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Excerpt
I have had occasion recently to send several patients who I considered to have an acid-sensitive esophagus for a Bernstein test. I was dismayed to find that cheap and easy test has been replaced by 24-hour pH monitoring, the gastroenterologist's Holter monitor. I was assured with only slight disdain that the pH probe was more reliable than the Bernstein test because it was more "subjective."
After I read this excellent compendium by enthusiasts for ambulatory pH monitoring, I am not so sure that my colleagues are right. Of course they are all experts, but the comments by the contributors in the section about data analysis, the varying ways that "scores" can be reproduced to establish criteria for acid reflux, and the unlikelihood that patients will click the right button to make the right notations when they are having heartburn, all make me wonder whether the data really help a clinician. At least with the old acid infusion study, we had the patient's report in usually a "yes or no" format. Current techniques require cabalistic algorithms to make sense. I wish I could get a Bernstein test done.
This review should make it clear that the second edition of this book is a practical aid to clinicians, one that fulfills the goal of its editor to provide "valuable information for everyone who is using esophageal testing." They have easily achieved that goal, but I still believe that a roentgenograph demonstrating a large hiatal hernia is as good an indication as a pH probe for laparoscopic repair in a patient with persistent symptoms.
