DUAL-CHANNEL AMBULATORY ESOPHAGEAL PH MONITORING - A USEFUL DIAGNOSTIC-TOOL

Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux d isease (GERD). The measurement of proximal esophageal acid exposure ti me may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provid es useful information beyond that learned with distal esophageal pH mo nitoring. We routinely performed dual-channel pH monitoring with pH el ectrodes positioned at 20 and 5 cm above the manometric lower esophage al sphincter from January 1992 to August 1995. All patients scored the ir esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (ie, heartburn, regurgitation) and in patients with atypical symptoms (ie, chest pain, cough, hoarseness, and asthma). We compared symptom profi les between patients with and without PR. We reviewed our experience i n patients with abnormal PR, but with a normal amount of distal esopha geal reflux (DR). We studied 441 consecutive patients. There were no s ignificant differences in PR between patients with typical and atypica l symptoms. There were no differences in symptom profiles between pati ents with normal and abnormal PR. There were no differences of PR betw een the different atypical symptoms. PR did not correlate with the sev erity of the patient's symptoms. PR correlated well only with DR. Twen ty-four patients had isolated abnormal PR, but only six patients impro ved with antireflux therapy. We conclude that routine ambulatory esoph ageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux t herapy for suspected GERD should not be based on the presence or absen ce of PR.