ArticleAlimentary pharmacology & therapeutics2022
Clinical role of ambulatory reflux monitoring in PPI non-responders: recommendation statements.
Article in Alimentary pharmacology & therapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 22 citations in OpenAlex.
- Randomized Controlled Trial of Upper Esophageal Sphincter Assist Device in Laryngopharyngeal Reflux Disease.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Trial
- Sliding hiatal hernia detected by transnasal esophagogastroscopy is associated with poorer treatment response in reflux-associated globus sensation.Scientific reports · 2026Article
- Correlation between the type of esophagogastric junction and refractory reflux esophagitis.International journal of clinical and experimental pathology · 2025Article
- A comparative study of magnetic sphincter augmentation and Nissen fundoplication in the management of GERD.Hernia : the journal of hernias and abdominal wall surgery · 2024Article
- Optimizing the Management Algorithm for Heartburn in General Gastroenterology: Cost-Effectiveness and Cost-Minimization Analysis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Manometric esophagogastric junction barrier metrics as predictors of gastroesophageal reflux.Esophagus : official journal of the Japan Esophageal Society · 2024Article
- Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Prolonged acid reflux monitoring using acid exposure time and DeMeester score: two days are not enough.Surgical endoscopy · 2024Article
- Editorial: wireless pH-monitoring - is it time to put away the pH-impredance catheters: Authors' response.Alimentary pharmacology & therapeutics · 2022Article
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Authors and funding
17 authors at 15 institutions in 1 country.
Funding
Abstract
backgroundOptimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated.
aimsTo utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice
methodsThe RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness.
resultsProlonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease (GERD) and persisting typical reflux symptoms despite once-daily PPI. Acid exposure time (AET) <4.0% on all days of monitoring with negative reflux-symptom association excludes GERD and does not support ongoing PPI treatment. Conversely, AET >6.0% across ≥2 days is conclusive evidence for GERD and supports treatment for GERD, while AET >10% across ≥2 days identifies severe acid burden that supports escalation of anti-reflux treatment. In previously proven GERD, impedance-pH monitoring on PPI is helpful in defining refractory GERD and mechanisms of continued symptoms; the presence of <40 reflux events, AET <2.0% and a negative reflux-symptom association does not support escalation of anti-reflux treatment. In contrast, AET > 4.0% and positive reflux-symptom association support escalation of anti-reflux treatment, including use of invasive therapeutics.
conclusionsStatements meeting appropriateness for average clinical care have been identified when utilising reflux monitoring in patients with typical reflux symptoms and PPI non-response.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.