24-hour pH monitoring in symptomatic patients without erosive esophagitis who did not respond to antireflux treatment.
Twenty symptomatic patients without erosive esophagitis underwent 24-h esophageal pH monitoring after failing standard medical antireflux treatment. Sixty-five percent had abnormal esophageal acid exposure, and the majority of these improved on proton pump inhibitor therapy. However, 35% had a normal 24-h pH test. One patient had coronary artery disease, one had diffuse esophageal spasm, and two had a negative work-up and no improvement with omeprazole. Consequently, we suggest that patients like these have an omeprazole trial. If symptoms persist, 24-h esophageal pH monitoring can appropriately define more rational management. Patients with abnormal esophageal acid exposure will require more aggressive acid-control therapy, whereas those with normal esophageal acid exposure will need further work-up to assess the cause of their symptoms.
Fass
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University of Arizona Health Sciences Center, Tucson.
Mackel
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Sampliner
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RE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D004941:Esophagitis; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D017211:Treatment Failure
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole