Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease.

Johnsson, Folke; Joelsson, B.; Isberg, P-E

doi:10.1136/gut.28.9.1145

Cited by 189 publications

(98 citation statements)

References 19 publications

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“…the fraction of time at pH < 4. [18][19][20] Indeed, the percentage acid reflux time is currently considered to be the most useful parameter for the analysis and interpretation of 24-h oesophageal pH studies. 21 A knowledge of the role, if any, of supine nocturnal oesophageal acid exposure in the pathogenesis of oesophageal mucosal lesions may have practical implications.…”

Section: Introductionmentioning

confidence: 99%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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SummaryBackground : The reason why less than one‐half of patients with gastro‐oesophageal reflux disease develop complicated reflux disease (ulcerative oesophagitis, oesophageal strictures and Barrett's oesophagus) and erosive reflux oesophagitis is not fully understood. Supine nocturnal oesophageal acid reflux is considered to be critically involved in this phenomenon, but reliable data are lacking.Aim : To clarify whether high levels of supine nocturnal oesophageal acid exposure are associated with complicated reflux disease.Methods : Ambulatory 24‐h oesophageal pH monitoring was performed in 220 patients with gastro‐oesophageal reflux disease (56 with complicated reflux disease, 76 with erosive reflux oesophagitis and 88 with non‐erosive reflux disease). The total, supine nocturnal and upright diurnal percentage acid reflux times were calculated.Results : The total percentage acid reflux time was significantly greater in complicated reflux disease than in either erosive reflux oesophagitis (P = 0.024) or non‐erosive reflux disease (P = 0.000). These differences were entirely due to a greater supine nocturnal percentage acid reflux time (P = 0.038 and P = 0.000, respectively), whereas no difference was observed in the upright diurnal percentage acid reflux time.Conclusions : Complicated reflux disease is characterized by high levels of supine nocturnal percentage acid reflux time. Prospective studies would be appropriate to clarify whether the normalization of this parameter is relevant to the effective management of this subset of patients with gastro‐oesophageal reflux disease.

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Section: Introductionmentioning

confidence: 99%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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“…Twenty-four hour esophageal pH-monitoring has long been considered the best examination in order to differentiate the various types of heartburn patients because it can establish the amount of esophageal acid exposure and the correlation between reflux and symptoms. 7,8 More recently addition of impedance to measurement of pH has enabled detection of patients with heartburn related to non-acid reflux and their separation from those having FH. 9 So far studies on pathophysiological differences between patients with FH and those with NERD, for example intercellular space diameter or histopathological findings, basal impedance, acid sensitivity, somatisation, have relied on 24-hour pH or pH and impedance monitoring.…”

Section: Introductionmentioning

confidence: 99%

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

Penagini

Sweis

Mauro

et al. 2015

J Neurogastroenterol Motil

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Background/Aims The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients’ outcome. Methods Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38–57 years]) with a diagnosis of functional heart-burn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index ≥ 50%). Outcome was assessed by review of hospital files and/or telephone interview. Results Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients ( P < 0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients ( P < 0.05). Conclusions One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients’ management.

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“…11 Other parameters (e.g. number of reflux episodes) were not analysed separately to reduce the chance of type I errors related to multiple comparisons.…”

Section: Oesophageal Acid Exposure Measurementsmentioning

confidence: 99%

Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter‐based studies

Sweis

Fox

Anggiansah

et al. 2009

Aliment Pharmacol Ther

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SUMMARY BackgroundStandard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown.

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Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease.

Cited by 189 publications

References 19 publications

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Inconsistency in the Diagnosis of Functional Heartburn: Usefulness of Prolonged Wireless pH Monitoring in Patients With Proton Pump Inhibitor Refractory Gastroesophageal Reflux Disease

Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter‐based studies

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