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Esophageal pH monitoring

Esophageal pH monitoring
Intervention
PH-zond for gastroenterology.jpg
pH-probe for measuring acidity in gastrointestinal tract
MeSH D050782
OPS-301 code 1-316
MedlinePlus 003401
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Esophageal pH monitoring is the current gold standard for diagnosis of gastroesophageal reflux disease (GERD). It provides direct physiologic measurement of acid in the esophagus and is the most objective method to document reflux disease, assess the severity of the disease and monitor the response of the disease to medical or surgical treatment. It can also be used in diagnosing laryngopharyngeal reflux.

The importance of refluxed gastric contents in the pathogenesis of GERD was emphasized by Winkelstein who introduced the term "peptic esophagitis" and by Bernstein and Baker who reported the symptom of heartburn following instillation of hydrochloric acid in the distal esophagus. Formal measurement of acid in the esophagus was first described in 1960 by Tuttle . He used a glass pH probe to map the gastroesophageal pH gradient, and demonstrated a sharp gradient in normal subjects and a gradual sloping gradient in patients with esophagitis. Four years later, Miller used an indwelling esophageal pH electrode to continuously measure esophageal and gastric pH for a period up to 12 hours. This technique required that the patient keep their hands immersed in saline to serve as a reference. Prolonged monitoring became feasible in 1974 when Johnson and DeMeester developed a dependable external reference electrode. Using this technique to monitor esophageal acid exposure patients for periods up to 24 hours, DeMeester and Johnson were able to identify the most important parameters of esophageal acid exposure and they developed a composite pH score to quantify gastroesophageal reflux. The initial 24-hour pH studies required hospitalization until the introduction of microcircuits in the 1980s that allowed portable esophageal pH monitoring in an outpatient setting.

Gastroesophageal reflux disease (GERD) is a common disease in western countries. In the United States, 7% of the population experiences heartburn daily and 44% at least once a month.Heartburn occurs when esophageal mucosa is exposed to the acidic gastric content, but the complaint of heartburn is not always a reliable guide to the presence of acid reflux in the esophagus. Further, only half of the patients with increased esophageal acid exposure will have esophagitis. Therefore, the diagnosis of gastroesophageal reflux disease (GERD) on the basis of symptoms or endoscopic findings is problematic.


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