Article Outline
Abstract
The following guidelines were developed to assist the physician in the appropriate use of esophageal pH recording in patient care. They emanate from a comprehensive review of the medical literature pertaining to the pH recording technique.1 Esophageal pH recording is widely available and, when done in a technically appropriate manner, provides quantitative data on both esophageal acid exposure and on the temporal correlation between patient symptoms and reflux events. Despite these strengths, the inherent weakness of the technique is its inability to prove causality between symptoms or syndromes and acid reflux events. Alternatively, causality is reasonably assumed in clinical practice by the substantial reduction or elimination of suspected reflux symptoms during a therapeutic trial of a proton pump inhibitor. In view of this viable alternative, the major indications for esophageal pH monitoring are in documenting the failure of either medical or surgical therapy. This position statement should help the clinician apply esophageal pH studies most beneficially within the context of other clinical options.
GASTROENTEROLOGY 1996;110-1981
Back to Article Outline
Guidelines for the clinical use of esophageal pH recording
•Esophageal pH recording is indicated to document abnormal esophageal acid exposure in an endoscopy-negative patient being considered for surgical antireflux repair (pH study done after withholding antisecretory drug regimen for ≥ 1 week).
•Esophageal pH recording is indicated to evaluate patients after antireflux surgery who are suspected to have ongoing abnormal reflux (pH study done after withholding antisecretory drug regimen for ≥ 1 week).
•Esophageal pH recording is indicated to evaluate patients with either normal or equivocal endoscopic findings and reflux symptoms that are refractory to proton pump inhibitor therapy (pH study done after withholding antisecretory drug regimen for ≥ 1 week if the study is done to confirm excessive acid exposure or while taking the antisecretory drug regimen if symptom-reflux correlation is to be scored).
•Esophageal pH recording is possibly indicated to detect refractory reflux in patients with chest pain after cardiac evaluation using a symptom reflux association scheme, preferably the symptom association probability calculation (pH study done after a trial of proton pump inhibitor therapy for at least 4 weeks).
•Esophageal pH recording is possibly indicated to evaluate a patient with suspected otolaryngologic manifestations (laryngitis, pharyngitis, chronic cough) of gastroesophageal reflux disease after symptoms have failed to respond to at least 4 weeks of proton pump inhibitor therapy (pH study done while the patient continues taking their antisecretory drug regimen to document the adequacy of therapy).
•Esophageal pH recording is possibly indicated to document concomitant gastroesophageal reflux disease in an adult onset, nonallergic asthmatic suspected of having reflux-induced asthma (pH study done after with-holding antisecretory drugs for ≥ 1 week). Note: a positive test does not prove causality!
•Esophageal pH recording is not indicated to detect or verify reflux esophagitis (this is an endoscopic diagnosis).
•Esophageal pH recording is not indicated to evaluate for “alkaline reflux.”
Back to Article Outline
References
-
Kahrilas PJ, Quigley EMM.
Clinical esophageal pH recording: a technical review for practice guideline development.
Gastroenterology. 1996;110:1982–1996
☆ Address requests for reprints to: Chair, Patient Care Committee, AGA National Office, 7910 Woodmont Avenue, 7th Floor, Bethesda, Maryland 20814. Fax: (301) 654-5920.
PII: S0016-5085(96)00240-5
