Relationship Between Gastroesophageal Reflux and Symptoms in Patients Referred for Ambulatory pH Monitoring

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Abstract
Ambulatory pH monitoring is regarded as the most objective means of detecting and quantifying gastroesophageal reflux. Nevertheless, the relationship between symptoms and distal esophageal acid exposure is unclear, especially in patients with atypical reflux symptoms or noncardiac chest pain. The aim of this study was to explore the relationship between symptoms and the indices of gastroesophageal reflux currently used. We examined 100 consecutive, unselected patients referred for ambulatory pH monitoring with suspected symptomatic gastroesophageal reflux (n = 65) or unexplained noncardiac chest pain (n = 35). A symptom‐reflux association (SRA) was defined as the percentage of episodes of pain, or heartburn, during pH monitoring that were reported within 5 minutes of a gastroesophageal reflux event (pH fall to < 4). The two most sensitive predictors of symptomatic reflux (defined as a SRA < 50%) were the frequency of erect reflux episodes per hour (sensitivity 90%, specificity 77%, and accuracy 85%) and the erect reflux time (sensitivity 61%, specificity 93%, and accuracy 75%). To identify gastroesophageal reflux as a cause of symptoms, it is important to seek a temporal relationship between symptoms and reflux events. Reliance on acid exposure times alone will result in “false negative” diagnoses in some patients with symptomatic reflux who do not have excess reflux.