The combination of pH monitoring in the most distal esophagus and symptom association analysis markedly improves the clinical value of esophageal pH tests.
OBJECTIVE
The poor sensitivity of esophageal pH monitoring substantially limits the clinical value of the test. The aim of this study was to compare the diagnostic accuracy of esophageal pH monitoring and symptom association analysis performed at the conventional level with that obtained in the most distal esophagus.


METHODS
Eighty-two patients with typical reflux symptoms and 49 asymptomatic subjects underwent dual 48-h pH monitoring with the electrodes positioned immediately above, and 6 cm above the squamo-columnar junction (SCJ). The degree of esophageal acid exposure and the temporal relationship between reflux events and symptoms were evaluated.


RESULTS
The sensitivity of pH recording and the diagnostic yield of Symptom Association Probability (SAP) were significantly higher for pH monitoring performed at the distal compared with the conventional level (82% versus 65%, p<0.001 and 74% versus 62%, p<0.001, respectively). The greatest improvement was observed in patients with non-erosive disease. In this group, the sensitivity increased from 46% at the standard level to 66% immediately above the SCJ, and with the combination of a positive SAP as a marker for a positive pH test, the diagnostic yield further increased to 94%.


CONCLUSIONS
The diagnostic accuracy of esophageal pH monitoring in the most distal esophagus is superior to that performed at the conventional level and it is further improved with the combination of symptom association analysis. PH monitoring with the pH electrode positioned immediately above the SCJ should be introduced in clinical practice and always combined with symptom association analysis.
a Department of Gastroenterology , Skåne University Hospital , Lund , Sweden and.
Mats Guerrero Garcia
MG
Hall
a Department of Gastroenterology , Skåne University Hospital , Lund , Sweden and.
Jörgen
J
Wenner
b Department of Surgery , Helsingborg Hospital, Clinical Sciences, Lund University , Lund , Sweden.
Stefan
S
Öberg
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D004566:Electrodes; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring / Q000379:methods*; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D063189:Symptom Assessment; D013997:Time Factors; D055815:Young Adult
diagnostic accuracy; esophageal pH monitoring; gastroesophageal reflux disease