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Variations in results of simultaneous ambulatory esophageal pH monitoring
F J Hampton1, U M MacFadyen, J F Mayberry
1Department of Child Health, Leicester University, U.K.
Insights
Esophageal pH monitoring, the gold standard for diagnosing gastroesophageal reflux (GER), may yield variable results. Day-to-day biological variations in reflux are the likely cause, though equipment accuracy could also play a role.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy
- Reflux Monitoring
Background:
- Twenty-four-hour esophageal pH monitoring is the established gold standard for diagnosing gastroesophageal reflux (GER).
- The potential for false positive or false negative results in pH monitoring is infrequently considered.
- Variability in diagnostic outcomes can impact clinical decision-making for infants with suspected reflux.
Purpose of the Study:
- To investigate the day-to-day variability of 24-hour esophageal pH monitoring results in infants.
- To explore potential causes for observed discrepancies in reflux monitoring data.
- To assess the reliability of pH monitoring as a diagnostic tool in pediatric GER.
Main Methods:
- Infants underwent two consecutive 24-hour esophageal pH monitoring studies.
- Data from repeated pH monitoring sessions were compared for individual patients.
- Results were analyzed to identify the extent and potential sources of variability.
Main Results:
- Significant differences in esophageal pH monitoring results were observed between consecutive days in a cohort of infants.
- Similar day-to-day variations have been reported in other medical centers.
- The findings suggest that biological variability in GER is a likely contributor to these discrepancies.
Conclusions:
- Day-to-day biological variability in gastroesophageal reflux is a significant factor influencing the results of 24-hour esophageal pH monitoring.
- While biological variability is the primary suspected cause, potential variations in equipment accuracy for detecting acid reflux cannot be entirely excluded.
- These findings highlight the need to consider variability when interpreting pH monitoring data in the diagnosis of GER in infants.
Abstract:
Twenty-four-hour esophageal pH monitoring is regarded as the gold standard investigation for gastroesophageal reflux (GER) (1) and the possibility of an "incorrect" answer, false positive or false negative, is only rarely considered (2). However, when a group of infants in this hospital had such pH studies performed on two consecutive days, considerable differences in the results were found (3). This also had been reported from other centers (4-6). It seems likely that most of the differences were due to true "biological" variability in the amount of GER from day to day, but it remains possible that variation in the accuracy of the equipment in detecting acid reflux was also involved.