Bravo (wireless) ambulatory esophageal pH monitoring: How do day 1 and day 2 results compare?

AIM： To investigate if differences exist for patients＇ gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2.METHODS： A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under Ⅳ conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2.RESULTS： The mean doses of fentanyl and midazolam were 90.4 μg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH 〈 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score.CONCLUSION： Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d i compared to d 2. The Ⅳ sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients＇ true GE reflux profile.

Relationship between symptom response and esophageal pH level on standard dose of esomeprazole treatment for gastroesophageal reflux disease

Background The relationship between symptom elimination and normalization of esophageal acid level of gastroesophageal reflux disease （GERD） on proton-pump inhibitor （PPI） therapy has been questioned. This study aimed to evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese patients with GERD on esomeprazole therapy, and to assess the role of 24-hour esophageal pH-metry after therapy in GERD patients.Methods GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hour esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hour pH-metry after treatment. The pH- group achieved normalization of esophageal pH level whereas the pH＋ group did not.Results Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 90% （52/58） of symptom-free patients and 67% （12/18） of symptom-persistent patients achieved esophageal pH normalization after therapy （P=0.030）. The mean post-therapy gastric nocturnal percent time of pH 〈4.0 was significantly higher in pH＋group than that in pH- group （P 〈0.001） after therapy. The multivariate regression analysis identified hiatus hernia （P〈0.001） and persistent reflux symptom （P=0.004） were two independent factors predicting the low post-therapy esophageal pH level.Conclusions Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse.Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.

Esophageal manometry and 24-hour pH monitoring in esophagus surgery:28-year Chinese experience in a single center

Objective To retrospectively review the experience of esophageal manometry and 24-hour pH monitoring in e-sophagus surgery. Methods From 1982 to 2010,patients with unspecific chest pain and undergone esophageal surgery were received esophageal manometry and 24-hour pH monitoring. Results Among the patients with

Software improvement for evaluation of laryngopharyngeal pH testing(Restech)——a comparison between Data View 3 and 4

BACKGROUND When gastroesophageal reflux contents reach above the upper esophageal sphincter,patients may,in addition to typical reflux symptoms,present with atypical,extraesophageal symptoms related to laryngopharyngeal reflux(LPR).Surgical treatment of LPR has shown to lead to 70%symptom improvement,however no gold standard for the diagnosis of LPR exists.In 2007,the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter.Recently,a new software update was introduced for analysis of measured pH data and calculation of composite scores.The effect of the changes applied to the new software version have not yet been analyzed.AIM To compare results generated by Data View 3 to the most recently released Data View 4.METHODS All patients with gastroesophageal reflux disease symptoms were seen in a specialized surgical outpatient clinic for gastrointestinal function testing.Retrospective chart review was performed of all patients presenting with suspected gastroesophageal reflux disease and extraesophageal reflux symptoms,who underwent laryngopharyngeal pH monitoring using the Restech Dx-pH system(Respiratory Technology Corp.,Houston,TX,United States)and simultaneous esophageal pH monitoring.Data View 3 and Data View 4 were used to evaluate Restech studies obtained.Diary entries such as mealtimes,supine and upright periods,and symptoms were entered manually to ensure accuracy and precise conversion of data between both software versions.Paired t test was performed for statistical analysis of results.RESULTS A total of 174 patients(63.8%female)met inclusion criteria,all suffering from extraesophageal reflux symptoms as well as typical gastroesophageal reflux disease symptoms.Mean RYAN score upright was 48.77 in Data View 3 compared to 22.17 in Data View 4,showing a significant difference(~aP=0.0001).Similar results were shown for supine period(mean RYAN Score Data View 35.29 vs 1.42 in Data View 4,~cP=0.0001).For upright periods 80 patients showed a decrease of value of the RYAN score with a mean of-58.9(mean 51.1%decrease).For supine position 25 patients showed a decrease of value of the RYAN score with a mean of-15.13[range(-153.44)–(-0.01)],which equals a mean decrease of value of 44.5%.Ten patients showed no oropharyngeal acid exposure in Data View 3,but mild/moderate(n=7)or severe(n=3)acid exposure in Data View 4.Correlation with positive esophageal pH measurement was improved in all 10 patients.CONCLUSION Results of both software versions cannot be compared to each other.However,our data suggests that Data View 4 may be an improvement of the Restech pH measurement in the evaluation of LPR.

Prolapse gastropathy syndrome may be a predictor of pathologic acid reflux

AIM： To assess the occurrence of gastric acid reflux into the esophagus in endoscopically confirmed prolapse gastropathy syndrome （PGS）. METHODS： Using ambulatory esophageal pH measurement （BRAVOTM wireless esophageal pH monitoring system）, twenty-six patients with PGS were compared with twenty-one patients with erosive esophagitis （EE） as controls. We assessed several reflux parameters, including the percentage of total time at pH 〈 4, and the DeMeester score. RESULTS： There were no statistical differences between the PGS group and the EE group as to mean age, sex ratio and pH recording time. The EE group showed more severe reflux than the PGS group, as evaluated in terms of the longest duration of reflux, the number of reflux episodes, the number of reflux episodes lasting 〉 5 min, the total time with pH 〈 4 during acid reflux episodes, and the DeMeester score, but none of these parameters showed statistically significant difference. Although 53.8% （14/26） of the PGS group and 76.2% （16/22） of the EE group demonstrated pathologic acid reflux （DeMeester score 〉 14.72）, there was no statistically significant difference between the two groups in the incidence of pathologic acid reflux （P = 0.11）. CONCLUSION： There was no statistically significant difference in pathologic acid reflux between the PGS and EE group. These data suggest that endoscopically diagnosed PGS might be a predictor of pathologic acid reflux.

Diagnosis of gastroesophageal reflux disease in elderly subjects using 24-houres ophageal pH monitoring

Objective To evaluate the relationship between the parameters of 24 hour esophageal pH monitoring and gastroesophageal reflux disease (GERD) among elderly subjects. Methods Twenty four hour esophageal pH monitoring was carried out in 20 elderly subjects without apparent GERD symptoms (controls) and 69 suspected GERD subjects.Results Normal values of the parameters from 20 elderly controls were obtained. Percent of total time, percent of supine time and percent of upright time in which the pH was <4 (indicating reflux) were less than 3.3%, 1.4%, 5.5%, respectively. The number of reflux episodes and episodes lasting longer than 5 minutes were less than 65 and 2 times respectively. The values obtained in 66 GERD suspected subjects were significantly different from those in norrmal controls. The differences of reflux parameters between the esophagitis group and non esophagitis group, such as percent of total time with pH<4, percent of supine time with pH<4 and number of reflux lasting longer than 5 minutes were also significant. Conclusions About 51.6% patients (34/66) with reflux symptoms but without endoscopic evidence of esophagitis were definitely diagnosed as GERD by esophageal pH monitoring. Duration of esophageal acid exposure correlated with the severity of GERD.