Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications

• DOI: 10.1007/s00464-012-2602-z
• Publication Date: 2012-12-11T17:25:27Z
• Authors: David A. Kleiman; Matthew J. Sporn; Toni Beninato; Yasmin Metz; Carl Crawford; Thomas J. Fahey; Rasa Zarnegar
• Keywords: Male; Esophageal pH Monitoring; Time Factors; Proton Pump Inhibitors; Middle Aged; Drug Utilization; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Histamine H2 Antagonists; Gastroesophageal Reflux; Humans; Female; Referral and Consultation; Retrospective Studies

Gastroesophageal reflux disease (GERD) affects nearly 25 % of adults; however, an objective diagnosis is rarely established. We hypothesized that patients' symptoms and response to acid-reducing therapy are poor predictors of the outcome of 24-h esophageal pH monitoring.A review of 24-h esophageal pH monitoring studies performed at an ambulatory tertiary care center between 2004 and 2011 was performed. Demographics, type of GERD symptoms, and duration and response to acid-reducing medications before referral for pH monitoring were collected. DeMeester score, symptom sensitivity index (SSI), and symptom index (SI) were tabulated and compared with the patients' symptoms and response to medical therapy.One hundred patients were included. Of all reported symptoms, only heartburn was more common in patients with positive DeMeester scores, but there were no correlations between any symptoms and SSI or SI scores. Sixty-nine percent of patients with esophageal symptoms had a positive DeMeester score compared with only 29 % of patients with extraesophageal symptoms (P < 0.01). Esophageal symptoms and endoscopic evidence of GERD significantly increased the likelihood of having a positive DeMeester score, but they had no influence on SSI or SI scores. There was no correlation between response to acid-reducing medications and DeMeester, SSI, or SI scores. A total of 536 person-years of acid-reducing medications were prescribed to the study population, of which 151 (28 %) were prescribed to patients who had a negative pH study.Extraesophageal symptoms and response to empiric trials of acid-reducing medications are poor predictors of the presence of GERD and the DeMeester score is more likely to identify GERD in patients who met other empiric diagnostic criteria than SSI or SI. Early referral for 24-h esophageal pH monitoring may avoid lengthy periods of unnecessary medical therapy.