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Acid Perfusion Test: A Useful Test for Evaluating Esophageal Acid Sensitivity

Digestive Diseases and Sciences volume 50, pages 1611–1615 (2005)Cite this article

Abstract

The acid perfusion test (APT) is a test of esophageal acid sensitivity. In gastroesophageal reflux disease (GERD), the APT has largely been superseded by indexes derived from 24-hr esophageal pH monitoring: symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP). To evaluate the role of APT in patients with GERD we compared values of SI, SSI, and SAP in 126 APT+ and 146 APT− patients. Median values for SI, SSI, and SAP were higher in the APT+ compared with the APT− group (P < 0.001). More patients had a positive SI, SSI, and SAP in the APT+ compared with the APT– group (SI, P < 0.0001; SSI and SAP, P < 0.001). Patients with a negative APT were unlikely to have symptoms caused by acid reflux (negative predictive value, 86%). APT may be useful in detecting acid sensitivity in patients who do not report symptoms on 24-hr esophageal pH monitoring.

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References

  1. Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd: Prevalence and clinical spectrum of gastroesophageal reflux: a population based study in Olmsted County, Minnesota. Gastroenterology 112:1448–1456, 1997

    PubMed  Google Scholar 

  2. Radu T, Castell DO: Management of gastroesophageal reflux disease. Am J Med Sci 326(5):309–318, 2003

    Google Scholar 

  3. Klauser AG, Schindlebeck NE, Muellar-Lissner SA: Symptoms of gastro-oesophageal reflux disease. Lancet 335:205–208, 1990

    Article  CAS  PubMed  Google Scholar 

  4. Chan CC, Lee CL, Wu CH: Twenty-four-hour ambulatory esophageal pH monitoring in patients with symptoms of gastroesophageal reflux. J Formos Med Assoc 96:874–878, 1997

    CAS  PubMed  Google Scholar 

  5. Shi G, Bruley des Varannes S, Scarpignato C, Le Rhun M, Galmiche JP: Reflux related symptoms in patients with normal oesophageal exposure to acid. Gut 37(4):457–464, 1995

    CAS  PubMed  Google Scholar 

  6. Bernstein LM, Baker LA: A clinical test for esophagitis. Gastroenterology 34:760–781, 1958

    CAS  PubMed  Google Scholar 

  7. DeMeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB: Patterns of gastroesophageal reflux in health and disease. Ann Surg 184(4):459–470, 1976

    CAS  PubMed  Google Scholar 

  8. Richter JE, Bradley LA, DeMeester TR, Wu WC: Normal 24hr ambulatory oesophageal pH values: influence of study centre, pH electrode, age and gender. Dig Dis Sci 37:849–856, 1992

    Article  CAS  PubMed  Google Scholar 

  9. Johnson LF, DeMeester TR: Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 8 (Suppl 1):52–58, 1986

    PubMed  Google Scholar 

  10. Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO: The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol 83:358–361, 1988

    CAS  PubMed  Google Scholar 

  11. Breurnelhof R, Smout AJPM: The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH recording. Am J Gastroenterol 86:160–164, 1991

    Google Scholar 

  12. Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ: The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology 107:1742–1745, 1994

    Google Scholar 

  13. Anderson SHC, Anggiansah A, Arastu MH, Anggiansah R, Owen WJ: Heartburn in patients with untreated achalasia. Gastroenterology 122(4):A213, 2002

    Google Scholar 

  14. Singh S, Richter JE, Bradley LA, Haile JM: The symptom index: differential usefulness in suspected acid-related complaints of heartburn and chest pain. Dig Dis Sci 38:1402–1408, 1993

    Article  CAS  PubMed  Google Scholar 

  15. Shi G, Tatum RP, Joehl RJ, Kahrilas PJ: Esophageal sensitivity and symptom perception in gastroesophageal reflux disease. Curr Gastroenterol Rep 1:214–219, 1999

    CAS  PubMed  Google Scholar 

  16. Richter JE: Disorders of esophageal function. In Gastrointestinal Motility Disorders for the Clinician: practical Guidelines for Patient Care. McCallum RW, Phillips SF, Reynolds JC (eds). New York, Academy Professional Information Services, 1998, pp 5.1–28

    Google Scholar 

  17. Jung B, Steinbach J, Beaumont C, Mittal RK: Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing. Am J Gastroenterol 99(3):416–418, 2004

    Article  Google Scholar 

  18. Howard PJ, Maher L, Pryde A, Heading RC: Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease. Gut 32:128–132, 1991

    CAS  PubMed  Google Scholar 

  19. Trimble KC, Douglas S, Pryde A, Heading RC: Clinical characteristics and natural history of symptomatic but not excess gastroesophageal reflux. Dig Dis Sci. 40(5):1098–1104, 1995

    Article  CAS  PubMed  Google Scholar 

  20. Rodriguez-Stanley S, Robinson M, Earnest DL, Greenwood-Van Meerveld B, Miner PB: Esophageal hypersensitivity may be a major cause of heartburn. Am J Gastroenterol 94(3):628–631, 1999

    Article  CAS  PubMed  Google Scholar 

  21. Trimble KC, Pryde A, Heading RC: Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. Gut 37:7–12, 1994

    Google Scholar 

  22. Richter JE: Diagnostic tests for gastroesophageal reflux disease. Am J Med Sci 326(5):300–308, 2003

    PubMed  Google Scholar 

  23. Wiener GJ, Morgan TM, Copper 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

    CAS  Google Scholar 

  24. Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ, Lauritsen K, Reynolds JC, Shaw M, Talley NJ: An evidence-based appraisal of reflux disease management—the Genval Workshop Report. Gut 44 (Suppl 2):S1–S16, 1998

    Google Scholar 

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Affiliations

  1. Department of Gastroenterology, Hemel Hempstead General Hospital, Hillfield Road, Hemel Hempstead, Herts, HP2 4AD

    Alistair L. King PhD

  2. Oesophageal Laboratory, St Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH, UK

    Angela Anggiansah & Roy Anggiansah BSc

  3. Department of Gastroenterology, St Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH, UK

    Terry Wong MD

  4. Department of Gastroenterology, Hemel Hempstead General Hospital, Hillfield Road, Hemel Hempstead, Herts, HP2 4AD, UK

    Alistair L. King PhD

Authors
  1. Alistair L. King PhD
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  2. Angela Anggiansah
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  3. Roy Anggiansah BSc
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  4. Terry Wong MD
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Correspondence to Alistair L. King PhD.

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King, A.L., Anggiansah, A., Anggiansah, R. et al. Acid Perfusion Test: A Useful Test for Evaluating Esophageal Acid Sensitivity. Dig Dis Sci 50, 1611–1615 (2005). https://doi.org/10.1007/s10620-005-2904-2

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  • DOI: https://doi.org/10.1007/s10620-005-2904-2

Keywords

  • acid perfusion test
  • Bernstein test
  • gastroesophageal reflux disease
  • esophageal acid sensitivity
  • pH monitoring