Which is the better method for location of the gastro-esophageal junction: radiography or manometry?

Accurate positioning of the 24-hour pH monitoring catheter: Agreement between manometry and pH step-up method in two patient positions

AIM: To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions.

METHODS: Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed.

RESULTS: In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (≤ 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position.

CONCLUSION: In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.

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

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.