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Medical Evaluation of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Michael Camilleri, Jeffrey W. Frank
Prolonged (usually 24-hour) esophageal pH monitoring is performed by placing a small probe transnasally so that its tip is located 5 cm above the lower esophageal sphincter. A data-logger records pH and patient symptoms such as heartburn, chest pain, and cough and major events such as meal ingestion and lying down (Figure 5). In general, most centers diagnose significant reflux when the pH is below 4 for 5.8% of the duration of the study (18). The pattern of reflux relative to major events may also help identify the nature of “reflux” symptoms. For example, repetitive short-duration drops in the esophageal pH postprandially without reportings of heartburn and the lack of occurrence of reflux in the supine position may alert the physician to the possibility of rumination syndrome. On the other hand, prolonged periods of low intraesophageal pH with slow resumption of the normal neutral or slightly alkaline pH in the esophagus suggest that esophageal clearance mechanisms are impaired. These observations complement the manometric demonstration of the weakness of antireflux functions and may be useful in practice because they may permit selection of patients for prokinetic as well as antiacid secretory drugs.
Nutritional Management of Upper Gastrointestinal Disorders
Published in Mary J. Marian, Gerard E. Mullin, Integrating Nutrition Into Practice, 2017
Francis Okeke, Bani Chander Roland
Other diagnostic modalities that have been implemented include the following: Esophageal pH monitoring (and pH impedance, where available) is a useful diagnostic test to evaluate for GERD in patients with EE [20].Radiographic studies—barium studies may show mucosal abnormalities associated with EoE, but as noted in the endoscopic findings are nonspecific and will still require histologic diagnosis via mucosal biopsies.Endoscopic ultrasonography role in EoE Dx or management?Impedance planimetry (EndoFlip)—an imaging technique that displays the distensibility of hollow viscera and has been applied to the esophagus to characterize the biomechanical properties of the esophagogastric junction, the esophageal body, and the pharyngoesophageal sphincter [34].Esophageal manometry—EoE has been associated with esophageal dysmotility including panesophageal pressurization [35] and esophageal dysmotility of uncertain clinical significance [36]. These findings, however, are not pathognomonic for EoE.
Gastroenterology
Published in Hilary McClafferty, Integrative Pediatrics, 2017
Diagnosis can be made by consideration of clinical presentation and history, and be confirmed by upper endoscopy and esophageal pH monitoring. A trial of medication is sometimes used presumptively before full workup is done. Barium esophagram is no longer the test of choice in primary diagnosis of GERD (Badillo and Francis 2014).
Chronic cough: Investigations, management, current and future treatments
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
I. Satia, M. Wahab, E. Kum, H. Kim, P. Lin, A. Kaplan, P. Hernandez, J. Bourbeau, L. P. Boulet, S. K. Field
Lifestyle changes such as avoiding foods that exacerbate acidity, avoiding heavy meals before sleep and raising the head of the bed are important first steps to help control GERD. Guidelines also recommend elimination/reduction of caffeinated beverages (eg, coffee, tea, sodas), alcohol, chocolate, and citrus products.62 A trial of antacid medications (30 mins before meals) for 2 months (proton pump inhibitors [PPI] and H2 antagonists should only be undertaken in patients with objective evidence of reflux or at least symptoms of acid reflux.11 There are a few small randomized controlled trials of PPI in chronic cough and systematic reviews have not shown that PPI reduce coughs in the absence of symptomatic GERD.72,73 Only patients with symptoms of reflux or objective evidence of reflux on esophageal pH monitoring may have a modest benefit from PPI therapy. The duration of PPI trial has not been validated, however a minimum of 8 weeks is likely required to derive benefit.74
Esophageal dysmotility and other preoperative factors associated with acid suppressive therapy after fundoplication
Published in Scandinavian Journal of Gastroenterology, 2020
Carol Rouphael, Sampurna Shakya, Zubin Arora, Scott Gabbard, Thomas Rice, Rocio Lopez, Siva Raja, Sudish Murthy, Prashanthi N. Thota
Ambulatory esophageal pH monitoring was performed via 24-hour pH testing using a transnasal catheter probe positioned 5 cm above gastroesophageal junction (GEJ) or a 48-hour wireless bravo probe (Slimline, Medtronic, Minneapolis, MN, USA) endoscopically placed 6 cm above the GEJ were used. pH studies were interpreted using Accuview software. Parameters tested included total acid exposure, supine and upright acid exposure, symptom index, symptom sensitivity index and symptom association probability. Upright acid exposure of more than 8.2% and supine acid exposure of more than 3% in a 24-hour period were considered as abnormal [18]. A total pH time less than 4 ≥ 6% of the time was considered diagnostic for abnormal esophageal acid exposure in pH monitoring according to the Lyon Consensus for the modern diagnosis of GERD [19].
Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease
Published in Acta Oto-Laryngologica, 2019
Gang Wang, Changmin Qu, Lei Wang, Hongdan Liu, Haolun Han, Bingxin Xu, Ying Zhou, Baowei Li, Yiyan Zhang, Zhezhe Sun, Jing Gong, Lianyong Li, Wei Wu
LPRD occurs when the upper portion of the digestive tract is not functioning properly, causing stomach contents to flow across the upper esophageal sphincter (UES). If abnormal esophageal acid exposure is measured in only the upper probe, the relationship of reflux to LPRD symptoms is less certain. Even the proximal pH catheter during dual-sensor esophageal pH monitoring is placed in the proximal esophagus, which is close to the pharynx; however, it cannot fully represent the throat of the pharynx. A change in pH detected in the pharynx and larynx is direct evidence for LPRD. Pharyngeal pH recordings can be performed with a pH sensor positioned 2 cm above the UES previously located with manometry; however, this technique has many limitations mainly related to artifacts due to the drying of the pH sensor, the accumulation of saliva and upper airway secretions and the interruption of electrical continuity because of the contact of the sensor with the mucosa [7]. Buffering by saliva and upper airway secretions may also decrease the concentration of gastric contents. The probe is also larger in diameter, stiffer and bulkier at their tip, thus making the intubation procedure difficult and/or less tolerable.