Chest Discomfort with Catheter-Free Ambulatory pH Monitoring can be Predicted by Response to PPIs

Abstract

Purpose: Background: Bravo pH monitoring provides patients with the comfort of a wireless probe. Chest pain related to the attachment of the capsule can be distressing to many patients. The aim of this prospective study was to quantify the frequency of chest discomfort after pH capsule placement and to evaluate for patient variables that might be predictive of chest discomfort. Methods: 825 patients underwent catheter-free ambulatory pH monitoring from January 2004 through December 2008 primarily for a diagnosis of esophageal reflux disease. The records of all patients that complained of chest discomfort (different from their usual symptoms) during pH monitoring were retrospectively reviewed with attention to patient characteristics, ambulatory pH data, response to acid medication and additional gastroenterological workup (including EGD findings and pathology). Results: None of the 825 patients had a significant complication. 118 patients (14.3%) complained of chest discomfort. Nine patients needed to be excluded due to an inability to obtain sufficient information needed for the study. The affected patients had widely varying symptoms and ages with the majority of patients being women (87/109; 80%). Studies were performed both on and off proton pump inhibitors (PPIs). Forty-three patients were on PPIs (39%), fifty-three patients were off PPIs (49%) and thirteen patients denied taking medication due to poor relief of symptoms (12%). Pathologic acid reflux was found in (36/109) patients or (33%) with two of the (2/36) patients presenting with intra-study symptoms which correlated with acid in the distal esophagus >50% of the time. Eighty seven patients underwent an EGD with 10 (9%) noted to have gross esophagitis. In the group of patients (36) with pathologic pH studies only eight had some degree of inflammation on esophageal biopsy. All patients complained of ineffectiveness of their PPI in relieving symptoms. One of the affected patients were known to carry the diagnosis of irritable bowel syndrome (IBS) however, access to data was limited. Conclusion: Chest discomfort occurred relatively infrequently after pH capsule placement in our study (14.3% of patients). Affected patients tended to be women (80%). Ambulatory pH data, EGD findings and pathology were not predictive of chest discomfort. Failure of the PPI to provide relief of symptoms was an effective predictor to chest discomfort in patients with a normal pH study (67%) of the time.