Yield of 24-Hour Esophageal pH and Bilitec Monitoring in Patients with Persisting Symptoms on PPI Therapy

Current management algorithms propose pH monitoring under proton pump inhibitors (PPIs) in suspected gastroesophageal reflux disease (GERD) with insufficient treatment response, but recent observations challenge this approach because of its low yield. Aim To perform an audit of the outcomes of pH mo...

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Bibliographic Details
Published in:Digestive diseases and sciences 2008-09, Vol.53 (9), p.2387-2393
Main Authors: Karamanolis, George, Vanuytsel, Tim, Sifrim, Daniel, Bisschops, Raf, Arts, Joris, Caenepeel, Philip, Dewulf, Dominiek, Tack, Jan
Format: Article
Language:English
Subjects:
Biochemistry
Biological and medical sciences
Circadian Rhythm - physiology
Clinical Audit
Dose-Response Relationship, Drug
Esophageal pH Monitoring
Esophagus
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Gastroenterology
Gastroenterology. Liver. Pancreas. Abdomen
Gastroesophageal Reflux - drug therapy
Gastroesophageal Reflux - physiopathology
Hepatology
Humans
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Paper
Other diseases. Semiology
Proton Pump Inhibitors - therapeutic use
Retrospective Studies
Spectrophotometry
Transplant Surgery
Treatment Outcome
Vertebrates: anatomy and physiology, studies on body, several organs or systems
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Summary:Current management algorithms propose pH monitoring under proton pump inhibitors (PPIs) in suspected gastroesophageal reflux disease (GERD) with insufficient treatment response, but recent observations challenge this approach because of its low yield. Aim To perform an audit of the outcomes of pH monitoring under PPI therapy in our unit, and to study the yield of additional nonacid reflux monitoring. Methods All pH monitoring studies under antireflux therapy since 1997, with or without simultaneous Bilitec ® monitoring, were analyzed. Results From 1997 to 2003, 347 patients (157 men, mean age 49.4 ± 0.8 years) underwent pH studies on PPI therapy (28% half-, 67% full-, and 5% double-dose PPI) for persisting typical (53%) or atypical (75%) symptoms. In 184 patients, simultaneous Bilitec ® monitoring was performed. Esophageal pH monitoring on PPI was pathological in 105 (30%) patients. Pathological pH monitoring on PPI was associated with typical reflux symptoms (64 versus 52%, P  = 0.03), and a higher prevalence of persisting esophagitis (54 versus 36%, P  
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-007-0186-6