Does the intraesophageal pH probe accurately detect acid reflux? Simultaneous recording with two pH probes in humans

Little is known about the accuracy of intraesophageal pH monitoring, ie, do false negatives occur? This study was designed based on the assumption that if two pH probes are placed equidistant from a distal acid source, and the probes measure different values, then one probe might miss acid if it were there alone. We performed 24-hr intraesophageal pH monitoring in 10 patients with gastroesophageal reflux disease, simultaneously placing two pediatric pH probes (probes A and B) 5 cm proximal to the LES in such close proximity that one would expect only small differences in the acid exposure measured by the probes. However, the amount of acid exposure measured by probes A and B differed greatly in some instances. Individual probe performance does not alone account for these differences, since, when pH recordings were reviewed, one probe was as likely to miss acid exposure as the other. These differences would result in a change in the clinical diagnosis in two of 10 patients. Variability in the number of episodes was great and occurred even when there was concordance in percent acid exposure. These data raise questions about the absolute accuracy of the pH probe as the gold standard in the measurement of gastroesophageal reflux.