Clinical role of ambulatory reflux monitoring in PPI non‐responders: recommendation statements

Abstract

Background: Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated. Aims: To utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice Methods: The RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness. Results: Prolonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease | 1275 YADLAPATI et al.

Editorial: wireless pH‐monitoring—is it time to put away the pH‐impedance catheters?

“…A recent position statement recommended prolonged, wireless pH monitoring off PPI therapy as the preferred investigation in patients with suspected GERD. 5 Evidence was presented to support this statement; however, it may be too soon to put away the catheters just yet.…”

“…Wireless pH studies are an important addition to the diagnostic armamentarium for GERD. As we wait for more outcome data, the recent recommendations are a welcome initiative in the evaluation of this disease 5 . However, even with these results, the optimal diagnostic work‐up will continue to require multiple tests to address the needs of individual patients.…”

“…Controversy exists as to which is the diagnostic modality of choice and also whether proton pump inhibitors (PPIs) should be discontinued before investigation. A recent position statement recommended prolonged, wireless pH monitoring off PPI therapy as the preferred investigation in patients with suspected GERD 5 . Evidence was presented to support this statement; however, it may be too soon to put away the catheters just yet.…”

Editorial: wireless pH‐monitoring ‐ is it time to put away the pH‐impredance catheters: Authors' response

“…For these reasons, oesophageal experts agree that prolonged wireless pH monitoring is the optimal ambulatory reflux monitoring system when performed off acid suppression in patients with oesophageal reflux symptoms ( e.g ., heartburn and non‐cardiac chest pain) to measure oesophageal acid exposure and guide the use of acid‐suppressive agents 6,7 …”

“…1 For these reasons, oesophageal experts agree that prolonged wireless pH monitoring is the optimal ambulatory reflux monitoring system when performed off acid suppression in patients with oesophageal reflux symptoms (e.g., heartburn and non-cardiac chest pain) to measure oesophageal acid exposure and guide the use of acid-suppressive agents. 6,7 Yet, MII-pH monitoring is still preferred in scenarios including a contraindication to wireless pH monitoring or inability to undergo upper GI endoscopy for wireless capsule placement. MII-pH monitoring may provide additional relevant data in the evaluation of extra-oesophageal reflux symptoms or belching disorders.…”