title: Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) affects nearly 25 % of adults; however, an objective diagnosis is rarely established. We hypothesized that patients' symptoms and response to acid-reducing therapy are poor predictors of the outcome of 24-h esophageal pH monitoring.
  
  
  METHODS
  A review of 24-h esophageal pH monitoring studies performed at an ambulatory tertiary care center between 2004 and 2011 was performed. Demographics, type of GERD symptoms, and duration and response to acid-reducing medications before referral for pH monitoring were collected. DeMeester score, symptom sensitivity index (SSI), and symptom index (SI) were tabulated and compared with the patients' symptoms and response to medical therapy.
  
  
  RESULTS
  One hundred patients were included. Of all reported symptoms, only heartburn was more common in patients with positive DeMeester scores, but there were no correlations between any symptoms and SSI or SI scores. Sixty-nine percent of patients with esophageal symptoms had a positive DeMeester score compared with only 29 % of patients with extraesophageal symptoms (P < 0.01). Esophageal symptoms and endoscopic evidence of GERD significantly increased the likelihood of having a positive DeMeester score, but they had no influence on SSI or SI scores. There was no correlation between response to acid-reducing medications and DeMeester, SSI, or SI scores. A total of 536 person-years of acid-reducing medications were prescribed to the study population, of which 151 (28 %) were prescribed to patients who had a negative pH study.
  
  
  CONCLUSIONS
  Extraesophageal symptoms and response to empiric trials of acid-reducing medications are poor predictors of the presence of GERD and the DeMeester score is more likely to identify GERD in patients who met other empiric diagnostic criteria than SSI or SI. Early referral for 24-h esophageal pH monitoring may avoid lengthy periods of unnecessary medical therapy.
authors.affiliation: Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, 525 East 68th Street, F-2024, New York, NY 10065, USA. dak2011@nyp.org
authors.forename: David A
authors.initials: DA
authors.lastname: Kleiman
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sporn
authors.forename: Toni
authors.initials: T
authors.lastname: Beninato
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Metz
authors.forename: Carl
authors.initials: C
authors.lastname: Crawford
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fahey
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
mesh_terms: D004363:Drug Utilization; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors