The combination of pH monitoring in the most distal esophagus and symptom association analysis markedly improves the clinical value of esophageal pH tests

Scandinavian Journal of Gastroenterology
Mats Guerrero Garcia HallStefan Öberg

Abstract

The poor sensitivity of esophageal pH monitoring substantially limits the clinical value of the test. The aim of this study was to compare the diagnostic accuracy of esophageal pH monitoring and symptom association analysis performed at the conventional level with that obtained in the most distal esophagus. Eighty-two patients with typical reflux symptoms and 49 asymptomatic subjects underwent dual 48-h pH monitoring with the electrodes positioned immediately above, and 6 cm above the squamo-columnar junction (SCJ). The degree of esophageal acid exposure and the temporal relationship between reflux events and symptoms were evaluated. The sensitivity of pH recording and the diagnostic yield of Symptom Association Probability (SAP) were significantly higher for pH monitoring performed at the distal compared with the conventional level (82% versus 65%, p<0.001 and 74% versus 62%, p<0.001, respectively). The greatest improvement was observed in patients with non-erosive disease. In this group, the sensitivity increased from 46% at the standard level to 66% immediately above the SCJ, and with the combination of a positive SAP as a marker for a positive pH test, the diagnostic yield further increased to 94%. The diagnostic accuracy o...Continue Reading

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Citations

Nov 9, 2016·Scandinavian Journal of Gastroenterology·Mats Guerrero Garcia HallStefan Öberg
Oct 26, 2018·Scandinavian Journal of Gastroenterology·Elisabeth Norder GrusellHenrik Bergquist
Sep 7, 2017·Journal of Clinical Gastroenterology·Sharon J M KesselsTracy L Merlin

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