Skip to main content
SpringerLink
Log in

The Value of Ambulatory 24 hr Esophageal pH Monitoring in Clinical Practice in Patients Who Were Referred with Persistent Gastroesophageal Reflux Disease (GERD)-Related Symptoms While on Standard Dose Anti-Reflux Medications

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

To determine the value of pH testing in clinical practice in gastroesophageal reflux disease patients who failed anti-reflux treatment. Patients resistant to standard dose proton pump inhibitor or an H2-blocker underwent pH testing. Randomly selected patients from the proton pump inhibitor failure group underwent the modified acid perfusion test as compared to patients with non-erosive reflux disease. In the proton pump inhibitor failure group (n = 70), 63.8% had a normal pH test as compared to 29% in the H2-blocker group (n = 31) (P = 0.007). Sensory intensity rating and acid perfusion sensitivity score were significantly higher in the non-erosive reflux disease control group than the proton pump inhibitor failure group (P < 0.05). Most patients who continued to be symptomatic on proton pump inhibitor once daily demonstrated a normal pH test and overall lack of increased chemoreceptor sensitivity to acid.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hunt RH: Importance of pH control in the management of GERD. Arch Intern Med 159:649–657, 1999

    Article  PubMed  Google Scholar 

  2. Sifrim D, Holloway R, Silny J, Xin Z, Tack J, Lerut A, Janssens J: Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24 hr pH-impedance recordings. Gastroenterology 120:1862–1864, 2001

    Article  PubMed  Google Scholar 

  3. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO: Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 120:1599–1606, 2001

    PubMed  Google Scholar 

  4. Tack J, Fass R: Approaches to endoscopic-negative reflux disease: part of the GERD spectrum or a unique acid-related disorder? Aliment Pharmacol Ther 19:28–34, 2004

    Article  PubMed  Google Scholar 

  5. Fass R: Gastroesophageal reflux disease revisited. Gastroenterol Clin North Am 31:S1–S10, 2002

    Article  PubMed  Google Scholar 

  6. Leite LP, Johnston BT, Just RJ, Castell DO: Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy. Am J Gastroenterol 91:1527–1531, 1996

    PubMed  Google Scholar 

  7. Klinkenberg-Knol EC, Meuwissen SG: Combined gastric and oesophageal 24 hr pH monitoring and oesophageal manometry in patients with reflux disease, resistant to treatment with omeprazole. Aliment Pharmacol Ther 4:485–495, 1990

    PubMed  Google Scholar 

  8. Savarino V, Mela GS, Zentilin P, Celle G: Is gastric acid hypersecretion the only reason for refractory gastroesophageal reflux disease? Gastroenterology 99, 1990

  9. Carlsson R, Dent J, Watts R, Riley S, Sheikh R, Hatlebakk J, Haug K, de Groot G, van Oudvorst A, Dalvag A, Junghard O, Wiklund I: Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. International GORD Study Group. Eur J Gastroenterol Hepatol 10:119–124, 1998

    Google Scholar 

  10. Fass R, Fennerty MB, Vakil N: Nonerosive reflux disease—current concepts and dilemmas. Am J Gastroenterol 96:303–314, 2001

    PubMed  Google Scholar 

  11. Fass R: Epidemilogy and pathophysiology of symptomatic gastroesophageal reflux disease. Am J Gastroenterol 98:S2–S7, 2003

    Article  PubMed  Google Scholar 

  12. Kahrilas PJ, Quigley EM: American Gastroenterological Association Medical Position Statement: guidelines on the use of esophageal pH recording. Gastroenterology 110:1981–1996, 1996

    Article  PubMed  Google Scholar 

  13. Dekel R, Malagon IB, Green C, Fass R: Abstract: Comparison of transnasaly placed wireless pH capsule (BRAVO) versus traditional 24 hr esophageal pH monitoring—A randomized trial. Am J Gastroenterol 98(108):S38, 2003

    Article  Google Scholar 

  14. Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, Richter JE: Ambulatory 24 hr esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci 33:1127–1133, 1988

