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Day-to-day discrepancy in Bravo pH monitoring is related to the degree of deterioration of the lower esophageal sphincter and severity of reflux disease.

Ayazi S, Hagen JA, Zehetner J, Banki F, Augustin F, Ayazi A, DeMeester SR, Oh DS, Sohn HJ, Lipham JC, DeMeester TR - Surg Endosc (2011)

Bottom Line: Lower esophageal sphincter (LES) characteristics were compared between groups.Of the 60 patients with a discrepancy, 27 were abnormal the first day and 33 (55%) were abnormal the second day.Variability between the 2 days represents early deterioration of the gastroesophageal barrier and indicates less advanced reflux disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Thoracic Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.

ABSTRACT

Background: The Bravo capsule allows monitoring of esophageal acid exposure over a two-day period. Experience has shown that 24-32% of patients will have abnormal esophageal acid exposure detected on only one of the 2 days monitored. This variation has been explained by the effect of endoscopy and sedation. The aim of this study was to assess the day-to-day discrepancy following transnasal placement of the Bravo capsule without endoscopy or sedation and to determine factors related to this variability.

Methods: Bravo pH monitoring was performed by transnasal placement of the capsule in 310 patients. Patients were divided into groups based on the composite pH score: both days normal, both days abnormal and only one of the 2 days abnormal. Lower esophageal sphincter (LES) characteristics were compared between groups.

Results: Of the 310 patients evaluated, 60 (19%) showed a discrepancy between the 2 days. A total of 127 patients had a normal pH score on both days and 123 had an abnormal pH score on both days. Of the 60 patients with a discrepancy, 27 were abnormal the first day and 33 (55%) were abnormal the second day. Patients with abnormal esophageal acid exposure on both days had higher degrees of esophageal acid exposure and were more likely to have a defective LES compared to those with an abnormal score on only one day (35 vs. 83%, p=0.027).

Conclusion: Patients with a discrepancy between days of Bravo pH monitoring have lower esophageal acid exposure. Variability between the 2 days represents early deterioration of the gastroesophageal barrier and indicates less advanced reflux disease.

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Related in: MedlinePlus

The proportion of the patients who had a discrepancy between day 1 and day 2. Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted. Fifty-one percent of patients with a pH score between 8.7 and 19.3 on the first day had a discrepancy between day 1 and day 2. In contrast, of those who had a pH score of <8.7 or >19.3 on their first day of monitoring, only 11% had a day-to-day discrepancy
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Fig3: The proportion of the patients who had a discrepancy between day 1 and day 2. Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted. Fifty-one percent of patients with a pH score between 8.7 and 19.3 on the first day had a discrepancy between day 1 and day 2. In contrast, of those who had a pH score of <8.7 or >19.3 on their first day of monitoring, only 11% had a day-to-day discrepancy

Mentions: To evaluate the severity of reflux in patients with an abnormal composite pH score on only 1 day and those with an abnormal pH score on both days, we compared the frequency of abnormality for each of the components of pH monitoring and the individual values for these components from the worst day of reflux, defined as the day with the highest composite pH score. Patients who had an abnormal score on both days had a higher frequency of abnormality for each of the individual components (Fig. 2) and more severe reflux confirmed by each of the six components and the composite pH score (Table 2). Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted in Fig. 3. Patients with a composite pH score less than 8.7 and greater than 19.3 on day 1 had a low likelihood of discrepancy.Fig. 2


Day-to-day discrepancy in Bravo pH monitoring is related to the degree of deterioration of the lower esophageal sphincter and severity of reflux disease.

Ayazi S, Hagen JA, Zehetner J, Banki F, Augustin F, Ayazi A, DeMeester SR, Oh DS, Sohn HJ, Lipham JC, DeMeester TR - Surg Endosc (2011)

The proportion of the patients who had a discrepancy between day 1 and day 2. Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted. Fifty-one percent of patients with a pH score between 8.7 and 19.3 on the first day had a discrepancy between day 1 and day 2. In contrast, of those who had a pH score of <8.7 or >19.3 on their first day of monitoring, only 11% had a day-to-day discrepancy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3116124&req=5

Fig3: The proportion of the patients who had a discrepancy between day 1 and day 2. Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted. Fifty-one percent of patients with a pH score between 8.7 and 19.3 on the first day had a discrepancy between day 1 and day 2. In contrast, of those who had a pH score of <8.7 or >19.3 on their first day of monitoring, only 11% had a day-to-day discrepancy
Mentions: To evaluate the severity of reflux in patients with an abnormal composite pH score on only 1 day and those with an abnormal pH score on both days, we compared the frequency of abnormality for each of the components of pH monitoring and the individual values for these components from the worst day of reflux, defined as the day with the highest composite pH score. Patients who had an abnormal score on both days had a higher frequency of abnormality for each of the individual components (Fig. 2) and more severe reflux confirmed by each of the six components and the composite pH score (Table 2). Patients were divided into ten groups of equal size (31 in each group) based on the composite pH score on day 1, and the percentage of patients with a discrepancy between day 1 and day 2 is plotted in Fig. 3. Patients with a composite pH score less than 8.7 and greater than 19.3 on day 1 had a low likelihood of discrepancy.Fig. 2

Bottom Line: Lower esophageal sphincter (LES) characteristics were compared between groups.Of the 60 patients with a discrepancy, 27 were abnormal the first day and 33 (55%) were abnormal the second day.Variability between the 2 days represents early deterioration of the gastroesophageal barrier and indicates less advanced reflux disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Thoracic Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.

ABSTRACT

Background: The Bravo capsule allows monitoring of esophageal acid exposure over a two-day period. Experience has shown that 24-32% of patients will have abnormal esophageal acid exposure detected on only one of the 2 days monitored. This variation has been explained by the effect of endoscopy and sedation. The aim of this study was to assess the day-to-day discrepancy following transnasal placement of the Bravo capsule without endoscopy or sedation and to determine factors related to this variability.

Methods: Bravo pH monitoring was performed by transnasal placement of the capsule in 310 patients. Patients were divided into groups based on the composite pH score: both days normal, both days abnormal and only one of the 2 days abnormal. Lower esophageal sphincter (LES) characteristics were compared between groups.

Results: Of the 310 patients evaluated, 60 (19%) showed a discrepancy between the 2 days. A total of 127 patients had a normal pH score on both days and 123 had an abnormal pH score on both days. Of the 60 patients with a discrepancy, 27 were abnormal the first day and 33 (55%) were abnormal the second day. Patients with abnormal esophageal acid exposure on both days had higher degrees of esophageal acid exposure and were more likely to have a defective LES compared to those with an abnormal score on only one day (35 vs. 83%, p=0.027).

Conclusion: Patients with a discrepancy between days of Bravo pH monitoring have lower esophageal acid exposure. Variability between the 2 days represents early deterioration of the gastroesophageal barrier and indicates less advanced reflux disease.

Show MeSH
Related in: MedlinePlus