Ambulatory Reflux Monitoring
Histamine H2 Antagonists
Proton Pump Inhibitors
Prolonged ambulatory reflux monitoring is an important tool in evaluating patients with gastroesophageal reflux (GERD) symptoms. While current clinical practice guidelines favor empiric trials of proton pump inhibitors (PPI) before pH testing or endoscopy to diagnose GERD, esophageal pH testing is recommended in patients with persistent symptoms despite acid-suppressive therapy and in patients who are considering antireflux surgery. In many circumstances the decision to test the patient on or off therapy is problematic and one of debate amongst experts. Off-therapy testing allows for a diagnosis of abnormal esophageal acid exposure and assessment of relationship of symptoms and acid reflux. On therapy testing can assess the effect of therapy, the relationship of reflux and the remaining symptoms and if impedance is added to pH the presence of non acid reflux. This chapter will review the options available for ambulatory reflux monitoring, as well as the potential benefits in the clinical arena. © 2010 Blackwell Publishing Ltd.
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