PMID- 15667483
OWN - NLM
STAT- MEDLINE
DCOM- 20050301
LR  - 20131121
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 100
IP  - 2
DP  - 2005 Feb
TI  - The role of esophageal pH monitoring in symptomatic patients on PPI therapy.
PG  - 283-9
AB  - BACKGROUND: Ambulatory pH monitoring while on therapy is often recommended in 
      gastroesophageal reflux disease (GERD) patients with continued symptoms. However, 
      to date, little data exist to justify this indication. AIM: To assess the role of 
      pH monitoring in symptomatic patients despite aggressive therapy with typical or 
      extra esophageal GERD. METHODS: Retrospective review of 2,291 ambulatory pH 
      tracings (1999-2003) identified subgroup of studies performed on proton pump 
      inhibitor (PPI) therapy. Patients with prior fundoplication or Barrett's 
      esophagus were excluded. Patients grouped on predominant presenting GERD 
      symptoms: typical (heartburn and regurgitation) or extra esophageal (chest pain, 
      cough, hoarseness, sore throat, shortness of breath, asthma). The distribution of 
      abnormal pH parameters in each group calculated and univariate analyses assessed 
      the probability of abnormal pH in each group. Abnormal cutoff values 
      traditionally used in clinical practice and more stringent cutoff values used to 
      determine distribution of abnormality as a function of cutoff values. RESULTS: A 
      total of 250 patients (mean age 54.3 yrs, 59% female) underwent pH monitoring on 
      either daily (b.i.d.) or twice daily (q.d.) on PPI therapy: 115 (46%) with extra 
      esophageal and 135 (54%) with typical GERD symptoms. Extra esophageal GERD 
      patients were more likely to undergo pH monitoring on b.i.d. PPIs (OR = 2.7; 95% 
      CI = 1.6-4.4; p < 0.01). 52 (93%) of typical and 74 (99%) of extra esophageal 
      GERD patients on b.i.d. PPIs tested normal. The odds of a normal pH values were 
      11 times higher for patients on b.i.d. PPIs (OR = 11.4; 95% CI = 4.3-30.1, p < 
      0.01) than those on q.d. PPIs. CONCLUSIONS: 1) The likelihood of an abnormal 
      esophageal pH for symptomatic GERD patients on b.i.d. PPI is very small. 2) In 
      this group of patients failing b.i.d. PPIs causes other than GERD should be 
      sought.
FAU - Charbel, Samer
AU  - Charbel S
AD  - Departments of Gastroenterology and Hepatology, Center for Swallowing and 
      Esophageal Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, 
      OH 44195, USA.
FAU - Khandwala, Farah
AU  - Khandwala F
FAU - Vaezi, Michael F
AU  - Vaezi MF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Am J Gastroenterol. 2005 Aug;100(8):1893-4; author reply 1894. PMID: 16086728
MH  - Adult
MH  - Esophagus/*metabolism
MH  - Female
MH  - Gastroesophageal Reflux/*drug therapy/metabolism
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - *Monitoring, Ambulatory
MH  - *Proton Pump Inhibitors
EDAT- 2005/01/26 09:00
MHDA- 2005/03/02 09:00
CRDT- 2005/01/26 09:00
PHST- 2005/01/26 09:00 [pubmed]
PHST- 2005/03/02 09:00 [medline]
PHST- 2005/01/26 09:00 [entrez]
AID - AJG41210 [pii]
AID - 10.1111/j.1572-0241.2005.41210.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2005 Feb;100(2):283-9. doi: 10.1111/j.1572-0241.2005.41210.x.