Digestive Diseases and Sciences

, Volume 35, Issue 8, pp 929–938 | Cite as

Ambulatory 24-hr pH monitoring of esophagus, fundus, and antrum

A new technique for simultaneous study of gastroesophageal and duodenogastric reflux
  • Sandro Mattioli
  • Vladimiro Pilotti
  • Valentino Felice
  • Andrea Lazzari
  • Romano Zannoli
  • Maria Letizia Bacchi
  • Paola Loria
  • Alberto Tripodi
  • Giuseppe Gozzetti
Original Articles

Abstract

A method for outpatient 24-hr simultaneous recording of pH in the distal esophagus, fundus, and antrum was developed in order to detect acid, alkaline, alkalacid gastroesophageal reflux, and duodenogastric reflux and to study these phenomena in patients complaining of gastroesophageal reflux and dyspepsia related symptoms. Two hundred ninety-four studies were performed in 42 healthy volunteers and 237 patients. Three-probe ambulatory 24-hr esophagogastric pH monitoring applicability, tolerability, and capability to determine a relationship between symptoms which occurred during the tests, gastroesophageal reflux, and duodenogastric reflux episodes were assessed. Eighty-nine percent of the three-probe esophagogastric pH studies were easily performed. The examination was tolerated well by 86.1% of the patients and poorly by 13.9%. A temporal correlation between symptoms and pH activities was recognized in 61.3% when the esophageal tracing was considered (acid gastroesophageal reflux recording) and in 95.6% when the three pH traces were simultaneously interpreted. Alkalacid gastroesophageal reflux and duodenogastric reflux total percentage times were significantly higher in patients complaining of dyspeptic symptoms than in patients only affected by typical gastroesophageal symptoms. Three-probe 24-hr ambulatory esophagogastric pH monitoring is a simple, well-tolerated test that should be routinely adopted for the study of patients complaining of unclear upper gastrointestinal tract symptomatology.

