Abstract
Gastroesophageal reflux disease (GERD) is one of the most frequent benign diseases of the gastrointestinal tract and in some cases the diagnosis may be very difficult. There are many diagnostic procedures but none of them could prove or definitely exclude the disease. The 24-h pH-monitoring is the “gold standard” for detection of gastroesophageal reflux and in many patients the reflux correlates with the GERD. The evaluation of a diagnostic method has to be done in a similar manner to the evaluation of therapeutic study (phase 1 to phase 4). For the definition of the “gold standard” for detection of a special diagnosis (e.g., the gastroesophageal reflux disease), the results of phase 3 studies for different methods had to be compared. The method with the best values for sensitivity and specificity is yet to be discovered. Until now, pH monitoring has been the gold standard for the diagnosis of GERD. However, there are many problems connected with using this method in clinical practice.
Similar content being viewed by others
References
Gallup Organization 1988: Heartburn across America: a Gallup Organization national survey. Princeton, NJ
Dodds WJ, Hauser R, Hogan WJ, Dent J: Gastroesophageal reflux (GER) and esophageal clearance in normal volunteers and patients with reflux esophagitis. In: Christensen J (ed.):Gastrointestinal Motility. New York: Raven Press, 1980, pp 87–88
Weiser HF, Bollschweiler E, Lange R, Siewert JR: Update on esophageal pH-monitoring. In: De Meester TR, Matthews HR (eds.):International Trends in General Thoracic Surgery, Vol. 3.Benign Esophageal Disease. St. Louis: C.V. Mosby (1987), pp 31–39
Jenkinson LR, Norris TL, Watson A: The role of acid exposure in the inition and progression of reflux oesophagitis. In Fuchs KH, Hamelmann H (eds.):Gastrointestinale Funktionsdiagnostik in der Chirurgie. Berlin: Blackwell Wissenschaft, 1991, pp 40–54
Johnson LF, DeMeester TR: Development of the 24-hour intraesophageal pH monitoring composite scoring system.J Clin Gastroenterol 8:52–58, 1986
Hölscher AH, Bollschweiler E, Bumm R: pH-Metrie von Oesophagus und Magen. In: Classen M, Siewert JR, Blum AL (ed.).Aktuelle gastroenterologische Diagnostik 2. Auflage, Berlin: Springer-Verlag, 1992
Fletcher RH, Fletcher SW, Wagner EH:Clinical Epidemiology—the Essentials. Baltimore: Williams & Wilkins, 1988, pp 43–44
Köbberling J, Trampisch H-J, Windeler J: Memorandum zur Evaluierung diagnostischer Methoden.Z Gastroenterol: 28:173–176, 1990
Pattrick FG: Investigation of gastroesophageal reflux in various positions with a two lumen pH electrode.GUT: 11:659–667, 1970
Johnson LF, DeMeester TR: 24-Hour pH-monitoring of the distal esophagus: a quantitative measure of gastroesophageal reflux.Am J Gastroenterol 62:325–332, 1974
Weiser HF, Pace F, Lepsien F, Müller-Lissner SA, Blum AL, Siewert JR: Gastroösophagealer Reflux: Was ist physiologisch?Dtsch Med Wochenschr 107:366–370, 1982
Murphy DW, Yuan Y, Castell DO: Does the intraoesophageal pH probe accurately detect acid reflux?Dig Dis Sci 34:649–656, 1989
Gustafsson PM, Tibbling L: 24-Hour oesophageal two-level pH-monitoring in healthy children and adolescents.Scand J Gastroenterol 23:91–94, 1988
Ball CS, Jenkinson LR, Watson A: Reproducibility of 24-hour oesophageal pH monitoring.Gut A723, 1988
Johnsson F, Joelsson B: Reproducibility of ambulatory oesophageal pH monitoring.Gut 29:886–889, 1988
Wiener GJ, Morgan TM, Cooper JB, Wu WC, Castell DO, Sinclair JW, Richter JE: Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters.Dig Dis Sci 33(9):1127–1133, 1988
Emde C, Garner A, Blum AL: Technical aspects of intraluminal pH-metry in man: current status and recommendations.Gut 28:1177–1188, 1987
DeMeester TR: Definition, detection, and pathophysiology of gastroesophageal reflux disease. In: De Meester TR, Matthews HR (eds):International Trends in General Thoracic Surgery, Vol 3.Benign Esophageal Disease. St. Louis: CV Mosby, 1987, pp 99–127
Schindlbeck NE, Heinrich Ch, König A, Dendorfer A, Pace F, Müller-Lissner St: Optimal thresholds, sensitivity and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease.Gastroenterology 93:85–90, 1987
Fuchs KH, DeMeester RT, Albertucci M: Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease.Surgery 102(4):575–580, 1987
Vitale GC, Cheadle WG, Sadek S, Michel ME, Cuschieri A: Computerized 24-hour ambulatory esophageal pH monitoring and esophago-gastroduodenoscopy in the reflux patient.Ann Surg 200:724–738, 1984
Jorgensen F, Elsborg L, Hesse B: The diagnostic value of computerized short-term esophageal pH-monitoring in suspected gastro-esophageal reflux.Scand J Gastroenterol 23:363–368, 1988
Bollschweiler E, Hölscher AH: Wertigkeit verschiedener diagnostischer Verfahren bei der Refluxkrankheit—eine prospecktive klinische Untersuchung. In: Fuchs KH, Hamelmann H (eds.):Gastrointestinale Funktionsdiagnostik in der Chirurgie. Berlin: Blackwell, 1991, pp 75–85
Johnson R, Joelsson B, Gudmundsson K, Grieff L: Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease.Scand J Gastroenterol 22:714–718, 1987
Klauser A, Schindlbeck N, Müller-Lissner SA: Symptoms in gastroesophageal reflux disease.Lancet 335:205–208, 1990
Richter JR, Castell DO: Gastroesophageal reflux: pathogenesis, diagnosis and therapy.Ann Intern Med 97:93–103, 1982
Johansson KE, Boeryd B, Fransson SG, Tibbling L: Esophageal reflux tests, manometry, endoscopy, biopsy and radiology in healthy subjects.Scand J Gastroenterol 21:399–406, 1986
Bollschweiler E, Feussner H, Hoelscher AH, Siewert JR: Reflux-esophagitis: correlation between endoscopic classification and gastroesophageal reflux-pattern in 24-h pH-metry.Gastroenterology A756, 1989
Bollschweiler E, Hoelscher AH, Feussner H, Dittler HJ, Siewert JR: Classification of reflux-esophagitis according to the severity of gastroesophageal reflux-pattern in 24-h pH-metry. Book of Abstracts; The World Congresses of Gastroenterology, 1990, p 38
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bollschweiler, E., Feussner, H., Hölscher, A.H. et al. pH monitoring: The gold standard in detection of gastrointestinal reflux disease?. Dysphagia 8, 118–121 (1993). https://doi.org/10.1007/BF02266991
Issue Date:
DOI: https://doi.org/10.1007/BF02266991