    Article  Google Scholar 

  15. Richter JE, Hewson EG, Sinclair JW, Dalton CB: Acid perfusion test and 24 hr esophageal pH monitoring with symptom index. Comparison of tests for esophageal acid sensitivity. Dig Dis Sci 36:565–571, 1991

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  17. 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, 1995

    PubMed  Google Scholar 

  18. Hobson A, Matthews P, Furlong P, Qasim A: Abstract: The role of esophageal afferent pathway sensitivity in non-erosive reflux disease. Gastroenterology 4(128):A-18, 2004

    Google Scholar 

  19. Gracely RH, McGrath P, Dubner R: Ratio scales of sensory and affective verbal pain descriptors. Pain 5:5–18, 1978

    Article  PubMed  Google Scholar 

  20. Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA: Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology 112:64–72, 1997

    PubMed  Google Scholar 

  21. Dekel R, Morse C, Fass R: The role of proton pump inhibitors in gastro-oesophageal reflux disease. Drugs 64:277–295, 2004

    PubMed  Google Scholar 

  22. Chiba N, De Gara CJ, Wilkinson JM, Hunt RH: Speed of healing and symptom relief in grade II and IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology 112:1798–1810, 1997

    Article  PubMed  Google Scholar 

  23. Vaezi MF, Charbel S: Abstract: On-therapy pH monitoring: usually recommended but should we do it? Gastroenterology 126(640):A-82, 2004

    Google Scholar 

  24. Levy AH, Benwait KS, DiMarino AJ, Cohen S: Abstract: Utility of twenty-four hour esophageal pH monitoring in patients with persistent symptoms on PPI therapy. Gastroenterology 126(132):A-19, 2004

    Google Scholar 

  25. Steinbach J, Fass R, Mittal R: Assessment of relationship between acid reflux and heartburn suing receiver operating characteristics curves. Gastroenterol Clin North Am 31:S35–S58, 2002

    PubMed  Google Scholar 

  26. Katz PO: Editorial: Diagnosis and therapy of noncardiac chest pain: a clinical dilemma. J Clin Gastroenterol 35:292–294, 2002

    Article  PubMed  Google Scholar 

  27. Fass R, Ofman J, Sampliner RE, Camargo L, Wendel C, Fennerty MB: The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive esophagitis. Aliment Pharmacol Ther 14:389–396, 2000

    Article  PubMed  Google Scholar 

  28. Venables TL, Newland RD, Patel AC, Hole J, Wilcock C, Tubitt ML: Omeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol 32:965–973, 1997

    PubMed  Google Scholar 

  29. Cloud ML, Offen WW, Robinson M: Nizatidine versus placebo in gastroesophageal reflux disease: a 12-week, multicenter, randomized, double-blind study. Am J Gastroenterol 86:1735–1742, 1991

    PubMed  Google Scholar 

  30. Sabesin SM, Berline RG, Humphries TJ, Bradstreet DC, Walton-Bowen KL, Zaidi S: Famotidine relieves symptoms of gastroesophageal reflux disease and heals erosions and ulcerations. Results of a multicenter, placebo-controlled, dose-ranging study. USA Merck Gastroesophageal Reflux Disease Study Group. Arch Intern Med 151:2394–2400, 1991

    Article  PubMed  Google Scholar 

  31. Kahrilas PJ, Fennerty MB, Joelsson B: High- versus standard dose ranitidine for control of heartburn in poorly responsive acid reflux disease: a prospective, controlled trial. Am J Gastroenterol 94:92–97, 1999

    Article  PubMed  Google Scholar 

  32. Fass R, Murthy U, Hayden CW, Malagon IB, Pulliam G, Wendel C, Kovacs TO: Omeprazole 40 mg once a day is equally effective as lansoprazole 30 mg twice a day in symptom control of patients with gastro-oesophageal reflux disease (GERD) who are resistant to conventional-dose lansoprazole therapy—a prospective, randomized, multi-centre study. Aliment Pharmacol Ther 14:1595–1603, 2000

    Article  PubMed  Google Scholar 

  33. Fass R, Tougas G: Functional heartburn: the stimulus, the pain, and the brain. Gut 51:885–892, 2002

    Article  PubMed  Google Scholar 

  34. Castell DO, Kahrilas PJ, Richter JE, Vakil NB, Johnson DA, Zuckerman S, Skammer W, Levine JG: Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis. Am J Gastroenterol 97:575–583, 2002

