Esophageal pH Monitoring (cont.)
How is esophageal pH monitoring used?
Everyone has some acid reflux, but the amount of reflux is small
and rarely causes inflammation of the esophagus (esophagitis). As the
amount of acid reflux increases above the normal range, so does the
probability of developing esophagitis and its symptoms. In patients
with symptoms that suggest acid reflux, a diagnosis of reflux can be
made by demonstrating an acid pH in the esophagus for a greater than
normal amount of time. (A common alternative method to diagnose
reflux is to treat patients with medications that reduce reflux. If
the patient's symptoms stop, then they are likely to be due to acid
reflux.) Another way of diagnosing acid reflux as the cause of
symptoms is to demonstrate that episodes of acid reflux recorded by
esophageal pH monitoring occur at exactly the same time as
symptoms.
Esophageal pH monitoring also can be used to determine why
treatment for reflux is not working. For example, a patient treated for acid
reflux may continue to have symptoms. If so, then the question must
be asked as to why the symptoms are continuing. Is it because the
medication is not adequate or is it because the symptoms are not due
to reflux and, therefore, are not responding to treatment for
reflux? If the pH monitoring study performed while the patient takes
his or her medication for reflux shows abnormal amounts of reflux,
then treatment is inadequate and needs to be changed. If the amount
of acid reflux is within the normal range, then it is likely that the
symptoms are not being caused by acid reflux, and other potential
problems need to be considered as the cause of the symptoms.
What are the limitations of esophageal pH monitoring?
The demonstration of abnormal amounts of acid reflux does not mean
that symptoms are being caused by the reflux. Only treatment with
medications that treat reflux coupled with a marked reduction of
symptoms can be used to substantiate reflux as the cause of the
symptoms. Nevertheless, it is important to remember that treatment
is associated with a placebo response. For instance, 10-20% of
patients without acid reflux report an improvement in symptoms with
anti-reflux medications. Therefore, even a good response to
treatment does not definitely prove that reflux is the cause of
symptoms.
Some of the strongest evidence that a symptom is being caused by
acid reflux is provided by demonstrating that the symptom coincides with
an episode of acid reflux. If there are very frequent episodes of
reflux, however, it may not be possible to separate a true
association between a symptom and reflux from a chance association
due to the great frequency of episodes of reflux. Conversely, if a
symptom occurs infrequently, for example, once every few days, it is
unlikely that the symptom will occur during a routine 24 hour
monitoring session, and therefore, a correlation will not be
possible. (One attempt to get around the latter problem is to extend
the monitoring to several days, though this is not done commonly.)
Next: Are there other ways in which pH monitoring can be used? »
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