Su1090 Wireless Esophageal pH Monitoring Could Play a Role in the Initial Evaluation of GERD in Tertiary Referral Setting

Abstract

It is difficult to differentiate proton pump inhibitor (PPI) failure from functional heartburn. We assessed the role of wireless esophageal pH monitoring (WEPM) as an initial evaluation of GERD in referral patients with suspected GERD. Method: We enrolled consecutive referral patients with suspected GERD. All patients underwent WEPM at off-PPI after endoscopy on the first visit. PPI response was estimated by patient's global assessment as rated on a 7 Likert scale. Results: A total of 230 patients (M 101, F 129, age 49.7 ± 12.4yrs) were enrolled. 32 (13.9%) patients failed WEPM due to Attachment failure or misplacement (4.3%) and early detachment (7.4%) of pH capsule, as well as poor recording (2.2%). 20 patients (8.7%) had erosive reflux disease (ERD). Among patients with non-erosive patients, 63 (27.4%) had pathologic reflux (>4% of PH ≤4), 35 (27.4%) hypersensitive esophagus and 87 (37.8%) functional heartburn (FH). The diagnostic yield of WEPM was lower in patients with normal endoscopy (52.4%) than with ERD (70%). Female predominance was noted in NERD group (53%) than ERD (20%). Age, BMI, smoking, alcohol, symptom severity, QOL, presence of atypical symptoms, and overlap with IBS were not different among the 4 groups. The frequency of somatization, depression, and anxiety were also not different among the 4 groups. The rate of PPI responder in FHB (47.8%) was significantly lower than those with ERD (100%) and NERD (68%, P<0.05). Conclusion; Demographics, symptomatology and PPI response do not identify pathophysiologically distinct subgroups in tertiary referral patients. In view of low PPI response in NERD and the tolerability of the wireless capsule, WEPM should be considered for the initial evaluation of GERD in tertiary referral setting. However, the substantial failure rate still limits its wide usage and needs to be improved.