• Heart Failure
  • Cardiovascular Clinical Consult
  • Adult Immunization
  • Hepatic Disease
  • Rare Disorders
  • Pediatric Immunization
  • Implementing The Topcon Ocular Telehealth Platform
  • Weight Management
  • Monkeypox
  • Guidelines
  • Men's Health
  • Psychiatry
  • Allergy
  • Nutrition
  • Women's Health
  • Cardiology
  • Substance Use
  • Pediatrics
  • Kidney Disease
  • Genetics
  • Complimentary & Alternative Medicine
  • Dermatology
  • Endocrinology
  • Oral Medicine
  • Otorhinolaryngologic Diseases
  • Pain
  • Gastrointestinal Disorders
  • Geriatrics
  • Infection
  • Musculoskeletal Disorders
  • Obesity
  • Rheumatology
  • Technology
  • Cancer
  • Nephrology
  • Anemia
  • Neurology
  • Pulmonology

For Recalcitrant GERD Symptoms, Order 24-h pH/Imepdance Study


Persistent GERD symptoms such as regurgitation may indicate poor response to PPI therapy.

A 35-year-old man is referred for the evaluation of GERD symptoms. His primary symptom is regurgitation, although he occasionally experiences heartburn as well. He was started on once daily PPI for 2 months and only experienced mild relief in symptoms. His dosage was increased to twice daily for an additional month without much improvement. He denies any dysphagia, weight loss, early satiety, or melena. He is otherwise healthy and takes no other medications. Which of the following would be recommended?

A. Ambulatory 24-hour pH/impedance study
B. Upper endoscopy
C. Barium esophagram
D. Switch PPI to H2 receptor antagonist


Answer: A.

This patient with GERD symptoms has a partial and suboptimal response to PPI therapy. The symptom of regurgitation is generally less responsive to acid suppressants than heartburn. This may be a result of PPIs not directly affecting the mechanisms of reflux, rather these medications change the acidity of the refluxate. As this patient is without red flag signs (weight loss, dysphagia, melena), an upper endoscopy is not warranted. The preferred testing would be ambulatory pH monitoring. This study would be able to assess (1) whether he has adequate acid suppression on PPI; (2) whether his symptoms correlate with reflux; and (3) determine if his symptoms may be attributed to non-acid reflux, which occurs in up to one-third of patients whose symptoms persist despite PPI therapy. A barium swallow is not a good screening test for GERD. Changing acid suppressants is unlikely to improve his symptoms.

Related Videos
New Research Amplifies Impact of Social Determinants of Health on Cardiometabolic Measures Over Time
Overweight and Obesity: One Expert's 3 Wishes for the Future of Patient Care
Donna H Ryan, MD Obesity Expert Highlights 2021 Research Success and Looks to 2022 and Beyond
"Obesity is a Medically Approachable Problem" and Other Lessons with Lee Kaplan, MD, PhD
Related Content
© 2024 MJH Life Sciences

All rights reserved.