Lower oesophageal pH monitoring--a useful clinical tool.

Early diagnosis and prompt treatment of gastrooesophageal reflux (GOR) can halt unnecessary investigations and prevent medical complications, such as failure to thrive,1 severe oesophagitis,2 and aspiration syndromes.3 The standard investigation for GOR is the upper gastrointestinal barium contrast series. However, because of poor sensitivity and specificity the role of this test in clinical practice has been questioned.4 Several other methods of investigation are available and to some extent the choice of investigation depends on the clinical problem.5 Over the last 10 years, 24 hour lower oesophageal pH monitoring has increasingly become established as the 'gold standard' for documenting 'acid' GOR.3 5 The ability to monitor over prolonged time intervals and the avoidance of any radiation are particularly attractive features of this test. However, until recently, the use of the technique has largely been confined to clinical research studies. At the Royal Hospital for Sick Children (RHSC), Glasgow, over the last four years an open clinical pH monitoring service has been available and has proved valuable in diagnosing and managing GOR. We describe here the development of this service, our experience with the technique, and our current practice.