Key words

esophagogastric pH monitoring gastroesophageal reflux duodenogastric reflux 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB: Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980PubMedGoogle Scholar
  2. 2.
    Wienbeck M, Berges W: Esophageal disorders in the etiology and pathophysiology of dyspepsia. Scand J Gastroenterol 109(suppl):133–137, 1985Google Scholar
  3. 3.
    Johnson AG: Where do symptoms come from in disorders of gastric motility?In Gastric and Gastroduodenal Motility. LMA Akkermans, AG Johnson, NW Read (eds). New York, Praeger, 1984, pp 223–240Google Scholar
  4. 4.
    Talley NJ, Phillips SF: Non-ulcer dyspepsia: Potential causes and pathophysiology. Ann Intern Med 108:865–879, 1988PubMedGoogle Scholar
  5. 5.
    Azpiroz F: Gastroesophageal reflux.In Benign Esophageal Disease. International Trends in General Thoracic Surgery, Vol 3. TR DeMeester, HR Matthews (eds). St. Louis, CV Mosby, 1987, pp 16–25Google Scholar
  6. 6.
    Little AG, Martinez El, DeMeester TR, Blough RM, Skinner DB: Duodenogastric reflux and reflux esophagitis. Surgery 96(2):447–454, 1984PubMedGoogle Scholar
  7. 7.
    Donovan IA, Harding LK, Keighley MRB, Griffin DW, Leigh Collis J: Abnormalities of gastric emptying and pyloric reflux in uncomplicated hiatus hernia. Br J Surg 64:847–848, 1977PubMedGoogle Scholar
  8. 8.
    Mattioli S, Pilotti V, Zannoli R, Felice V, Castellini A, Conci A, Gozzetti G: Gastroesophageal and duodenogastric reflux: Simultaneous twenty-four-hour home recording with a threeprobe system.In Diseases of the Esophagus. JR Siewert, AH Holscher (eds). Berlin, Springer-Verlag, 1988, pp 836–838Google Scholar
  9. 9.
    Mattioli S, Pilotti V, Spangaro M, Grigioni WF, Zannoli R, Felice V, Conci A, Gozzetti G: Reliability and clinical applications of 24-hr home esophageal pH monitoring in the diagnosis of gastroesophageal reflux. Dig Dis Sci 34:71–78, 1989PubMedGoogle Scholar
  10. 10.
    Johnson LF, DeMeester TR: Twenty-four-hour pH monitoring of the distal esophagus. Am J Gastroenterol 62:325–332, 1974PubMedGoogle Scholar
  11. 11.
    Gozzetti G, Pilotti V, Spangaro M, Bassi F, Grigioni WF, Carulli N, Loria P, Felice V, Lerro F, Mattioli S: Pathophysiology and natural history of acquired short esophagus. Surgery 102(3):507–514, 1987PubMedGoogle Scholar
  12. 12.
    Hoare AM, Keighley MRB, Starkey B, Alexander-Williams J: Measurements of bile acids in fasting gastric aspirates: an objective test for bile reflux after gastric surgery. Gut 19:166–169, 1978PubMedGoogle Scholar
  13. 13.
    Talalay P: Enzymatic analysis of steroid hormones. Methods Biochem Anal 8:119–149, 1960PubMedGoogle Scholar
  14. 14.
    Ward BW, Wu WC, Richter JE, Lui KW, Castell DO: Ambulatory 24-hour esophageal pH monitoring. Technology searching for clinical application. J Clin Gastroenterol 8(suppl 1):59–67, 1986PubMedGoogle Scholar
  15. 15.
    Skinner DB: Symptoms.In Gastroesophageal Reflux and Hiatal Hernia. DB Skinner, RH Belsey, TR Hendrix, GD Zuidema (eds). Boston, Little, Brown and Company, 1972, pp 31–42Google Scholar
  16. 16.
    Johnsson F, Joelsson B, Isberg PE: Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut 28:1145–1150, 1987PubMedGoogle Scholar
  17. 17.
    Schindlbeck NE, Heinrich C, Konig A, Dendorfer A, Pace F, Muller-Lissner SA: Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85–90, 1987PubMedGoogle Scholar
  18. 18.
    Evans DF: Twenty-four hour ambulatory oesophageal pH monitoring: an update. Br J Surg 74:157–161, 1987PubMedGoogle Scholar
  19. 19.
    Schlesinger PK, Donahue PE, Schmid B, Layden TJ: Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology 89:797–804, 1985PubMedGoogle Scholar
  20. 20.
    Cooper JD: Discussion in: DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB: Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980Google Scholar
  21. 21.
    Baldi F, Ferrarini F, Longanesi A, Angeloni M, Ragazzini M, Barbara L: Acid gastroesophageal reflux and occurrence of reflux symptoms: Are they related?In Diseases of the Esophagus. JR Siewert, AH Holscher (eds). Berlin, Springer-Verlag, 1988, pp 1058–1061Google Scholar
  22. 22.
    Pellegrini CA, DeMeester TR, Wernly JA, Johnson LF, Skinner DB: Alkaline gastroesophageal reflux. Am J Surg 135:177–184, 1978PubMedGoogle Scholar
  23. 23.
    Mattioli S, Pilotti V, Carulli N, Loria P, Felice V, Conci A, Castellini A, Gozzetti G: Simultaneous esophagogastric pH monitoring: A method for the study of acid and not acid gastroesophageal (GER) (Abstract). Gastroenterology 90(2):1538, 1986Google Scholar
  24. 24.
    Fimmel CJ, Etienne A, Cilluffo T, Ritter C, Gasser T, Rey JP, Caradonna-Moscatelli P, Sabbatini F, Pace F, Buhler HW, Bauerfeind P, Blum AL: Long-term ambulatory gastric pH monitoring: Validation of a new method and effect of H2-antagonists. Gastroenterology 88:42–51, 1985Google Scholar
  25. 25.
    Meshkinpour H, Marks JW, Schoenfleld LJ, Bonnoris GG, Carter S: Reflux gastritis syndrome: Mechanism of symptoms. Gastroenterology 79:1283–1287, 1980PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1990

Authors and Affiliations

  • Sandro Mattioli
    • 1
    • 2
  • Vladimiro Pilotti
    • 1
    • 2
  • Valentino Felice
    • 1
    • 2
  • Andrea Lazzari
    • 1
    • 2
  • Romano Zannoli
    • 1
    • 2
  • Maria Letizia Bacchi
    • 1
    • 2
  • Paola Loria
    • 1
    • 2
  • Alberto Tripodi
    • 1
    • 2
  • Giuseppe Gozzetti
    • 1
    • 2
  1. 1.Istituto di Clinica Chirurgica e Cardiochirurgia and Istituto di CardiologiaUniversitá di BolognaBologna-ModenaItaly
  2. 2.Istituto di Clinica Medica IUniversitá di ModenaBologna-ModenaItaly

Personalised recommendations