American Gastroenterological Association medical position statement: guidelines on the use of esophageal pH recording.

T if the study is done to confirm excessive acid exposure or while taking the antisecretory drug regimen if he following guidelines were developed to assist the physician in the appropriate use of esophageal pH symptom-reflux correlation is to be scored). recording in patient care. They emanate from a comprehensive review of the medical literature pertaining to the pH • Esophageal pH recording is possibly indicated to derecording technique. Esophageal pH recording is widely tect refractory reflux in patients with chest pain after available and, when done in a technically appropriate mancardiac evaluation using a symptom reflux association ner, provides quantitative data on both esophageal acid scheme, preferably the symptom association probabilexposure and on the temporal correlation between patient ity calculation (pH study done after a trial of proton symptoms and reflux events. Despite these strengths, the pump inhibitor therapy for at least 4 weeks). inherent weakness of the technique is its inability to prove • Esophageal pH recording is possibly indicated to evalcausality between symptoms or syndromes and acid reflux uate a patient with suspected otolaryngologic manifesevents. Alternatively, causality is reasonably assumed in tations (laryngitis, pharyngitis, chronic cough) of gasclinical practice by the substantial reduction or elimination troesophageal reflux disease after symptoms have failed of suspected reflux symptoms during a therapeutic trial of to respond to at least 4 weeks of proton pump inhibitor a proton pump inhibitor. In view of this viable alternative, therapy (pH study done while the patient continues the major indications for esophageal pH monitoring are in taking their antisecretory drug regimen to document documenting the failure of either medical or surgical therthe adequacy of therapy). apy. This position statement should help the clinician • Esophageal pH recording is possibly indicated to docuapply esophageal pH studies most beneficially within the ment concomitant gastroesophageal reflux disease in context of other clinical options. an adult onset, nonallergic asthmatic suspected of having reflux-induced asthma (pH study done after withGuidelines for the Clinical Use of holding antisecretory drugs for ¢1 week). Note: a Esophageal pH Recording positive test does not prove causality! • Esophageal pH recording is not indicated to detect or • Esophageal pH recording is indicated to document verify reflux esophagitis (this is an endoscopic diagnosis). abnormal esophageal acid exposure in an endoscopynegative patient being considered for surgical antire• Esophageal pH recording is not indicated to evaluate flux repair (pH study done after withholding antisecrefor ‘‘alkaline reflux.’’ tory drug regimen for ¢1 week). References • Esophageal pH recording is indicated to evaluate patients after antireflux surgery who are suspected to 1. Kahrilas PJ, Quigley EMM. Clinical esophageal pH recording: a have ongoing abnormal reflux (pH study done after technical review for practice guideline development. Gastroenterology 1996;110:1982–1996. withholding antisecretory drug regimen for ¢1 week). • Esophageal pH recording is indicated to evaluate pa-