Dual-Channel Ambulatory Esophageal pH Monitoring (A Useful Diagnostic Tool?)
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Ambulatory pH monitoring of the distal esophagusis the most accurate diagnostic study for patients withsuspected gastroesophageal reflux disease (GERD). Themeasurement of proximal esophageal acid exposure time may be useful in patients with atypicalreflux symptoms. The aim of this study is to evaluate ifproximal esophageal pH monitoring provides usefulinformation beyond that learned with distal esophageal pH monitoring. We routinely performeddual-channel pH monitoring with pH electrodes positionedat 20 and 5 cm above the manometric lower esophagealsphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero(none) to four (severe). We compared proximal esophagealreflux (PR) in patients with typical symptoms (i.e.,heartburn, regurgitation) and in patients with atypical symptoms (i.e., chest pain, cough, hoarseness,and asthma). We compared symptom profiles betweenpatients with and without PR. We reviewed our experiencein patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied441 consecutive patients. There were no significantdifferences in PR between patients with typical andatypical symptoms. There were no differences in symptom profiles between patients with normal andabnormal PR. There were no differences of PR between thedifferent atypical symptoms. PR did not correlate withthe severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients hadisolated abnormal PR, but only six patients improvedwith antireflux therapy. We conclude that routineambulatory esophageal pH monitoring of the proximalesophagus appears to be of little value. The decision tooffer patients an empiric trial of antireflux therapyfor suspected GERD should not be based on the presenceor absence of PR.
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