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  • 1
    Electronic Resource
    Electronic Resource
    Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain (1990)
    Springer
    Digestive diseases and sciences 35 (1990), S. 302-309 
    Details
    ISSN: 1573-2568
    Keywords: gastroesophageal reflux disease ; esophageal motility disorders ; chest pain ; diffuse spasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prolonged ambulatory esophageal pH and pressure monitors are being developed to evaluate noncardiac chest pain. This new technology needs comparison with conventional esophageal tests before determining which studies are most useful in diagnosing and treating esophageal chest pain. Therefore, we studied 45 patients with esophageal manometry, acid perfusion and edrophonium tests, and 24 hr pH and pressure monitoring. Manometry was abnormal in 20 patients (44%) with nutcracker esophagus, the most common motility disorder. Fifteen (33%) had positive acid perfusion test and 24 (55%) positive edrophonium test. During ambulatory monitoring, all patients experienced chest pain with a total of 202 individual events: 32 events (15%) secondary to acid reflux, 15 (7%) secondary to motility abnormalities, 7 (3%) to both pH and pressure changes, and 149 events (74%) occurred in the absence of any abnormal pH or motility changes. Patients with normal manometry were significantly (P〈0.01) more likely to have acid reflux chest pain events than did nutcracker patients, who had an equal frequency of pH and motility events. A positive acid perfusion test was significantly associated with abnormal pressure events (P=0.02; odds ratio 5.95), while a positive edrophonium test more likely predicted acid reflux chest pain during 24-hr monitoring (P=0.007; odds ratio 7.25). Therefore, abnormal manometry and positive provocative tests point to the esophagus as the likely source of chest pain. However, ambulatory pH and pressure monitoring are required to accurately define the relationship between chest pain and acid reflux or motility disorders. Acid reflux is the most common identifiable cause of esophageal chest pain, while motility disorders are much less frequent than previously suggested by laboratory tests.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01537406
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of a pH electrode across the lower esophageal sphincter (1992)
    Springer
    Digestive diseases and sciences 37 (1992), S. 667-672 
    Details
    ISSN: 1573-2568
    Keywords: prolonged esophageal pH monitoring ; gastric pH monitoring ; lower esophageal sphincter ; gastroesophageal reflux disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent studies have suggested that combined monitoring of the esophagus and stomach for prolonged periods may be the best method for investigating patients with upper gastrointestinal complaints. However, the effects of an electrode across the LES on esophageal reflux parameters have not been extensively studied. We studied 10 healthy volunteers and 10 patients with GERD twice with 24-hr pH monitoring. In phase 1, two glass electrodes were placed 1 cm below the UES and 5 cm above the LES. One week later in phase 2, patients were restudied with one electrode 5 cm above and one 5 cm below the LES. Although total acid exposure remained the same in healthy volunteers, three volunteers who spontaneously refluxed at night had abnormal prolongation of their supine acid exposure during phase 2 of the study. In patients with GERD, the electrode across the LES resulted in significant (P=0.01) increase in supine acid exposure and showed a strong tendency for the number of reflux episodes 〉5 min supine (P=0.02) and longest reflux episode supine (P=0.06) to increase without a change in the number of reflux episodes. In conclusion, a small glass electrode across the LES results in prolongation of supine acid exposure in both healthy volunteers spontaneously refluxing at night and the majority of patients with GERD. This results from the electrode interfering with clearance of refluxed acid in the supine position. Thus, combined esophageal and gastric pH monitoring may have important limitations in investigating gastroesophageal symptoms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01296421
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Normal 24-Hr ambulatory esophageal pH values (1992)
    Springer
    Digestive diseases and sciences 37 (1992), S. 849-856 
    Details
    ISSN: 1573-2568
