Wireless pH monitoring in patients with non-cardiac chest pain.
OBJECTIVE
Gastroesophageal reflux disease (GERD) is an important cause of non-cardiac chest pain (NCCP), and its detection can require ambulatory pH monitoring. The purpose of this study was to determine the advantages of a wireless ambulatory pH monitoring system and 2 days of recording in diagnosing GERD in NCCP patients.


METHODS
Results from ambulatory pH studies using the BRAVO capsule were reviewed from 62 subjects referred for evaluation of NCCP after non-diagnostic response to proton pump inhibitor therapy. Acid exposure time (AET) and symptom-reflux association tests were calculated after 1 day of recording and compared to the final outcome from the 2-day study.


RESULTS
Extending the recording time increased the number of subjects having elevated AET from 16 after 1 day to 22 after 2 days of recording, a 9.7% gain in subjects (95% CI 4.6-19.6%). The number of chest pain episodes doubled from 1 to 2 days, and 4 subjects (7.3%) developed symptoms only on the second day of monitoring. Statistically significant reflux-symptom association probabilities surfaced in an additional 13 subjects (21.0%; 95% CI 12.7-32.7%) by the conclusion of the 2-day study. The effect primarily was to identify significant associations in patients with lower proportions of reflux-associated symptoms. Taken together, 19.4% (95% CI 11.5-30.9%) of the subject group gained meaningful information suggesting a reflux diagnosis by extending the pH monitoring time to 2 days.


CONCLUSIONS
Extending monitoring to 2 days with a wireless pH monitoring system increases the detection of GERD in a clinically significant proportion of patients with NCCP.
Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8124, St. Louis, MO 63110, USA.
Chandra
C
Prakash
Ray E
RE
Clouse
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D020701:Esophagoscopes; D005260:Female; D005745:Gastric Acidity Determination / Q000295:instrumentation*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization / Q000295:instrumentation*; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D054328:Proton Pump Inhibitors; D015203:Reproducibility of Results
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors