Skip to main content
Log in

Normal 24-Hr ambulatory esophageal pH values

Influence of study center, pH electrode, age, and gender

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Although the most sensitive and specific test for diagnosing gastroesophageal reflux disease, normal standards for prolonged esophageal pH monitoring are based on small sample sizes with questions raised about the effects of pH electrode, older age, gender, and methods of data analysis on pH variables. Recently three groups have established normal data bases using similar methodology. Multiple regression and nonparametric analyses showed that the values for the six traditional pH parameters were comparable across study centers. Therefore, the groups were combined for a total study population of 110 healthy subjects (47 men, 63 women, mean age 38 years with a range of 20–84 years). Further nonparametric analyses revealed the following: (1) type of pH electrode (antimony vs glass) is not significantly related to parameters of physiologic acid reflux; (2) age is not independently related to pH parameters; (3) men tend to have more physiologic reflux than women; and (4) older men tend to experience longer episodes of reflux than younger men and women. There was a significant effect of gender and a significant interaction between age and gender on the number of episodes >5 min (P=0.008). Nearly significant differences were found for percentage of total acid exposure time (P=0.03), total reflux episodes (P=0.02), and the longest reflux episode (P=0.02). We believe these normal esophageal pH values can be used confidently as standards in any laboratory, and consideration should be given to developing separate standards for men and women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Miller FA: Utilization of inlaying pH probe for evaluation of acid-peptic diathesis. Arch Surg 89:199–203, 1964

    Google Scholar 

  2. Rosen SN, Pope CE II: Extended esophageal pH monitoring. An analysis of the literature and assessment of its role in the diagnosis and management of gastroesophageal reflux disease. J Clin Gastroenterol 11:260–270, 1989

    Google Scholar 

  3. Johnson LF, DeMeester TR: Advantage of distal esophageal 24-hour pH monitoring over other tests for gastroesophageal reflux. Gastroenterology 66:716A, 1974

    Google Scholar 

  4. Euler AR, Byrne WJ: Twenty-four hour esophageal intraluminal pH probe testing: a comparative analysis. Gastroenterology 80:957–961, 1981

    Google Scholar 

  5. Roth A, Gars R, Bettex M: Significance of esophageal manometry and long-term pH monitoring for the evaluation of gastroesophageal reflux in infancy and childhood. Prog Pediatr Surg 18:22–31, 1985

    Google Scholar 

  6. Stanciu C, Hoare RC, Bennett JR: Correlation between manometric and pH tests for gastro-oesophageal reflux. Gut 18:536–540, 1977

    Google Scholar 

  7. Irvin TT, Perez-Avila C: Diagnosis of symptomatic gastroesophageal reflux by prolonged monitoring of lower esophageal pH. Scand J Gastroenterol 127:115–120, 1977

    Google Scholar 

  8. Branicki FJ, Evans DF, Jones JA, Ogilvie AL, Atkinson M, Hardcastle JD: A frequency-duration index (FDI) for the evaluation of ambulatory recordings of gastro-oesophageal reflux. Br J Surg 71:425–430, 1984

    Google Scholar 

  9. Spence RAJ, Johnston GW, Parks TG: Prolonged ambulatory pH monitoring in patients following oesophageal transection and control subjects. Br J Surg 72:99–101, 1985

    Google Scholar 

  10. Vitale GC, Sadek S, Tulley FM, Rimmer AR, Hunter BE, Phelan J, Casahieri A: Computerized 24-hour esophageal pH monitoring: A new ambulatory technique using radiotelemetry. J Lab Clin Med 105:686–693, 1985

    Google Scholar 

  11. Schlesinger PK, Donahue PE, Schmid B, Layden TJ: Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology 89:797–804, 1985

    Google Scholar 

  12. Schindlebeck NE, Heinrich C, Konig A, Dendorfer A, Pace F, Muller-Lissner SA: Optimal thresholds, sensitivity and specificity of long-term pH-metry for the detection of gastroesophageal reflux. Gastroenterology 93:85–90, 1987

    Google Scholar 

  13. Smout AJPM, Breedijk M, Van der Zouw C, Akkermans LMA: Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis. Dig Dis Sci 34:372–378, 1989

    Google Scholar 

  14. Johnsson F, Joelsson B, Isberg PE: Ambulatory 24-hour intraesophageal pH monitoring in the diagnosis of gastroesophageal reflux disease. Gut 25:1145–1156, 1987

    Google Scholar 

  15. MacLauchlan G, Rawlings JM, Lucas ML, McCloy RF, Crean GP, McColl KEL: Electrodes for 24-hour pH monitoring—a comparative study. Gut 28:935–939, 1987

    Google Scholar 

  16. Johnson LF, DeMeester TR: Twenty-four hour pH monitoring of the distal esophagus. Am J Gastroenterol 62:325–332, 1974

    Google Scholar 

  17. Hartley HO: The maximum F-ratio as a short-cut test for heterogeneity of variance. Biometrika 37:308–312, 1950

    Google Scholar 

  18. Lipton A, Harvey HA, Balch C: C-paquum vs BCG adjuvant immunotherapy of stage II malignant melanoma. J Clin Oncol 1990 (in press)

  19. Cohen J, Cohen P: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Hillsdale, New Jersey, Lawrence Erlbaum, 1975

    Google Scholar 

  20. Spence RAJ, Collins BJ, Parks TG, Love AHG: Does age influence normal gastro-oesophageal reflux. Gut 26:799–801, 1985

    Google Scholar 

  21. Kruse-Andersen S, Wallin L, Madsen T: The influence of age on esophageal acid defense mechanisms and spontaneous acid gastroesophageal reflux. Am J Gastroenterol 83:637–639, 1988

    Google Scholar 

  22. Feldman M: Gastric secretion.In Gastrointestinal Disease. MH Sleisinger, JS Fordtran, (eds). Philadelphia, WB Saunders, 1983, pp 545–547

    Google Scholar 

  23. Baron JH: Lean body mass, gastric acid and peptic ulcer. Gut 637–642, 1969

  24. Cox AJ: Stomach size and its relation to chronic peptic ulcer. JAMA 54:407–410, 1952

    Google Scholar 

  25. Hollis JB, Castell DO: Esophageal function in elderly men. A new look at “presbyesophagus.” Ann Intern Med 80:371–374, 1974

    Google Scholar 

  26. Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987

    Google Scholar 

  27. Emde C, Garner A, Blum AL: Technical aspects of intraluminal pH-metry in man: current status and recommendations. Gut 28:1177–1188, 1987

    Google Scholar 

  28. A Gallup survey of heartburn across America. Princeton, New Jersey, The Gallup Organization, 1988

  29. Nebel OT, Fornes MF, Castell DO: Symptomatic gastroesophageal reflux: Incidence and precipitating factors. Am J Dig Dis 21:953–957, 1976

    Google Scholar 

  30. Wiener GJ, Morgan TM, Cooper JB, Wu WC, Castell DO, Sinclair JW, Richter JE: Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci 33:1127–1133, 1988

    Google Scholar 

  31. Murphy DW, Yuan Y, Castell DO: Does the intraesophageal pH probe accurately detect acid reflux? Dig Dis Sci 34:649–656, 1989

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richter, J.E., Bradley, L.A., DeMeester, T.R. et al. Normal 24-Hr ambulatory esophageal pH values. Digest Dis Sci 37, 849–856 (1992). https://doi.org/10.1007/BF01300382

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01300382

Key Words

Navigation