Dual-channel ambulatory esophageal pH monitoring: A useful diagnostic tool?

John Wo, John G. Hunter, J. Patrick Waring

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (ie, heartburn, regurgitation) and in patients with atypical symptoms (ie, chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.

Original languageEnglish (US)
Pages (from-to)2222-2226
Number of pages5
JournalDigestive Diseases and Sciences
Volume42
Issue number11
DOIs
StatePublished - 1997
Externally publishedYes

Fingerprint

Esophageal pH Monitoring
Gastroesophageal Reflux
Esophagus
Ambulatory Monitoring
Hoarseness
Heartburn
Lower Esophageal Sphincter
Chest Pain

Keywords

  • Ambulatory pH monitoring
  • Atypical gastroesophageal reflux disease
  • Gastroesophageal reflux disease
  • Proximal gastroesophageal reflux

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Dual-channel ambulatory esophageal pH monitoring : A useful diagnostic tool? / Wo, John; Hunter, John G.; Waring, J. Patrick.

In: Digestive Diseases and Sciences, Vol. 42, No. 11, 1997, p. 2222-2226.

Research output: Contribution to journalArticle

Wo, John ; Hunter, John G. ; Waring, J. Patrick. / Dual-channel ambulatory esophageal pH monitoring : A useful diagnostic tool?. In: Digestive Diseases and Sciences. 1997 ; Vol. 42, No. 11. pp. 2222-2226.
@article{dd8a11237aa245549ced1dcf3ff37d8b,
title = "Dual-channel ambulatory esophageal pH monitoring: A useful diagnostic tool?",
abstract = "Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (ie, heartburn, regurgitation) and in patients with atypical symptoms (ie, chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.",
keywords = "Ambulatory pH monitoring, Atypical gastroesophageal reflux disease, Gastroesophageal reflux disease, Proximal gastroesophageal reflux",
author = "John Wo and Hunter, {John G.} and Waring, {J. Patrick}",
year = "1997",
doi = "10.1023/A:1018802330957",
language = "English (US)",
volume = "42",
pages = "2222--2226",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "11",

}

TY - JOUR

T1 - Dual-channel ambulatory esophageal pH monitoring

T2 - A useful diagnostic tool?

AU - Wo, John

AU - Hunter, John G.

AU - Waring, J. Patrick

PY - 1997

Y1 - 1997

N2 - Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (ie, heartburn, regurgitation) and in patients with atypical symptoms (ie, chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.

AB - Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (ie, heartburn, regurgitation) and in patients with atypical symptoms (ie, chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.

KW - Ambulatory pH monitoring

KW - Atypical gastroesophageal reflux disease

KW - Gastroesophageal reflux disease

KW - Proximal gastroesophageal reflux

UR - http://www.scopus.com/inward/record.url?scp=0031437664&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031437664&partnerID=8YFLogxK

U2 - 10.1023/A:1018802330957

DO - 10.1023/A:1018802330957

M3 - Article

C2 - 9398798

AN - SCOPUS:0031437664

VL - 42

SP - 2222

EP - 2226

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 11

ER -