Utility of Catheter-Free Ambulatory pH Testing on PPI Therapy
2007; Lippincott Williams & Wilkins; Volume: 102; Linguagem: Inglês
10.14309/00000434-200709002-00035
ISSN1572-0241
AutoresLydell C. Horine, Sami R. Achem, Ernest P. Bouras, Mark E. Stark, Dawn D. Ferguson, Kenneth R. DeVault,
Tópico(s)Antibiotics Pharmacokinetics and Efficacy
ResumoPurpose: To determine the utility of performing ambulatory pH testing on proton pump inhibitor (PPI) therapy using a catheter-free system (BRAVO). Methods: All patients referred to our laboratory over a 24-month period for an ambulatory 48-hour pH test and who were on a PPI at least once daily were included. Patients were referred by a combination of gastroenterologists, other subspecialists or primary care providers. The pH capsule was placed during endoscopy, six centimeters above the squamo-columnar junction. Patients were excluded if incomplete data were available or if the patient inadvertently discontinued their PPI before or during the study. Percent acid exposure for each day and for the total study was the primary endpoint. We evaluated both the standard normal cutoff value for percent time pH < 4.0 (5.5%) and a commonly accepted normal value for BID PPI (1.6%). The percentages of patients with abnormal acid exposure on day 1, day 2 and for the total 2-day study period were calculated. Results: 122 of 259 consecutive pH studies (47%) were performed on PPI therapy. 12 patients were excluded from analysis (2 due to probe dislodgement early in the study, 5 due to discontinuation of PPI during the study and 5 because time recorded on one of the two days was less than 12 hours). Of the 110 remaining studies, 71 (65%) were on BID PPI and 39 (35%) on QD. The percentages of patients with excessive acid reflux are presented in the tables. Conclusion: Catheter-free esophageal pH testing in patients on PPI therapy provides complete data in the majority of patients. In this group of patients, 15.5% of studies on BID PPI show ongoing acid reflux (over 48 hours) using the common cutoff of 5.5% and 35.2% using the alternative cutoff of 1.6%. If abnormal reflux on either day is considered pathologic those percentages increase to 23.9 and 43.7% respectively. There was a paradoxical finding of fewer patients with a positive study on QD PPI possibly related to referral bias. Testing using this method provides useful information on the presence of ongoing acid reflux in patients on PPI therapy.Table
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