Value of pH probe testing in pediatric patients with extraesophageal manifestations of gastroesophageal reflux disease: A retrospective review

Extended pH probe testing is often performed in patients believed to have e xtraesophageal symptoms of gastroesophageal reflux disease (GERD), although for this indication its diagnostic value is not: well established. A retro spective review of all patients who underwent pH probe testing between 1994 and 1998 was conducted to determine the outcome of antireflux therapy in t he subgroup with probable extraesophageal symptoms of GERD. Sixty-eight pat ients underwent antireflux therapy and had adequate follow-up after pH prob e testing to be included in the study. Fifty-eight patients (85%) responded to antireflux therapy (improved, 44%; cured, 41%). The positive predictive value of distal pH probe testing was greater than 90%, but the negative pr edictive value was less than 50%. The reproducibility of pH probe testing o n different study days was poor, but pH probe testing was helpful in assess ing the adequacy of antireflux therapy. The presence of gastrointestinal sy mptoms did not correlate with the response of extraesophageal symptoms to a ntireflux therapy. Thirteen patients underwent double-probe pH studies. The mean percent time the pH was less than 4 in the upper esophagus was 2.6% ( range, 1% to 9.6%). Twelve of these patients were improved or cured with an tireflux therapy. Distal pH probe testing is of limited benefit in predicti ng whether patients with extraesophageal symptoms of GERD will respond to a ntireflux therapy. If extraesophageal symptoms of GERD are suspected. patie nts should undergo an empiric trial of antireflux therapy. Distal pH probe testing should be reserved for assessing the adequacy of antireflux therapy if symptoms persist. A prospective, randomized, controlled study will aid in determining the predictive value of double-probe pH studies in pediatric patients with probable extraesophageal symptoms of GERD.