title: Ambulatory reflux monitoring in GERD--which test should be performed and should therapy be stopped?
abstract: Diagnosing gastroesophageal reflux disease (GERD) often entails using a combination of patient symptoms, response to proton pump inhibitors (PPI), upper endoscopy, and ambulatory reflux testing. Each of these has limitations of which the clinician must be aware when managing patients with reflux symptoms. Ambulatory reflux monitoring, in particular, can potentially document the true presence of pathologic GERD. Consequently, reflux testing is often necessary in our evaluation of patients with reflux symptoms, and can be useful in distinguishing etiologies driving a lack of response to PPI therapy. Reflux testing results can be also used to guide appropriate PPI prescribing and clinical decision making for appropriate or unnecessary therapy. This review focuses on the limitations of our current diagnostic paradigm and highlights how reflux testing can be helpful in the diagnosis and management of patients with poor response to PPI therapy.
authors.affiliation: Department of Medicine, The Feinberg School of Medicine, Northwestern University, 676 St Clair St, Suite 1400, Chicago, IL 60611-2951, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gawron
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000465:Algorithms; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D050782:Esophageal pH Monitoring; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D018670:Monitoring, Ambulatory / Q000379:methods*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors