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PTH-179 Prolonged reflux monitoring may change the diagnosis of oesophageal hypersensitivity to pathological gastroesophageal reflux
  1. R-I Rusu,
  2. J Jafari,
  3. I Miah,
  4. T Wong
  1. Guy’s and St Thomas’ Hospitals, London, UK

Abstract

Introduction Esophageal hypersensitivity is diagnosed in 5–12% of patients referred for reflux monitoring. These patients do not have pathological gastroesophageal reflux (GOR) which is mainly monitored for 24–48 h but perceive their symptoms with normal degree of GOR. As a result of such diagnosis clinicians tend to shift the focus of treatment from antireflux therapy to pain modulation agents. Our aim was to investigate change of diagnosis from oesophageal hypersensitivity to true GOR when more prolonged reflux monitoring is applied.

Method All patients with heartburn and/or chest pain referred for prolonged wireless reflux monitoring in the period of January 2010 to February 2015 were selected for this retrospective study. Those with a positive reflux-symptom association for the above symptoms during the first 48 h of recording were included. The cut off for positive symptom association probability (SAP) was ≥95% and a positive symptom index (SI) was ≥50%. The total duration of reflux monitoring was 96 h. Presence of pathological GOR on the 3rdand/or 4th24 h of recording was considered as positive GORD. Change of diagnosis from oesophageal hypersensitivity to true reflux was identified.

Results 183 patients with normal wireless pH monitoring at 48 hr completed a full 4 days study. During the 1st 48 h, 40 patients had positive SAP and/or SI for heartburn[13 males (M) and 27 females (F)]. Of these, 12 (30%) showed pathological GOR on extended monitoring (M: F- 3:9). The prevalence of pathological GOR on extended monitoring was: 11/38 (28.9%) patients with SAP + (regardless of SI), 4/13 (30.7%) with SI + (regardless of SAP), 8/27 (29.6%) with SAP + and SI –, 3/11 (27.3%) of those with both SAP and SI +. Only 2 patients were SAP –, SI + and only one had reflux.

During the first 48 h, a total of 27 patients (M: F = 8: 19) with chest pain, had positive SAP and/or SI. Of these, 5 (18.5%) showed pathological reflux (M: F 1:4) during extended reflux monitoring. The prevalence of pathological GOR on extended monitoring was: 5/24 (20.8%) SAP + patients (regardless of SI), 4/10 (40%) with SI+ (regardless of SAP), 1/17 (5.9%) with SAP + and SI –, 4/7 (57.1%) with both SAP and SI +.

Conclusion This study demonstrates that for the patients diagnosed with oesophageal hypersensitivity based on their chest pain or heartburn, this diagnosis can change in nearly 20 to 30% of the cases (respectively) to pathological GOR if prolonged reflux monitoring is applied. Diagnosis of oesophageal hypersensitivity might be partially technology or methodology dependent and modification of reflux monitoring methods can influence detection of GORD and oesophageal hypersensitivity.

Disclosure of interest None Declared.

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