Computerized 24-hour Ambulatory Esophageal pH Monitoring and Esophagogastroduodenoscopy in the Reflux Patient

Abstract

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Successful oesophageal pH monitoring with a catheter‐free system

“…Normal values for control subjects undergoing conventional catheterbased pH monitoring were used to determine whether oesophageal acid exposure was normal. [7][8][9][10][11][12][13][14] Representative tracings obtained from the Bravo capsule are illustrated in Figures 3 and 4. Six patients also underwent colonoscopy during the same endoscopic session, four (67%) of whom had positive tests.…”

Precise Role of Acid in Non-Erosive Reflux Disease

“…(b) EAE may be underestimated. Concerns about sensitivity are highlighted by the observation that as many as 23% of patients with endoscopically detected esophagitis may demonstrate distal EAE values that fall within the normal range [70]. Many other studies have reported high sensitivities for pH monitoring that approximate 90% for erosive esophagitis (EE) patients, while the sensitivity of pH monitoring in patients with NERD is significantly lower, raising questions as to how to best define GERD in the absence of erosions [71].…”

pH monitoring: The gold standard in detection of gastrointestinal reflux disease?

“…Our laboratory results of [23] have shown that even in clearly existing primary reflux disease (e.g., esophagitis without other disease) it was not possible to prove pathological reflux by pH monitoring in 18% of the cases. Vitale et al [21] published similar results. In a group of patients with suspected esophagitis, they did not find a pH metrical correlate in 8 of 40 patients with endoscopically proved esophagitis.…”