2017-08-31 14:32:37 UTC

Aug. 31, 2017

Esophageal testing should be undertaken for esophageal symptoms potentially attributed to GERD that persist despite optimized PPI therapy.

Patients and clinicians often utilize an empiric therapeutic trial of proton pump inhibitors (PPIs) as an initial test for gastroesophageal reflux disease (GERD). Studies have shown that these tests have a specificity of only 54 percent as a diagnostic approach to GERD symptoms; diagnostic yields are even lower for atypical and extra-esophageal symptoms.

In an article for in The New Gastroenterologist, researchers Amit Patel, MD, and C. Prakash Gyawail, MD, MRCP, recommend starting with endoscopy and continuing with ambulatory reflux and motility testing. Ambulatory reflux testing is recommended as it affords insight into three areas:

  1. Measurement of esophageal acid exposure time (AET); the cumulative time duration when distal esophageal pH is less than four at the recording site, reported as a percentage of the recording period.
  2. Measurement of the number of reflux events both acid (from pH monitoring) and weakly acidic/alkaline (from impedance monitoring).
  3. Quantitative evaluation of the association between reported symptom episodes and reflux events.

The three available modalities of ambulatory reflux monitoring consist of catheter-based pH, wireless pH and combined catheter-based pH-impendence monitoring.

Drs. Patel and Gyawail’s findings and recommendations, including how to manage different GERD phenotypes, are available in The New Gastroenterologist.

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