists with a physiology and motility interest, not general endoscopists
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GI physiologists trained in HRM and Chicago Classification v4.0 reporting
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A proper physiology lab with HRM, pH-impedance, Bravo and EndoFLIP under one roof
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Upper GI surgical MDT input for pre- and post-anti-reflux-surgery cases
Safety and practicalities
What to expect on the day - honestly.
Oesophageal physiology is a safe outpatient investigation. The things worth planning are stopping PPIs on time, tolerating the catheter, and having someone to collect you if sedation is used.
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Nasal catheter tests are uncomfortable, not painful
HRM and pH-impedance need a thin catheter passed through one nostril. Local anaesthetic spray helps. Most patients tolerate it well; a few find the gag reflex difficult.
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Transient sore throat and nose
A mildly sore throat, hoarse voice or nose is normal for a day or two after catheter tests. A little bleeding at the nasal passage settles on its own.
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Rare vasovagal syncope
Very occasionally patients feel faint during catheter placement. The physiologist stops, lays you flat, and it settles within a few minutes.
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Bravo capsule detachment
The wireless capsule usually falls off within seven days and passes through the gut unnoticed. Early detachment shortens the recording; persistence beyond two weeks is rare and occasionally needs endoscopic removal.
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EndoFLIP needs sedation
EndoFLIP is done during an OGD, so the usual sedation risks apply - you need someone to collect you and cannot drive for 24 hours.
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PPIs stop seven days before pH testing
To measure baseline reflux, PPIs are stopped for seven days (H2 blockers for three days). Alginates and antacids are allowed as rescue.
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You can eat normally on pH studies
The whole point is to record real-life reflux. You are asked to eat your usual meals and note them in a diary.
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A normal test is a useful result
If HRM is normal and pH-impedance shows no pathological reflux, that changes management - anti-reflux surgery is off the table and other causes are looked for.
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Red flags
New progressive dysphagia, unintentional weight loss, vomiting blood or black stools need urgent OGD, not physiology testing first.
Reading your physiology report
Your report in four parts. Read the last one first.
Whichever combination of tests was done, the physiologist’s report keeps to the same shape.
A quiet reminder
Chicago v4.0 language is precise and can read technically - we translate it for you.
If you would like us to talk you through the report before your MDT review, just ask.
- 01 Header
Which tests, on what medication
Which studies were done, whether you were on or off PPIs, and the position of the catheter or capsule.
- 02 Technique
HRM swallows and Chicago v4.0 metrics
The ten test swallows, the integrated relaxation pressure (IRP) of the EGJ, distal contractile integral (DCI), and distal latency - the numbers that drive the classification.
- 03 Findings
Motility diagnosis and DeMeester score
The Chicago v4.0 diagnosis - normal, achalasia I/II/III, EGJ outflow obstruction, spasm, hypercontractile or ineffective motility - plus the DeMeester score from pH-impedance.
- 04 Impression
What it means for treatment
Read this first: whether medical therapy, endoscopic treatment (dilatation, POEM) or surgery (Heller, fundoplication, LINX) is the next step - and any test the MDT wants to add.
Recognised by major UK insurers
Cover for oesophageal physiology varies by insurer - usually funded when clinically indicated (refractory reflux, dysphagia, pre-anti-reflux surgery). We confirm cover before booking.
Frequently asked
Everything we get asked about oesophageal physiology.
Quick answers on what the tests involve, DeMeester scores, Chicago v4.0 and why the workup matters before anti-reflux surgery.
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Why do I need oesophageal physiology tests before anti-reflux surgery?
Because roughly one in twenty patients referred for anti-reflux surgery actually has achalasia or another motility disorder, and a Nissen fundoplication in those patients makes things worse. HRM excludes achalasia; pH-impedance confirms that reflux is really the driver of your symptoms. Skipping these tests is the commonest reason fundoplications fail.
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Does high-resolution manometry hurt?
It is uncomfortable rather than painful. A thin catheter is passed through one nostril to the lower oesophagus using local anaesthetic spray. Placement takes a minute or two, then you swallow ten small sips of water lying down. The whole test is 15–20 minutes.
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What is the difference between 24-hour pH-impedance and the Bravo capsule?
Both measure reflux. The 24-hour catheter is cheaper, faster to fit and reports both acid and non-acid (weakly acidic) reflux - the standard pre-surgery test. Bravo is a wireless capsule clipped during an OGD; it records for 48–96 hours with no nasal catheter, which lets you eat and sleep normally and picks up day-to-day variation.
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What is EndoFLIP and when is it used?
EndoFLIP is a balloon probe that measures how distensible the oesophagogastric junction is during an OGD. It is used for EGJ outflow obstruction, to phenotype achalasia, to assess eosinophilic oesophagitis, and intraoperatively during Heller myotomy or POEM to check the muscle release is adequate.
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How much does private oesophageal physiology testing cost in the UK?
Indicatively: HRM £600–£1,100, 24-hour pH-impedance £700–£1,300, Bravo £900–£1,600, EndoFLIP £600–£1,000 as an add-on to OGD. A full pre-anti-reflux surgery workup runs £1,500–£2,600 across two visits. We confirm a firm figure within one working day.
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Do I need to stop my PPIs before the test?
For pH studies, yes - PPIs are stopped seven days before, and H2 blockers three days before, so we can measure your true baseline reflux. Alginates and antacids are allowed as rescue. HRM alone does not require stopping acid suppression.
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What is a DeMeester score?
A composite score from 24-hour pH monitoring that combines the total time acid is in the oesophagus, upright and supine reflux time, number of episodes and length of the longest episode. A score above 14.7 confirms pathological acid reflux.
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What is Chicago Classification v4.0?
The international system used since 2020 to interpret HRM. It groups results into normal motility, EGJ outflow obstruction, achalasia types I, II and III, absent contractility, distal oesophageal spasm, hypercontractile (jackhammer) oesophagus and ineffective oesophageal motility - each of which points to a different treatment.
Related treatments
Looking for something else?
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Laparoscopic Nissen fundoplication
Keyhole anti-reflux surgery for confirmed pathological reflux.
Learn more -
LINX reflux surgery
Magnetic sphincter augmentation as an alternative to fundoplication.
Learn more -
Laparoscopic Heller for achalasia
Definitive surgical treatment for confirmed achalasia.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more