The impact of open access 24-h pH-metry on the diagnosis and management of esophageal reflux disease

Abstract

OBJECTIVE: This study investigates whether the results of 24-h pH-metry can be predicted from clinical information and whether they affect patient management. METHODS: A total of 200 consecutive patients referred for 24-h pH-metry underwent structured interviews as well as endoscopic and manometric investigations. The most recent 53 patients were prospectively followed to determine the impact of pH monitoring on long term management. RESULTS: Among a variety of risk factors, the presence of lower esophageal sphincter hypotension (OR = 3.3) and erosive esophagitis (OR = 2.3) were highly predictive of a pathological pH test result. If both abnormalities were present, the risk for an abnormal 24-h pH study increased by a factor of seven. Twenty-four-hour pH monitoring led to an immediate change in management in 42% of all investigated patients. However, such alterations in therapy were maintained for prolonged periods in less than half of them and only 6% of all patients associated changes in management with an improvement of symptoms. CONCLUSIONS: The results of “open access” 24-h pH-metry are often predictable, and only a minority of patients benefit from this procedure in terms of a change in therapy and an improvement of symptoms.