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Acid Reflux Detection and Symptom-Reflux Association Using 4-Day Wireless pH Recording Combining 48-Hour Periods Off and On PPI Therapy

Garrean, Carol P., M.D.; Zhang, Qing, M.D.; Gonsalves, Nirmala, M.D.; Hirano, Ikuo, M.D.

American Journal of Gastroenterology: July 2008 - Volume 103 - Issue 7 - p 1631–1637

OBJECTIVES Studies have shown that extended pH recording improves the sensitivity of esophageal pH monitoring. Controversy exists as to whether pH studies are optimally done off or on proton pump inhibitor (PPI) therapy. The aim of this study was to incorporate periods both off and on PPI therapy in a single, extended pH test and describe the effect of PPI therapy on symptom-reflux associations.

METHODS Sixty patients underwent 4-day pH recordings using two separate receivers calibrated to a single wireless pH capsule. Patients were off PPI therapy for days 1 and 2. Either rabeprazole 20 mg twice daily or omeprazole/sodium bicarbonate 40 mg twice daily were administered on days 3 and 4. Symptom-reflux correlation was determined by the symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP).

RESULTS Twenty studies were excluded due to premature detachment (9) or incomplete data capture for >6 of the 96-h period (11). Off therapy, 14 patients (35%) had abnormal esophageal acid exposure values. On day 4, 39 patients (98%) had normal acid exposure. The number of symptoms and acid reflux events were significantly higher off PPI therapy. Furthermore, the percentage of patients with a positive SI fell from 50% off PPI to 9% on PPI (P < 0.01), whereas 63% of patients symptomatic off PPI therapy became asymptomatic on PPI therapy and could not have an SI calculated. Similarly, the SAP was abnormal in 45% of patients off PPI therapy but only 10% on PPI therapy (P < 0.01).

CONCLUSIONS Extended pH recording improves the detection of abnormal acid reflux and increases the number of recorded symptoms and acid reflux events. Combined off and on PPI therapy pH testing enhances the interpretation of pH monitoring and symptom-reflux correlations, which can be helpful in the management of patients with PPI-unresponsive gastroesophageal acid reflux symptoms.

Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Reprint requests and correspondence: Ikuo Hirano, M.D., Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611-2951.


Guarantor of the article: Ikuo Hirano, M.D.

Specific author contributions: Carol Garrean collected and analyzed the data. Ikuo Hirano had the original concept, designed the protocol, and analyzed the data. Both authors were involved with writing and approving the final manuscript.

Financial support: None.

Potential competing interests: None.

Received September 24, 2007; accepted January 11, 2008.

© The American College of Gastroenterology 2008. All Rights Reserved.
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