Computerized 24-hour Ambulatory Esophageal pH Monitoring and Esophagogastroduodenoscopy in the Reflux Patient

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Abstract
Ambulatory 24-h esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additonally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 min/h of reflux below pH 4 was found compared in 0.70 min/h in controls (P < 0.0001). The mean number and duration of reflux events in this group were 1.51 events/h and 4.0 min/event, compared with 0.31 events/h and 2.26 min/event in volunteers (P < 0.001, P < 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in 7 of 11 patients with normal endoscopic findings. Conversely, 8 of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.