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 24 February 2018

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News

Role of esophageal pH monitoring in symptomatic patients on PPIs

The likelihood of an abnormal esophageal pH for symptomatic GERD patients on daily PPI is very small, reports February's issue of The American Journal of Gastroenterology and hence, causes other than GERD should be sought.

News image

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Ambulatory pH monitoring while on therapy is often recommended in gastroesophageal reflux disease (GERD) patients with continued symptoms.

However, to date, little data exist to justify this indication.

Dr Vaezi and colleagues from Ohio, America undertook a study in order to assess the role of pH monitoring in symptomatic patients despite aggressive therapy with typical or extra esophageal GERD.

The research team carried out a retrospective review of 2,291 ambulatory pH tracings (1999-2003) and identified a subgroup of studies performed on proton pump inhibitor (PPI) therapy.

The researchers excluded patients with prior fundoplication or Barrett's esophagus.

The investigators grouped all the patients according to their predominant presenting GERD symptoms: typical (heartburn and regurgitation) or extra esophageal (chest pain, cough, hoarseness, sore throat, shortness of breath, asthma).

46% of patients had extra esophageal GERD symptoms and 54% had typical GERD symptoms
The American Journal of Gastroenterology

The researchers calculated the distribution of abnormal pH parameters in each group and used univariate analyses in order to assess the probability of abnormal pH in each group.

The research team oversaw pH monitoring of 250 patients (mean age 54.3 yrs, 59% female) either daily (b.i.d.) or twice daily (q.d.) on PPI therapy.

Out of these patients on PPI therapy, 115 (46%) had extra esophageal GERD symptoms and 135 (54%) had typical GERD symptoms.

The researchers found that extra esophageal GERD patients were more likely to undergo pH monitoring on b.i.d. PPIs.

In addition, the research team noted that 52 (93%) of typical and 74 (99%) of extra esophageal GERD patients on b.i.d. PPIs tested normal.

The odds of a normal pH values were 11 times higher for patients on b.i.d. PPIs than those on q.d. PPIs.

Dr Vaezi concluded, "The likelihood of an abnormal esophageal pH for symptomatic GERD patients on b.i.d. PPI is very small."

"In this group of patients failing b.i.d. PPIs causes other than GERD should be sought."

The American Journal of Gastroenterology; 2005: 100 (2): 283
26 January 2005

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