Reliability of 24-hour home esophageal ph monitoring in diagnosis of gastroesophageal reflux

Abstract

Twenty-four-hour home esophageal pH monitoring is proposed in order to study gastroesophageal reflux (GER) so that prolonged use of costly hospital equipment and staff can be curtailed and the diagnostic accuracy of the examination improved. Eighty-six patients affected by GER symptoms and 20 healthy volunteers underwent 24-hr home esophageal pH monitoring, x-rays, and endoscopy of the upper gastrointestinal tract to investigate reliability of outpatient recording. Fifteen more patients consecutively underwent out- and inpatient recording to detect possible differences between these methods in the two daily periods. Outpatient monitoring was well tolerated in 94.7% of the patients; 14.3% of them markedly reduced their routine activities. The range of normality of outpatient recording does not differ from that of inpatients. In the 15 patients who consecutively underwent out- and inpatient monitoring, no significant differences were reported. The sensitivity of 24-hr home esophageal pH recording is 0.85, the specificity 1, the accuracy for negative prediction 0.68, and the accuracy for positive prediction 1. The reliability of 24-hr home esophageal pH monitoring is comparable to inpatient recording. It allows hospital cost reduction and is also better tolerated by patients but has not greatly improved the diagnostic accuracy of the gastroesophageal reflux pH monitoring.

Wireless Capsule pH Monitoring: Does It Fulfil All Expectations?

“…41 patients with GERD symptoms (25 with confirmed oesophagitis and 16 with normal upper endoscopy) and 44 asymptomatic controls underwent ambulatory wireless capsule pH monitoring during 48 h. Sensitivity and specificity to diagnose pathologic reflux over 48 h with the wireless capsule (median total time of pH <4) were comparable to those reported in studies on traditional pH monitoring [15,16,17]. Although data from the first and second day were comparable for each group, 12 out of 37 GERD patients as well as 7 out of 39 asymptomatic controls had pathologic reflux (defined as more than 5.3% of total time of pH <4, which was the 95th percentile in the asymptomatic controls over 48 h) on one but not the other day of recording, an observation also reported by others [6, 18].…”

Esophageal motility in Japanese patients with Barrett?s esophagus

“…[18][19][20] Two factors that influence esophageal acid exposure time are the frequency of acid reflux and the length of time necessary to restore esophageal pH to normal after a reflux event. 21 Esophageal peristalsis removes the refluxed acid from the esophagus and brings swallowed saliva to acidified regions of the esophagus.…”

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.…”