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Is pH Testing Necessary Before Antireflux Surgery in Patients with Endoscopic Erosive Esophagitis?

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The relationship between the Los Angeles (LA) grade of esophagitis and acid exposure by pH monitoring is unclear. The aim of this study was to correlate the results of pH testing in patients with esophagitis to determine at what LA grade of esophagitis a pH test is not necessary.

Methods

A retrospective review was performed of the records of all patients who underwent upper endoscopy and were found to have esophagitis graded using the LA system and who had pH monitoring from 2014 to 2016. An abnormal pH test was determined based on the DeMeester score.

Results

There were 56 patients with a median age of 57 years. Esophagitis was LA grade A in 19, B in 20, C in 15 and D in 2 patients. An abnormal pH score was present in 47 patients (84%). All patients with C or D esophagitis had an abnormal pH score compared to 79% and 75% of patients with A and B esophagitis, respectively.

Conclusions

The presence of LA C or D esophagitis was always associated with increased esophageal acid exposure on pH testing and is proof of reflux disease. However, pH testing is recommended prior to antireflux surgery in patients with LA A or B esophagitis.

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Authors and Affiliations

  1. Department of Surgery; Keck School of Medicine, University of Southern California, 1510 San Pablo Street, HCC I, 5th Floor, Los Angeles, CA, 90033, USA

    Katrin Schwameis, Brenda Lin, Jordan Roman & Ketetha Olengue

  2. Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Steve Siegal

  3. Division of Foregut and Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street Suite 6N60, Portland, OR, 97213, USA

    Steven R. DeMeester

Authors
  1. Katrin Schwameis
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  2. Brenda Lin
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  3. Jordan Roman
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  4. Ketetha Olengue
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  5. Steve Siegal
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  6. Steven R. DeMeester
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Contributions

All authors listed above contributed substantially to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; and all authors contributed to the drafting of the work or revising it critically for important intellectual content and the final approval of the version to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Steven R. DeMeester.

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This study was approved by the Institutional Review Board of the University of Southern California.

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Schwameis, K., Lin, B., Roman, J. et al. Is pH Testing Necessary Before Antireflux Surgery in Patients with Endoscopic Erosive Esophagitis?. J Gastrointest Surg 22, 8–12 (2018). https://doi.org/10.1007/s11605-017-3554-3

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  • DOI: https://doi.org/10.1007/s11605-017-3554-3

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