| The role of esophageal pH monitoring in symptomatic patients on PPI therapy. | |
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MedLine Citation:
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PMID: 15667483 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Ambulatory pH monitoring while on therapy is often recommended in gastroesophageal reflux disease (GERD) patients with continued symptoms. However, to date, little data exist to justify this indication. AIM: To assess the role of pH monitoring in symptomatic patients despite aggressive therapy with typical or extra esophageal GERD. METHODS: Retrospective review of 2,291 ambulatory pH tracings (1999-2003) identified subgroup of studies performed on proton pump inhibitor (PPI) therapy. Patients with prior fundoplication or Barrett's esophagus were excluded. Patients grouped on predominant presenting GERD symptoms: typical (heartburn and regurgitation) or extra esophageal (chest pain, cough, hoarseness, sore throat, shortness of breath, asthma). The distribution of abnormal pH parameters in each group calculated and univariate analyses assessed the probability of abnormal pH in each group. Abnormal cutoff values traditionally used in clinical practice and more stringent cutoff values used to determine distribution of abnormality as a function of cutoff values. RESULTS: A total of 250 patients (mean age 54.3 yrs, 59% female) underwent pH monitoring on either daily (b.i.d.) or twice daily (q.d.) on PPI therapy: 115 (46%) with extra esophageal and 135 (54%) with typical GERD symptoms. Extra esophageal GERD patients were more likely to undergo pH monitoring on b.i.d. PPIs (OR = 2.7; 95% CI = 1.6-4.4; p < 0.01). 52 (93%) of typical and 74 (99%) of extra esophageal GERD patients on b.i.d. PPIs tested normal. The odds of a normal pH values were 11 times higher for patients on b.i.d. PPIs (OR = 11.4; 95% CI = 4.3-30.1, p < 0.01) than those on q.d. PPIs. CONCLUSIONS: 1) The likelihood of an abnormal esophageal pH for symptomatic GERD patients on b.i.d. PPI is very small. 2) In this group of patients failing b.i.d. PPIs causes other than GERD should be sought. |
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Authors:
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Samer Charbel; Farah Khandwala; Michael F Vaezi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 100 ISSN: 0002-9270 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2005 Feb |
Date Detail:
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Created Date: 2005-01-25 Completed Date: 2005-03-01 Revised Date: 2005-10-05 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 283-9 Citation Subset: IM |
Affiliation:
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Departments of Gastroenterology and Hepatology, Center for Swallowing and Esophageal Disorders, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Esophagus / metabolism* Female Gastroesophageal Reflux / drug therapy*, metabolism Humans Hydrogen-Ion Concentration Male Manometry Middle Aged Monitoring, Ambulatory* Proton Pumps / antagonists & inhibitors* |
| Chemical | |
Reg. No./Substance:
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0/Proton Pumps |
| Comments/Corrections | |
Comment In:
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Am J Gastroenterol. 2005 Aug;100(8):1893-4; author reply 1894
[PMID:
16086728
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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