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The Role of Esophageal pH Monitoring in Symptomatic Patients on High Dose PPI Therapy

63

Rodriguez-Luna, Hector, M.D.; Young, Michele A., M.D.; Atkins, Rodney, LPN; Ramirez, Francisco C., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S44
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology Department, Carl T. Hayden VA Medical Center, Phoenix, AZ.

Purpose: Ambulatory esophageal pH monitoring is often recommended for gastroesophageal reflux patients on high dose acid suppressive therapy with persistent symptoms. Previous investigations have yielded inconsistent results regarding the utility of this diagnostic study in the managment of these patients. A recent study demonstrated a high Odds Ratio for a normal study in double dose PPI when compared to single dose PPI, thus creating further controversy in this area.

Aim: To assess the utility of 24-hrs esophageal pH testing in patients on single and double dose PPI with persistent symptoms and to determine the Odds Ratio for a normal test in the latter group when compared to single dose PPI.

Methods: Retrospective review of 24-hrs ambulatory pH tests performed at a VA Medical Center from January 1999 to April 2005 in patients with persistent reflux symptoms despite single dose (QD) or double dose (BID) PPI therapy. Abnormal pH was defined as total time of pH < 4.0 ≥ 4.2%, or upright pH < 4.0 ≥ 6.3%, or supine pH < 4.0 ≥ 4.2%. Patients were instructed to continue their medication while undergoing pH testing. The distribution of abnormal pH in each group and Odds Ratio for normal pH studies were calculated.

Results: A total of 128 patients (107 men and 21 women) underwent 24-hr esophageal pH monitoring for persistent reflux symptoms. Of those, 87 were on PPI BID and 41 on PPI QD. Total time the pH was < 4 was abnormal in ninety three patients (73%). In the PPI BID group, 50/87 (57%) had a total esophageal pH < 4.0 vs. 22/41 (53%) in the PPI QD group (p = 0.03).

Conclusions:

  1. Majority of patients with refractory gastroesophagel reflux symptoms have a positive pH study on antisecretory therapy.
  2. The probability of finding a normal pH is equally likely in patients on either single or double dose PPI.
  3. Although controversial, we belive that 24-hrs ambulatory esophageal pH monitoring is effective for the evaluation of persistent GERD symptoms in patients on high dose PPI therapy.
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