Inconsistency in the diagnosis of functional heartburn: Usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease

Roberto Penagini, Rami Sweis, Aurelio Mauro, Gerson Domingues, Andres Vales, Daniel Sifrim

Research output: Contribution to journalArticle

Abstract

Background/Aims: The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients' outcome. Methods: Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38-57 years]) with a diagnosis of functional heartburn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index = 50%). Outcome was assessed by review of hospital files and/or telephone interview. Results: Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients (P <0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients (P <0.05). Conclusions: One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients' management.

Original languageEnglish
Pages (from-to)265-272
Number of pages8
JournalJournal of Neurogastroenterology and Motility
Volume21
Issue number2
DOIs
Publication statusPublished - 2015

Fingerprint

Heartburn
Proton Pump Inhibitors
Physiologic Monitoring
Gastroesophageal Reflux
Acids
Proton Pumps
Fundoplication
Interviews

Keywords

  • Esophageal pH monitoring
  • Gastroesophageal reflux
  • Proton pump inhibitors

ASJC Scopus subject areas

  • Gastroenterology
  • Clinical Neurology

Cite this

Inconsistency in the diagnosis of functional heartburn : Usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease. / Penagini, Roberto; Sweis, Rami; Mauro, Aurelio; Domingues, Gerson; Vales, Andres; Sifrim, Daniel.

In: Journal of Neurogastroenterology and Motility, Vol. 21, No. 2, 2015, p. 265-272.

Research output: Contribution to journalArticle

@article{91aeb843a3d94ecfa70232c3c7015b35,
title = "Inconsistency in the diagnosis of functional heartburn: Usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease",
abstract = "Background/Aims: The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients' outcome. Methods: Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38-57 years]) with a diagnosis of functional heartburn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5{\%} or normal acid exposure time and symptom index = 50{\%}). Outcome was assessed by review of hospital files and/or telephone interview. Results: Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11{\%} of functional heartburn patients (P <0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77{\%} of non-erosive reflux disease vs 43{\%} of functional heartburn patients (P <0.05). Conclusions: One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients' management.",
keywords = "Esophageal pH monitoring, Gastroesophageal reflux, Proton pump inhibitors",
author = "Roberto Penagini and Rami Sweis and Aurelio Mauro and Gerson Domingues and Andres Vales and Daniel Sifrim",
year = "2015",
doi = "10.5056/jnm14075",
language = "English",
volume = "21",
pages = "265--272",
journal = "Journal of Neurogastroenterology and Motility",
issn = "2093-0879",
publisher = "Korean Society of Neurogastroenterology and Motility",
number = "2",

}

TY - JOUR

T1 - Inconsistency in the diagnosis of functional heartburn

T2 - Usefulness of prolonged wireless ph monitoring in patients with proton pump inhibitor refractory gastroesophageal reflux disease

AU - Penagini, Roberto

AU - Sweis, Rami

AU - Mauro, Aurelio

AU - Domingues, Gerson

AU - Vales, Andres

AU - Sifrim, Daniel

PY - 2015

Y1 - 2015

N2 - Background/Aims: The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients' outcome. Methods: Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38-57 years]) with a diagnosis of functional heartburn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index = 50%). Outcome was assessed by review of hospital files and/or telephone interview. Results: Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients (P <0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients (P <0.05). Conclusions: One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients' management.

AB - Background/Aims: The diagnosis of functional heartburn is important for management, however it stands on fragile pH monitoring variables, ie, acid exposure time varies from day to day and symptoms are often few or absent. Aim of this study was to investigate consistency of the diagnosis of functional heartburn in subsequent days using prolonged wireless pH monitoring and its impact on patients' outcome. Methods: Fifty proton pump inhibitotor refractory patients (11 male, 48 years [range, 38-57 years]) with a diagnosis of functional heartburn according to Rome III in the first 24 hours of wireless pH monitoring were reviewed. pH variables were analysed in the following 24-hour periods to determine if tracings were indicative of diagnosis of non-erosive reflux disease (either acid exposure time > 5% or normal acid exposure time and symptom index = 50%). Outcome was assessed by review of hospital files and/or telephone interview. Results: Fifteen out of 50 patients had a pathological acid exposure time after the first day of monitoring (10 in the second day and 5 in subsequent days), which changed their diagnosis from functional heartburn to non-erosive reflux disease. Fifty-four percent of non-erosive reflux disease vs 11% of functional heartburn patients (P <0.003) increased the dose of proton pump inhibitors or underwent fundoplication after the pH test. Outcome was positive in 77% of non-erosive reflux disease vs 43% of functional heartburn patients (P <0.05). Conclusions: One-third of patients classified as functional heartburn at 24-hour pH-monitoring can be re-classified as non-erosive reflux disease after a more prolonged pH recording period. This observation has a positive impact on patients' management.

KW - Esophageal pH monitoring

KW - Gastroesophageal reflux

KW - Proton pump inhibitors

UR - http://www.scopus.com/inward/record.url?scp=84928527395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928527395&partnerID=8YFLogxK

U2 - 10.5056/jnm14075

DO - 10.5056/jnm14075

M3 - Article

AN - SCOPUS:84928527395

VL - 21

SP - 265

EP - 272

JO - Journal of Neurogastroenterology and Motility

JF - Journal of Neurogastroenterology and Motility

SN - 2093-0879

IS - 2

ER -