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Esophageal pH Monitoring (cont.)

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What are the limitations of esophageal pH monitoring?

The demonstration of abnormal amounts of acid reflux does not mean that symptoms are being caused by the reflux. Only treatment with medications that treat reflux coupled with a marked reduction of symptoms can be used to substantiate reflux as the cause of the symptoms. Nevertheless, it is important to remember that treatment is associated with a placebo response. For instance, 10% to 20% of patients without acid reflux report an improvement in symptoms with anti-reflux medications. Therefore, even a good response to treatment does not definitely prove that reflux is the cause of symptoms.

Some of the strongest evidence that episodic chest pain is being caused by acid reflux is provided by demonstrating that the painful episodes coincides with an episode of acid reflux. If there are very frequent episodes of reflux, however, it may not be possible to separate a true association between a symptom and reflux from a chance association due to the great frequency of episodes of reflux. Conversely, if a symptom occurs infrequently, for example, once every few days, it is unlikely that the symptom will occur during a routine 24 hour monitoring session, and therefore, a correlation will not be possible. One attempt to get around the latter problem is to extend the monitoring to several days, but this extended monitoring is done infrequently.

Medically Reviewed by a Doctor on 9/2/2016


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