title: Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group.
abstract: Gastroesophageal reflux disease (GERD) can be difficult to diagnose - symptoms alone are often not enough, and thus, objective testing is often required. GERD is a manifestation of pathologic levels of reflux into the esophagus of acidic, nonacidic, and/or bilious gastric content. However, in our current evidence-based knowledge approach, we only have reasonable outcome data in regards to acid reflux, as this particular type of refluxate predictably causes symptoms and mucosal damage, which improves with medical or surgical therapy. While there are data suggesting that nonacid reflux may be responsible for ongoing symptoms despite acid suppression in some patients, outcome data about this issue are limited. Therefore, this working group believes that it is essential to confirm the presence of acid reflux in patients with 'refractory' GERD symptoms or extraesophageal symptoms thought to be caused by gastroesophageal reflux before an escalation of antireflux therapy is considered. If patients do not have pathologic acid reflux off antisecretory therapy, they are unlikely to have clinically significant nonacid or bile reflux. Patients who do not have pathologic acid gastroesophageal reflux parameters on ambulatory pH monitoring then: (i) could attempt to discontinue antisecretory medications like proton pump inhibitors and H2-receptor antagonists (which are expensive and which carry risks - i.e. C. diff, etc.); (ii) may undergo further evaluation for other causes of their esophageal symptoms (e.g. functional heartburn or chest pain, eosinophilic esophagitis, gastroparesis, achalasia, other esophageal motor disorders); and (iii) can be referred to an ear, nose, and throat/pulmonary/allergy physician for assessment of non-GERD causes of their extraesophageal symptoms.
authors.affiliation: Esophageal Diagnostic Working Group, Digestive Disease Week 2011, Chicago, Illinois, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Richter
authors.forename: J E
authors.initials: JE
authors.lastname: Pandolfino
authors.forename: M F
authors.initials: MF
authors.lastname: Vela
authors.forename: P J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: B E
authors.initials: BE
authors.lastname: Lacy
authors.forename: R
authors.initials: R
authors.lastname: Ganz
authors.forename: W
authors.initials: W
authors.lastname: Dengler
authors.forename: B K
authors.initials: BK
authors.lastname: Oelschlager
authors.forename: J
authors.initials: J
authors.lastname: Peters
authors.forename: K R
authors.initials: KR
authors.lastname: DeVault
authors.forename: R
authors.initials: R
authors.lastname: Fass
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
authors.forename: J
authors.initials: J
authors.lastname: Conklin
authors.forename: T
authors.initials: T
authors.lastname: DeMeester
mesh_terms: D026683:Advisory Committees; D015154:Esophageal Motility Disorders / Q000175:diagnosis; D050782:Esophageal pH Monitoring / Q000295:instrumentation*; D004947:Esophagus / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D059015:Wireless Technology / Q000295:instrumentation
chemical_list: D054328:Proton Pump Inhibitors