Wireless pH Monitoring Is Better at 96 Hours Than 48 Hours in Patients With GERD Unresponsive to PPI Therapy
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Wireless pH Monitoring Is Better at 96 Hours Than 48 Hours in Patients With GERD Unresponsive to PPI Therapy

Prateek Sharma, MD, FASGE, reviewing Yadlapati R, et al. Am J Gastroenterol 2022 Oct.

A significant portion of patients with reflux-like symptoms do not have GERD and could potentially discontinue proton pump inhibitor (PPI) therapy. Although wireless pH monitoring is commonly performed, the diagnostic thresholds and optimal duration for reflux monitoring are not well defined. 

This double-blind single-arm prospective study enrolled 132 participants (40% men; mean age, 47.3 years; mean body mass index, 27.1 kg/m2) with PPI unresponsive symptoms. Participants underwent 96-hour pH monitoring off PPI therapy (1 week) with the primary aim to see whether they would successfully discontinue their PPI medication or resume it within 3 weeks. Patients were instructed to continue withholding PPI medication for 2 weeks after the procedure. Over-the-counter medications were permitted. 

Of the participants, 30% (40) were able to discontinue PPI use, whereas 70% (92) resumed their medications. Acid exposure thresholds (AETs) were measured, and an AET of ≤4.0% had the highest odds of predicting whether the patient would be able to discontinue PPI therapy (odds ratio, 2.9; 95% confidence interval, 1.4-6.4; P=.006). For the first 24 hours, AET was significantly higher among all participants compared with the second 24 hours (P=.001), and an assessment of only the first 48 hours of monitoring showed a significant decline in prognostic performance.

Prateek Sharma, MD, FASGE

COMMENT

Wireless pH monitoring without acid suppression is more optimal with 96-hour monitoring than 48-hour monitoring for predicting discontinuation of PPI therapy. Acid exposure time <4.0% appears to be the optimal predictor of the ability to discontinue PPI therapy.

 

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Yadlapati R, Gyawali CP, Masihi M, et al. Optimal wireless reflux monitoring metrics to predict discontinuation of proton pump inhibitor therapy. Am J Gastroenterol 2022;117:1573-1582. (https://doi.org/10.14309/ajg.0000000000001871)

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