Accurate positioning of the 24-hour pH monitoring catheter: agreement between manometry and pH step-up method in two patient positions.
OBJECTIVE
To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions.


METHODS
Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed.


RESULTS
In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (< or = 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position.


CONCLUSIONS
In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.
Can
Mehmet-Fatih
MF
Department of General Surgery, Gulhane Military Medical Academy, Kent Koop Mh. 11.Cd. Guneyce Merkez Sit. A/10, 06370, Batikent Ankara, Turkey. mfcan@gata.edu.tr
Yagci
Gokhan
G
Cetiner
Sadettin
S
Gulsen
Mustafa
M
Yigit
Taner
T
Ozturk
Erkan
E
Gorgulu
Semih
S
Tufan
Turgut
T
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D050782:Esophageal pH Monitoring / Q000295:instrumentation*; D004947:Esophagus / Q000502:physiology*; D019317:Evidence-Based Medicine; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D016684:Prone Position / Q000502:physiology*; D016683:Supine Position / Q000502:physiology*