Esophageal-reflux monitoring

Esophageal-reflux monitoring can be very helpful in the evaluation and management of GERD if one understands the strengths and limitations of the available technologies. Each specific device can provide the practicing clinician with important information regarding the presence of abnormal reflux and whether or not there is a consistent relationship between reflux events and symptoms. Choosing the right test and the right setting (off or on medication) relies heavily on the pretest probability of GERD and the question that needs to be answered. However, even this is not straightforward, and occasionally a test may need to be repeated under a different circumstance or to look for a different outcome measurement (nonacid reflux). Given these unclear issues, reflux testing should be performed with some degree of flexibility, and a single test or technology may not be enough to satisfy all of our needs. Thus, one should use reflux monitoring to support management decisions but should never rely solely on this technology to make a clinical decision. © 2009 American Society for Gastrointestinal Endoscopy.