Five-year audit of ambulatory 24-hour esophageal pH-manometry in clinical practice.
BACKGROUND
Esophageal function testing was developed to aid diagnosis in patients with negative endoscopy. Although combined 24-h esophageal pH-manometry is now commercially available, its routine clinical effectiveness has not yet been studied.


METHODS
From 1992 to 1996 we evaluated 303 consecutive patients who were first-time referrals to our unit for 24-h esophageal pH-manometry. The referral indications were gastroesophageal reflux disease, 47.2%; dysphagia, 18.5%; non-cardiac chest pain, 14.9%; connective tissue disease, 13.2%; and symptomatic patients after antireflux surgery, 6.3%.


RESULTS
Overall, esophageal function testing altered the diagnosis of 44% of the patients, confirmed it in 38%, and specifically changed the management of 66%. The final clinical 'diagnosis' was reflux disease, 54% (32% with non-specific esophageal motility disorder); connective tissue disease, 9.9%; achalasia, 9.6%; other specific esophageal motility disorders, 3.3%; non-specific esophageal motility disorders, 6.9%; and normal, 16.2%. The cost per testing was estimated to be US$305 and per change in management US$465.


CONCLUSIONS
Combined 24-h pH-manometry has been shown to be a useful and cost-effective test for the management of selected patients in whom the primary investigation was insufficient.
Netzer
P
P
Dept. of Medicine, Inselspital, University of Berne, Switzerland.
Gut
A
A
Heer
R
R
Gries
N
N
Pfister
M
M
Halter
F
F
Inauen
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis; D003240:Connective Tissue Diseases / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D019468:Disease Management; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000191:economics* / Q000379:methods; D008485:Medical Audit; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies