S1900 EGJ pH Mapping: A Novel Model for Esophageal pH Monitoring Not Preceded By Lower Esophageal Sphincter Manometry

Abstract To clarify the significance of the lower esophageal sphincter (LES) for prevention of alkaline reflux esophagitis (ARE) after total gastrectomy reconstructed by Roux-en-Y (TGRY) for gastric cancer, we investigated LES function and lower esophageal pH in TGRY patients with or without LES preservation. A total of 51 patients 5 years after TGRY were divided into groups A (26 patients without preserved LES) and B (25 patients with preserved LES) and compared with 22 control participants (group C). Manometric study and ambulatory 24-hour esophageal pH monitoring were performed on all patients. Symptomatic and endoscopic AREs in group A were significantly higher than those in group B (P < 0.05). The length of LES and maximum LES pressure in group A were significantly shorter and lower, respectively, than in groups B and C (P < 0.01). The length of LES and maximum LES pressure in patients with symptomatic ARE were significantly shorter and lower, respectively, than in patients without symptomatic ARE (P < 0.01). Percentages of time with pH >7 and pH >8 within 24 hours in group A were significantly higher than those in groups B and C (P < 0.01). Preservation of the LES may be necessary to prevent ARE after TGRY.

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Positioning of the pH-probe by manometry or radiography for monitoring of the esophagus: Influence on diagnostic results?

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00093.x ◽

2003 ◽

Vol 44 (4) ◽

pp. 360-362

Author(s):

K. Aksglæde ◽

P. Thommesen

Keyword(s):

Gastroesophageal Reflux ◽

Lower Esophageal Sphincter ◽

Ph Monitoring ◽

Gastroesophageal Junction ◽

Ph Probe ◽

Rye Bread ◽

Esophageal Ph ◽

Significant Difference ◽

Oblique Position ◽

Esophageal Sphincter

Purpose: To correlate gastroesophageal reflux (GER), demonstrated by radiography using bread and barium, with 24-h pH monitoring in the esophagus, with the pH-probe positioned by manometry or radiology. Material and Methods: In all, 146 patients, 41 females and 105 males, with a median age of 47 years, suspected of GER were examined. Radiography was performed with the patient in the supine right oblique position during mastication and swallowing a piece of rye bread with liver pâté and barium. The test was positive if barium was observed more than 5 cm proximal to the gastroesophageal junction (GEJ). An antimony pH-probe was placed 5 cm above the lower esophageal sphincter determined by manometry, or 5 cm above the GEJ determined by radiography. The total time of esophageal pH < 4 exceeding 5% was considered pathological. Results: The radiological method had a specificity of 100% and a sensitivity of 52% compared to 24-h pH monitoring with the pH-probe positioned manometrically, and a specificity of 100% and sensitivity of 67% with the pH-probe positioned by radiography, with no significant difference between the two positionings. Conclusion: In 146 patients submitted to 24-h pH monitoring, the pH-probe could be placed as safely by radiography as by manometry.

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