title: The value of early wireless esophageal pH monitoring in diagnosing functional heartburn in refractory gastroesophageal reflux disease.
abstract: OBJECTIVE
  It is difficult to differentiate functional heartburn from proton pump inhibitor (PPI) failure. The aims of this study were to assess the role of early wireless esophageal pH monitoring in patients referred with gastroesophageal reflux disease (GERD) and to identify differences in the clinical spectrum among GERD subtypes.
  
  
  METHODS
  We enrolled consecutive referred patients with suspected GERD. After endoscopy on the first visit, all underwent wireless esophageal pH monitoring when off the PPI.
  
  
  RESULTS
  Two hundred thirty patients were enrolled. These patients were classified into a reflux esophagitis group (20, 8.7 %) and a normal endoscopic findings group (210, 91.3 %). Among the 210 patients in the normal endoscopic findings group, 63 (27.4 %) were diagnosed with pathological reflux, 35 (15.2 %) with hypersensitive esophagus, 87 (37.8 %) with normal acid exposure with negative symptom association, and 25 (10.9 %) with test failure. These groups did not differ in age, body mass index, smoking habit, alcohol consumption, symptom severity, quality of life, presence of atypical symptoms, overlap with irritable bowel syndrome, and the frequency of somatization, depression, and anxiety. PPI responses were evaluated in 135 patients. Fifty patients (37.0 %) were not responsive to the 4-week treatment; 26 (19.3 %) were diagnosed with refractory non-erosive gastroesophageal disease, and 24 (17.8 %) with functional heartburn. The demographics and clinical and psychological characteristics did not differ between the two groups.
  
  
  CONCLUSIONS
  Demographic characteristics and symptom patterns alone cannot differentiate functional heartburn from various subtypes of GERD. Wireless esophageal pH monitoring should be considered for the initial evaluation of GERD in the tertiary referral setting.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, Seoul, 137-040, Korea, peyoung97@hanmail.net.
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Park
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: Meonggi
authors.initials: M
authors.lastname: Baeg
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.forename: Jinsu
authors.initials: J
authors.lastname: Kim
authors.forename: Yukyung
authors.initials: Y
authors.lastname: Cho
authors.forename: Jaemyung
authors.initials: J
authors.lastname: Park
authors.forename: Inseok
authors.initials: I
authors.lastname: Lee
authors.forename: Sangwoo
authors.initials: S
authors.lastname: Kim
authors.forename: Kyuyong
authors.initials: K
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004351:Drug Resistance; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006356:Heartburn / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors