Abstract
At present, the ambulatory 24-hr pH test has been used as a diagnostic tool to assess gastroesophageal reflux disease (GERD) in those patients with reflux symptoms and a normal endoscopy. However, patients poorly tolerate the prolonged nature of the 24-hr test. The aim of this study was to determine whether analyzing a 3-hr postprandial period from a full 24-hr study would be as sensitive as the longer test. Data were analyzed from a standard ambulatory 24-hr pH recording. A positive test was determined if the pH was <4 for more than 4% of the study period with the probe placed 5 cm above the lower esophageal sphincter for both groups. The data were then reanalyzed by determining the percent time of pH < 4 during a 3-hr postprandial period. The results of 50 patients with a positive 24-hr test were compared with 50 patients with normal tests. The meal that was used to study the 3-hr postprandial period occurred in the late afternoon or early evening. The 3-hr postprandial test had a sensitivity of 88% when compared to the 24-hour test and a specificity of 98%. The positive predictive value was 100% for the 3-hr test, and the accuracy of this shorter test when compared with the standard 24-hour test was 95%. In conclusion the 3-hr postprandial analysis is a highly sensitive and specific test for demonstrating GERD. By using the shorter test, patient discomfort may be reduced and compliance enhanced.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Locke G, Talley N, Fett S: Prevalence and clinical spectrum of gastroesophageal reflux: A population based study in Olmsted County, Minnesota. Gastroenterology 112:1448-1456, 1997
Spechler S: Epidemiology and natural history of gastro-esophageal reflux disease. Digestion 5(suppl):24-29, 1992
Howden C, Castell D, Cohen S, Freston J: The rationale for continuous maintenance treatment of reflux esophagitis. Arch Intern Med 155:1465-1471, 1995
Howden CW: Optimizing the pharmacology of acid control in acidrelated disorders. Am J Gastroenterol 92(4 suppl):17S-21S, 1997
Ott D, McManus C, Ledbetter M, Chen M: Heartburn correlated to 24-hour pH monitoring and radiographic examination of the esophagus. Am J Gastroenterol 92:1827-1834, 1997
Johnston B, TroshinskyM, Castell J, Castell D: Comparison of barium radiology with esophageal pH monitoring in the diagnosis of gastroesophageal reflux disease. AmJ Gastroenterol 91:1181-1184, 1996
Richter J: Ambulatory esophageal pH monitoring. Am J Med 103:130S-134S, 1997
Castell D: pH monitoring versus other tests for GERD: is this the gold standard? In Ambulatory Esophageal pH Monitoring: Practical Approach and Clinical Applications, 2nd ed: J, Richter (ed.). Baltimore, Williams and Wilkins, 107-118, 1997
Shoenut J, Yaffe C: Ambulatory esophageal pH testing: referral patterns, indication and treatment in a Canadian teaching hospital. Dig Dis Scin 41:1102-1107, 1996
Dobhan R, Castell DO: Prolonged intra-esophageal pH monitoring with 16-hour overnight recording. Comparison with the 24-hour analysis. Dig Dis Sci 37:857-861, 1992
Schan C: What are the optimal length and setting for esophageal pH testing? In Ambulatory esophageal pH monitoring, 2nd ed (J, Richter (ed). Baltimore, Williams and Wilkins, p 46-56, 1997
MacMahon M, Murray J, Hogan B, Doyle JS, Courtney MG: 3 hour vs. 24 hour intra-oesophageal pH monitoring. Gut 30:A1492, 1989
Porro G, Pace F: Comparison of intraesophageal pH recording in the diagnosis of gastroesophageal reflux. Scand J Gastroenterol 23:743-750, 1988
Walther BTD: Comparison of 8-h and 16-h esophageal pH monitoring. In Esophageal Disorders: Pathophysiology and Therapy. New York, Raven Press, 1985 (T, DeMeester D, Skinner (eds). p589-591
Richter J: Do we know the cause of reflux disease? Eur J Gastroenterol Hepatol 11(suppl):S3-S9, 1999
Mittal R, Holloway R, Penagini R, Blackshaw L, Dent J: Transient lower esophageal sphincter relaxation. Gastroenterology 109:601-610, 1995
Klauser A, Heinrich C, Schindlbeck N, Müller-Lissner SA: Is longterm esophageal pH monitoring of clinical value? Am J Gastroenterol 84:362-365, 1989
Smith J, Opekun A, Larkai E, Graham DY: Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease. Gastroenterology 96:683-689, 1989
Schlessinger P, Donahue P, Schmid B, Layden TJ: Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology 89:797-804, 1985
Mearin F, Balboa A, Dot J, Maldonado O, Malagelada JR: How standard is a standard day during a standard ambulatory 24-hour esophageal pH monitoring? Scand J Gastroenterol 33:583-585, 1998
Schindlbeck N, Heinrich C, Konig A, Dendorfer A, Pace F, Müller-Lissner SA: Optimal thresholds, sensitivity and specificity of longterm pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85-90, 1987
Huang J-Q, Hunt R: pH, healing rate and symptom relief in patients with GERD. Yale J Biol Med 72:181-194, 1999
Shoenut J, Duerksen D, Yaffe C: Impact of ingested liquids on 24-hour ambulatory pH tests. Dig Dis Scie 43:834-839, 1998
Dhiman R, Saraswat V, Mishra A, et al: Inclusion of supine period in short-duration pH monitoring is essential in diagnosis of gastroesophageal reflux disease. Dig Dis Scie 41:764-772, 1996
Ours T, Richter J: Bravo pH vs ambulatory 24 hour catheter pH monitoring: a prospective assessment of patient satisfaction and impairment of daily activities. Gastroenterology 122(4):W1174, 2002 (abstract)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Arora, A.S., Murray, J.A. Streamlining 24-Hour pH Study for GERD: Use of a 3-Hour Postprandial Test. Dig Dis Sci 48, 10–15 (2003). https://doi.org/10.1023/A:1021765827272
Issue Date:
DOI: https://doi.org/10.1023/A:1021765827272