Table 3.
Strength of the GRADE recommendations for esophageal physiologic testing for typical reflux symptoms
| Statement | GRADE quality | Strength of recommendation |
|---|---|---|
| We suggest the use of ambulatory reflux monitoring over patient-reported symptoms on GERD questionnaires for a conclusive diagnosis of GERD in patients with esophagealreflux symptoms | Very low | Conditional |
| We suggest the use of ambulatory reflux monitoring over the assessment of response to PPI therapy fora conclusive diagnosis of GERD in patients with esophagealreflux symptoms | Very low | Conditional |
| We suggest the use of ambulatory reflux monitoring over upper endoscopy alone (if endoscopy is not definitive) for a conclusive diagnosis of GERD in patients with esophagealreflux symptoms not responding to PPI | Very low | Conditional |
| We suggest the use of ambulatory reflux monitoring performed off PPI therapy over ambulatory reflux monitoring on PPI therapy for a conclusive diagnosis of GERD in patients with typicalreflux symptoms and unproven GERD | Low | Conditional |
| We suggest the use of prolonged wireless pH monitoring over 24-hr catheter-based monitoringfor the diagnosis of GERD in adults with infrequent or day-to-day variation in esophagealsymptoms (conditionalrecommendation, very low quality of evidence). | Very low | Conditional |
| We suggest the use of ambulatory pH impedance monitoring on PPI therapy over endoscopic evaluation or pH monitoring alone to diagnose persisting GERD in adults with typicalesophageal reflux symptoms and previous confirmatory evidence of GERD (proven GERD) | Very low | Conditional |
| We suggest that for patients with esophagealsymptoms being evaluated for antireflux surgery, abnormalacid exposure time be considered a predictor of treatment outcome; reflux symptom association and mean nocturnalbaseline impedance provide adjunctive value | Very low | Conditional |
Please refer to the text for detailed discussion and evidence regarding each of the recommendations.
GERD, gastroesophageal reflux disease; GRADE, Grading of Recommendations Assessment, Development and Evaluation; PPI, proton pump inhibitor.