Ambulatory combined oesophageal pressure and pH monitoring: relationships between pathological reflux, oesophageal dysmotility and symptoms of oesophageal dysfunction

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Abstract

Objective:

To evaluate the relationships between symptoms and 24-h oesophageal pressure and pH data.

Methods:

Data from 193 consecutive patients (98 men, 95 women) referred to our laboratory for ambulatory oesophageal pressure and pH monitoring were examined. The classic reflux variables, as well as mean contraction amplitude and duration, and percentage of simultaneous contractions were calculated and compared with normal values established in our laboratory. Correlations with frequency and severity scores of oesophageal symptoms before the test were analysed. In addition, the association between symptoms during the test was analysed by calculating the symptom indices for reflux (SI-R) and motor (SI-M) abnormalities.

Results:

Pathological reflux was seen in 34% and abnormal motility in 17% of patients. None of the pretest symptom scores was significantly higher in patients with pathological reflux than in those with a normal pH profile. Likewise, no significant differences in symptom profile were found between patients with and without pathological motor activity. Of the patients, 125 (66%) experienced symptoms (range 1–20) during the test. In patients with pathological reflux, a SI-R ≥ 50% was observed in 56 compared with 16% of patients without pathological reflux (P<0.001). Patients with pathological oesophageal motility failed to show higher SI-M than those with normal motility. The pretest symptom scores of daytime heartburn, night-time heartburn and acid regurgitation correlated significantly with the SI-R values (P<0.01, P<0.01 and P<0.02, respectively).

Conclusion:

The global results of 24-h monitoring of both pH and pressure correlate poorly with symptoms. Calculation of the symptom indices for reflux and dysmotility is an indispensable step in the analysis of data acquired by combined ambulatory oesophageal pressure and pH monitoring.

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