Skip to main content
NCBI home page
Gut logoLink to Gut
. 1994 Mar;35(3):304–308. doi: 10.1136/gut.35.3.304

Simultaneous two level oesophageal pH monitoring in healthy controls and patients with oesophagitis: comparison between two positions.

P Singh 1, R H Taylor 1, D G Colin-Jones 1
PMCID: PMC1374579  PMID: 8150336

Abstract

For oesophageal pH monitoring, the pH probe is usually positioned 5 cm above the lower oesophageal sphincter (LOS). This is by convention, and has not been compared with other positions in its ability to discriminate between physiological and abnormal acid reflux. Using simultaneous two level 24 hour pH monitoring (5 and 10 cm above manometrically determined LOS) in 31 controls and 51 patients with reflux oesophagitis, the significance of the precise position of the probe in the oesophagus was examined. Secondly, this study compared the discrimination between the two groups achieved at the two levels. Patients had greater acid exposure than controls at both levels. In controls, acid exposure was greater at distal than at the proximal level except the supine acid exposure, which was similar at both levels. In patients, acid exposure was greater at the distal level for all variables (median % of total time pH < 4 = 11.7 v 7.6; p = 0.001). There was excellent correlation between the two levels for all variables in controls (r = 0.883, 0.935, 0.813, and p < 0.001 for percentage of time pH < 4 for total, supine, and upright times) as well as in patients (r = 0.848, 0.848, 0.779, and p < 0.001). On discriminant and receiver operating characteristic analysis, pH threshold 4 seemed as good as or better than other pH thresholds in discriminating between controls and patients. The percentage of total time pH below 4 seemed to discriminate as well or better than other variables at both levels. The distal level (5 cm above LOS) provided slightly better discrimination than proximal level (10 cm) (percentage of subjects correctly classified=81.7 v 75.6). The critical factor for the reliability of the test is not the precise position of the pH probe relative to the LOS, but that the same position is consistently used in patients and controls.

Full text

PDF
304

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cheadle W. G., Vitale G. C., Sadek S. A., Cuschieri A. Computerized ambulatory esophageal pH monitoring in 50 asymptomatic volunteer subjects. Results and clinical implications. Am J Surg. 1988 Mar;155(3):503–508. doi: 10.1016/s0002-9610(88)80123-5. [DOI] [PubMed] [Google Scholar]
  2. Colin-Jones D. G. Histamine-2-receptor antagonists in gastro-oesophageal reflux. Gut. 1989 Oct;30(10):1305–1308. doi: 10.1136/gut.30.10.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. DeMeester T. R., Wang C. I., Wernly J. A., Pellegrini C. A., Little A. G., Klementschitsch P., Bermudez G., Johnson L. F., Skinner D. B. Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg. 1980 May;79(5):656–670. [PubMed] [Google Scholar]
  4. Dehn T. C., Kettlewell M. 24-hour monitoring of oesophageal pH in outpatients. Lancet. 1987 Mar 14;1(8533):625–626. doi: 10.1016/s0140-6736(87)90261-3. [DOI] [PubMed] [Google Scholar]
  5. Donald I. P., Ford G. A., Wilkinson S. P. Is 24 h ambulatory oesophageal pH monitoring useful in a district general hospital? Lancet. 1987 Jan 10;1(8524):89–92. doi: 10.1016/s0140-6736(87)91921-0. [DOI] [PubMed] [Google Scholar]
  6. Fink S. M., McCallum R. W. The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux. JAMA. 1984 Sep 7;252(9):1160–1164. [PubMed] [Google Scholar]
  7. Fuchs K. H., DeMeester T. R., Albertucci M. Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease. Surgery. 1987 Oct;102(4):575–580. [PubMed] [Google Scholar]
  8. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  9. Houston A., Craig A. Perceptual and statistical analysis of cardiac phase and amplitude images. Eur J Nucl Med. 1991;18(9):720–724. doi: 10.1007/BF00956712. [DOI] [PubMed] [Google Scholar]
  10. Johansson K. E., Boeryd B., Fransson S. G., Tibbling L. Oesophageal reflux tests, manometry, endoscopy, biopsy, and radiology in healthy subjects. Scand J Gastroenterol. 1986 May;21(4):399–406. doi: 10.3109/00365528609015154. [DOI] [PubMed] [Google Scholar]
  11. Johnsson F., Joelsson B., Isberg P. E. Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut. 1987 Sep;28(9):1145–1150. doi: 10.1136/gut.28.9.1145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Katz P. O. Ambulatory esophageal and hypopharyngeal pH monitoring in patients with hoarseness. Am J Gastroenterol. 1990 Jan;85(1):38–40. [PubMed] [Google Scholar]
  13. Koufman J. A. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991 Apr;101(4 Pt 2 Suppl 53):1–78. doi: 10.1002/lary.1991.101.s53.1. [DOI] [PubMed] [Google Scholar]
  14. Masclee A. A., de Best A. C., de Graaf R., Cluysenaer O. J., Jansen J. B. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Determination of criteria and relation to endoscopy. Scand J Gastroenterol. 1990 Mar;25(3):225–230. [PubMed] [Google Scholar]
  15. Schindlbeck N. E., Heinrich C., König A., Dendorfer A., Pace F., Müller-Lissner S. A. Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology. 1987 Jul;93(1):85–90. doi: 10.1016/0016-5085(87)90318-0. [DOI] [PubMed] [Google Scholar]
  16. Schlesinger P. K., Donahue P. E., Schmid B., Layden T. J. Limitations of 24-hour intraesophageal pH monitoring in the hospital setting. Gastroenterology. 1985 Oct;89(4):797–804. doi: 10.1016/0016-5085(85)90575-x. [DOI] [PubMed] [Google Scholar]
  17. Shaker R., Dodds W. J., Helm J. F., Kern M. K., Hogan W. J. Regional esophageal distribution and clearance of refluxed gastric acid. Gastroenterology. 1991 Aug;101(2):355–359. doi: 10.1016/0016-5085(91)90011-9. [DOI] [PubMed] [Google Scholar]
  18. Singh P., Adamopoulos A., Taylor R. H., Colin-Jones D. G. Oesophageal motor function before and after healing of oesophagitis. Gut. 1992 Dec;33(12):1590–1596. doi: 10.1136/gut.33.12.1590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. TUTTLE S. G., GROSSMAN M. I. Detection of gastro-esophageal reflux by simultaneous measurement of intraluminal pressure and pH. Proc Soc Exp Biol Med. 1958 Jun;98(2):225–227. doi: 10.3181/00379727-98-23998. [DOI] [PubMed] [Google Scholar]
  20. Vitale G. C., Cheadle W. G., Sadek S., Michel M. E., Cuschieri A. Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study. Ann Surg. 1984 Dec;200(6):724–728. doi: 10.1097/00000658-198412000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. de Caestecker J. S., Blackwell J. N., Pryde A., Heading R. C. Daytime gastro-oesophageal reflux is important in oesophagitis. Gut. 1987 May;28(5):519–526. doi: 10.1136/gut.28.5.519. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES