Su1068 Do Patients Report Symptoms When They Occur? Fundamental Consequences for Interpretation of Ambulatory Reflux Monitoring

The role of impedance monitoring in patients with extraesophageal symptoms

“…23 However, two recent prospective trials have questioned the clinical reliability of symptom indices in reflux disease. 24,25 Furthermore, the most recent surgical trial in patients with extraesophageal syndrome showed that impedance parameters on therapy did not predict symptom response postfundoplication. 26 In this study, the traditional parameters of increased acid exposure, presence of hiatal hernia, and typical reflux symptoms (heartburn and regurgitation) were predictive of extraesophageal symptom response to fundoplication.…”

“…However, the use of SI and SAP is problematic in this group since patients have already declared lack of clinical response to aggressive acid suppression, and recent studies suggest that these metrics may not be reliable or reproducible. 24,25…”

“…Their chief complaints included: cough (53%), asthma (12%), hoarseness (7%), throat clearing (6%), pulmonary fibrosis (6%), sore throat (6%), postnasal drip (5%), and sinusitis (5%). A total of 58/75 (77%) of patients were female, 71/75 (95%) were Caucasian, with a median (IQR) age of 55 (45-64) years, and median (IQR) body mass index of 29 (25)(26)(27)(28)(29)(30)(31)(32)(33). Hiatal hernias greater than 1 cm in size were present in 29/75 (38%), of which 61% were 2 to 3 cm in size, and 39% were 4 cm or greater.…”