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Early esophageal pH monitoring can prevent unnecessary acid-reducing GERD therapy
Extraesophageal symptoms and patient response to acid-reducing treatment are less predictive of GERD than results of esophageal pH monitoring, according to recent results.
Researchers performed a retrospective review of 100 patients who underwent 24-hour esophageal pH monitoring at a single facility between 2004 and 2011. Results were calculated according to DeMeester score, symptom index (SI) and symptom sensitivity index (SSI), and demographics, GERD symptoms and response to and duration of acid-reducing therapy before referral were collected.
“Twenty-four hour esophageal pH monitoring is an attractive method to objectively diagnose GERD at relatively low cost and good patient tolerability,” the researchers wrote. “However, a major limitation … is the lack of consensus on which scoring system results in the most accurate diagnosis of GERD. Therefore … we employed three commonly used systems in a side-by-side fashion to allow for direct comparisons.”
Patients with positive DeMeester scores reported heartburn more frequently than those with negative scores (63% vs. 40%; P=.02), but no other symptoms occurred at different rates according to any of the scores. Among those with esophageal symptoms, 69% had positive DeMeester scores, compared with 29% of those with extraesophageal symptoms (P<.01 for difference). Esophageal symptoms were significantly associated with a positive DeMeester score (OR=6.36; 95% CI, 1.8-22.41) via multivariate analysis, as was GERD evidence on endoscopy (OR=6.71; 95% CI, 1.69-26.58), but SSI or SI scores were not.
Of 536 person-years of acid-reducing medication prescribed among the cohort, 28% were for patients with negative DeMeester scores. Treatment duration before pH monitoring was shortest among those who achieved complete response (median 1.0 years) and longest among those who experienced relapse (median 7.5 years; P<.01 for difference).
“We have shown that extraesophageal GERD symptoms and response to empiric trials of acid-reducing therapy are poor predictors … of GERD as diagnosed by pH monitoring studies,” the researchers concluded. “Delayed referral for esophageal pH monitoring often results in lengthy periods of unnecessary medical therapy. Patients with normal pH monitoring studies warrant further investigation for alternative causes of their symptoms.”