Ambulatory Esophageal pH Monitoring

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Abstract

Extraesophageal manifestations of gastroesophageal reflux may be best diagnosed using ambulatory esophageal pH monitoring. This test involves the placemenmt of a thin pH probe in the esophagus, which is connected to a small box on a waistbelt. Studies are done in an ambulatory state in the patient’s home and work environment. Data collected assesses acid exposure time over the circadian cycle and the relationship of symptoms to pH drops. Studies in adult asthmatics demonstrate abnormal amounts of acid reflux by 24-hour esophageal pH monitoring in >50% of patients. Likewise, large studies in patients with chronic ENT complaints find abnormal acid reflux values in 50–80% of patients. Several problems and issues with ambulatory pH monitoring still need addressing, including (1) the need for dual pH monitoring, (2) artifact and reproducibility, (3) normal values, (4) role in the initial diagnosis, and (5) role in the follow-up of poorly responding patients.

Section snippets

The Technique of Ambulatory pH Monitoring

Prolonged ambulatory monitoring of esophageal pH is the most reliable method for diagnosing GERD. The test involves the placement of a thin pH probe through the nares, which is positioned 5 cm above the manometrically determined lower esophageal sphincter. The probe is connected to a small lightweight box worn on a waistbelt. Data are collected in the box, downloaded into a computer, and graphic and numerical displays can be presented. Patients are allowed to smoke and drink alcohol while

Prevalence of GER by Ambulatory pH Monitoring

Studies in adult asthmatics demonstrate abnormal amounts of acid reflux by 24-hour esophageal pH monitoring in >50% of patients.1, 2This prevalence is 70–80% in patients with associated reflux symptoms and approaches 50%, even in asthma patients denying symptoms of reflux disease.[3]Likewise, large studies in patients with chronic ENT complaints find abnormal acid reflux by 24-hour pH monitoring in 50–80% of patients.2, 4The ENT studies have 2 other important findings. First, considerable

Problems With Ambulatory Esophageal pH Monitoring

Despite its wide availability and documented usefulness in classic GERD, ambulatory pH monitoring has several problems and issues yet to be resolved in diagnosing the extraesophageal complications of GERD. These include (1) the need for dual pH monitoring, (2) artifact and reproducibility, (3) normal values, (4) role in the initial diagnosis, and (5) role in the follow-up of poorly responding patients (Table 1).

Conclusions

Despite the above problems and uncertainties, 24-hour dual pH monitoring with a pH probe in the distal esophagus and hypopharynx is the best single test for identifying patients with extraesophageal complications of GERD. Further studies and technological advancements will resolve the current limitations with pH testing. Outcome studies and cost analyses will help determine whether initial pH testing or testing only in the poorly responding patient is the most cost effective method for using

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