Drawbacks of the Current Algorithm for Patients With Symptoms of Gastroesophageal Reflux Disease and the Impact of Adding Wireless pH Study to the Initial Diagnostic Endoscopy: Data From High-Volume Rural Antireflux Center

Abstract

Background Patients with symptoms of gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). When they respond, patients usually continue PPI therapy. If this empiric treatment fails, esophagogastroduodenoscopy (EGD) is recommended. When EGD findings are equivocal, pH study is warranted. We hypothesize that this algorithm results in prolonged PPI therapy, repetition of EGDs and patient dissatisfaction. This study evaluates the impact of placing a pH probe at the time of the initial EGD. Methods IRB approval was obtained for retrospective chart review of patients who presented with GERD symptoms between August 2015 and March 2019. Patients were included if they underwent EGD with placement of wireless pH probe. Results A total of 379 patients (260 females, 119 males) with average age was 56.7±14.2 years. There were 253/379 (66.7%) patients who had previous EGDs (1-10). Health Satisfaction Survey was completed by 357/379 (94.2%) patients and 250/357 (70%) reported dissatisfaction with GERD control. PPI use was noted in 299/379 (78.8%) patients with average duration of 10.9±9.1 years. Testing off antisecretory medication was performed in 360/379 (94.9%). The average time interval between the clinic visit and performing EGD and pH study was 22±25 days. Conclusion The current GERD algorithm results in prolonged PPI therapy, repeated endoscopies and patient dissatisfaction. Placing a pH probe at the time of initial endoscopy is safe and expedient in a rural setting. Positive pH studies avoid repeating EGDs and negative pH studies warrant a search for potential alternative diagnosis.

Advanced Endoscopic Evaluation of Gastroesophageal Reflux Disease in Morbidly Obese Patients in a Rural Setting

“…The Bravo capsule (Given Imaging; Medtronic Inc, Shoreview, Minnesota, USA) was placed 6 cm proximal to the EGJ. 4 Last, it must be understood that the potential for the procedure to be terminated at any stage due to patient nontolerance must be discussed and agreed upon by all parties before the procedure starts.…”

“…The Bravo capsule (Given Imaging; Medtronic Inc, Shoreview, Minnesota, USA) was placed 6 cm proximal to the EGJ. 4…”

“…3 The combination of diagnostic studies avoids risks of repeated procedures and reduces cost and inconvenience to GERD patients. 4 Wireless pH study provides objective diagnosis of GERD. The functional luminal imaging probe (endoFLIP) has recently emerged as a valuable tool in physiologic evaluation and diagnosis of esophageal disorders.…”

Impact of Participation of Surgeons in Diagnostic Studies of Gastroesophageal Reflux Disease on Completion of Workup and Utilization of Antireflux Surgery

“…3 Third, the repetition of tests such as EGD in order to place a pH probe is invasive, costly, and inconvenient. 4 These challenges lead to dropout of GERD patients prior to completion of the work-up.…”

“…3 Third, the repetition of tests such as EGD in order to place a pH probe is invasive, costly, and inconvenient. 4 These challenges lead to dropout of GERD patients prior to completion of the work-up. This is the first study examining the rate of completion of diagnostic workup and progression to antireflux procedures when a surgeon participated in diagnostic workup performed in the setting of a structured antireflux program.…”