    Keywords: gastroesophageal reflux disease ; 24-hr pH tests ; esophageal tests ; ambulatory monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the most sensitive and specific test for diagnosing gastroesophageal reflux disease, normal standards for prolonged esophageal pH monitoring are based on small sample sizes with questions raised about the effects of pH electrode, older age, gender, and methods of data analysis on pH variables. Recently three groups have established normal data bases using similar methodology. Multiple regression and nonparametric analyses showed that the values for the six traditional pH parameters were comparable across study centers. Therefore, the groups were combined for a total study population of 110 healthy subjects (47 men, 63 women, mean age 38 years with a range of 20–84 years). Further nonparametric analyses revealed the following: (1) type of pH electrode (antimony vs glass) is not significantly related to parameters of physiologic acid reflux; (2) age is not independently related to pH parameters; (3) men tend to have more physiologic reflux than women; and (4) older men tend to experience longer episodes of reflux than younger men and women. There was a significant effect of gender and a significant interaction between age and gender on the number of episodes 〉5 min (P=0.008). Nearly significant differences were found for percentage of total acid exposure time (P=0.03), total reflux episodes (P=0.02), and the longest reflux episode (P=0.02). We believe these normal esophageal pH values can be used confidently as standards in any laboratory, and consideration should be given to developing separate standards for men and women.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01300382
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    The symptom index (1993)
    Springer
    Digestive diseases and sciences 38 (1993), S. 1402-1408 
    Details
    ISSN: 1573-2568
    Keywords: heartburn ; chest pain ; gastroesophageal reflux disease ; 24-hr esophageal pH test ; symptom index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The symptom index is a quantitative measure developed for assessing the relationship between gastroesophageal reflux and symptoms. Controversy exists, however, over its accuracy and the appropriate threshold for defining acid-related symptoms of heartburn and chest pain. Therefore, a retrospective review was done of 153 consecutive patients referred to our esophageal laboratory. Three groups were identified: patients with normal 24-hr pH tests and no esophagitis, patients with abnormal 24-hr pH tests and no esophagitis, and patients with abnormal 24 hr pH values and endoscopic esophagitis. If symptoms occurred during the pH study, a symptom index (number of acid related symptoms/total number of symptoms x 100%) was calculated separately for heartburn and chest pain. Heartburn and chest pain episodes were similar among the three groups. However, the mean symptom index for heartburn was significantly (P〈0.001) higher in the patient groups with abnormal pH values [abnormal pH/no esophagitis: 70±7.1% (±se); abnormal pH/esophagitis: 85±4.6%] as compared to those with normal studies, ie, functional heartburn (26±10.7%). The mean symptom index for chest pain was similar for all three groups. Using receiver operating characteristic curves, a heartburn symptom index≥50% had excellent sensitivity (93%) and good specificity (71%) for acid reflux disease, especially if patients complain of multiple episoldes of heartburn. In contrast, an optimal symptom index threshold for defining acid-related chest pain episodes could not be defined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01308595
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Gastroesophageal pH step-up inaccurately locates proximal border of lower esophageal sphincter (1992)
    Springer
    Digestive diseases and sciences 37 (1992), S. 1185-1191 
    Details
    ISSN: 1573-2568
    Keywords: prolonged ambulatory esophageal pH monitoring ; gastroesophageal reflux disease ; lower esophageal sphincter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Limiting the widespread use of 24-hr pH monitoring is the necessity of manometrically placing the pH probe 5 cm above the proximal lower esophageal sphincter (LES) border. Therefore, we prospectively compared LES localization by gastroesophageal pH step-up with manometry in 71 patients and 14 asymptomatic volunteers. The gastroesophageal pH step-up significantly correlated with the proximal LES border in patients (r=0.53, P〈0.0001) and volunteers (r=0.91, P〈0.0001). Based on previously published criteria, the pH step-up value was considered acceptably accurate if it was within ±3 cm (6 cm total span) of the manometrically determined proximal LES border. In 58% of patients and 29% of volunteers the pH step-up occurred outside this accuracy range. Esophagitis (P=0.015) and abnormal reflux parameters (P=0.002) were variables contributing to this error. Subsequent analysis found that the pH step-up overestimated the proximal LES border and occurred at the midportion of the sphincter. The pH step-up still inaccurately located the mid LES in 34% of patients. Therefore, manometry should remain the standard for accurate LES localization prior to placing the pH probe.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01296558
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    Paper (German National Licenses)
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