Optimization of acid suppression utilizing esophageal ambulatory pH monitoring: a single center retrospective review.

Background: Ambulatory esophageal reflux monitoring allows for objective differentiation of pathologic reflux, reflux hypersensitivity, and functional heartburn. Defining a diagnosis as the etiology of symptoms allows for appropriate medication management, and specifically de-escalation of acid suppression medications such as proton-pump inhibitors. Methods: This retrospective chart review examined patients who underwent ambulatory esophageal reflux monitoring within a single health network between September 2021 and January 2024 to determine if appropriate postprocedure medication management occurred. Demographic data, acid suppressive therapy prior to monitoring, results of monitoring, and changes to therapy were reviewed and statistical analysis was performed. Results: In the study group, 85 patients were diagnosed with pathologic reflux based on a DeMeester score of ≥14.72; Caucasians and those with a higher body mass index were significantly more likely to be diagnosed with pathologic reflux. Acid suppression was de-escalated in 11 of the 29 patients diagnosed with functional heartburn and 4 of the 33 with reflux hypersensitivity. Conclusion: Opportunities remain to improve therapy de-escalation and adjustment in the nonpathologic reflux conditions of reflux hypersensitivity and functional heartburn.