    Article  PubMed  Google Scholar 

  35. Dekkers CP, Beker JA, Thjodleifsson B, Gabryelewicz A, Bell NE, Humphries TJ: Double-blind comparison [correction of Double-blind, placebo-controlled comparison] of rabeprazole 20 mg vs. omeprazole 20 mg in the treatment of erosive or ulcerative gastro-oesophageal reflux disease. The European Rabeprazole Study Group. Aliment Pharmacol Ther 13:49–57, 1999

    Article  PubMed  Google Scholar 

  36. Mossner J, Holscher AH, Herz R, Schneider A: A double-blind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis: a multicentre trial. Aliment Pharmacol Ther 9:321–326, 1995

    PubMed  Google Scholar 

  37. Kahrilas PJ, Falk GW, Johnson DA, Schmitt C, Collins DW, Whipple J, D'Amico D, Hamelin B, Joelsson B: Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial. The Esomeprazole Study Investigators. Aliment Pharmacol Ther 14:1249–1258, 2000

    Article  PubMed  Google Scholar 

  38. Dean BB, Gano A, Jr, Knight K, Ofman J, Fass R: Effectiveness of proton pump inhibitors in non-erosive reflux disease (NERD). Clin Gastroenterol Hepatol 2:656–664, 2004

    Article  PubMed  Google Scholar 

  39. Lind T, Havelund T, Carlsson R: Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Scand J Gastroenterol 32:974–979, 1997

    PubMed  Google Scholar 

  40. DeMeester TR, Wang CI, Wenly JA, Pellegrini CA, Little AG, Klementschitsch P, Bermudez G, Johnson LF, Skinner DB: Technique, indications, and clinical use of 24 hr esophageal pH monitoring. J Thorac Cardiovasc Surg 79:656–670, 1980

    PubMed  Google Scholar 

  41. Schenk BE, Juipers EJ, Klinkenberg-Knol EC, Festen HP, Jansen EH, Tuynman HA, Schrijver M, Dieleman LA, Meuwissen SG: Omeprazole as a diagnostic tool in gastroesophageal reflux disease. Am J Gastroenterol 92:1997–2000, 1997

    PubMed  Google Scholar 

  42. Trimble KC, Farouk R, Pryde A, Douglas S, Heading RC: Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity. Dig Dis Sci 40:1607–1613, 1995

    Article  PubMed  Google Scholar 

  43. Pehlivanov N, Liu J, Mittal R: Sustained esophageal contraction: a motor correlate of heartburn symptom. Am J Physiol Gastrointest Liver Physiol 281:G743–G751, 2001

    PubMed  Google Scholar 

  44. Tack J, Koek G, Demedts I, Sifrim D, Janssens J: Gastroesophageal reflux disease poorly responsive to single-dose proton pump inhibitors in patients without Barrett's esophagus: reflux, bile reflux, or both? Am J Gastroenterol 99:981–990, 2004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Southern Arizona VA Health Care System, University of Arizona College of Medicine, Tucson, Arizona, USA

    Jimmy M. Bautista MD, Wai-man Wong MD, Gloria Pulliam MD, Romeo F. Esquivel MD & Ronnie Fass MD

  2. Gastroenterology Section (1-111G-1), Southern Arizona VA Health Care System, Tucson, Arizona, 85723-0001, USA

    Ronnie Fass MD

Authors
  1. Jimmy M. Bautista MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wai-man Wong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gloria Pulliam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Romeo F. Esquivel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ronnie Fass MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronnie Fass MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bautista, J.M., Wong, Wm., Pulliam, G. et al. The Value of Ambulatory 24 hr Esophageal pH Monitoring in Clinical Practice in Patients Who Were Referred with Persistent Gastroesophageal Reflux Disease (GERD)-Related Symptoms While on Standard Dose Anti-Reflux Medications. Dig Dis Sci 50, 1909–1915 (2005). https://doi.org/10.1007/s10620-005-2960-7

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-005-2960-7

Key Words

Search

Navigation