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An audit of the role of ambulatory oesophageal pH monitoring in clinical practice

Objectives To audit the results and management outcomes resulting from 102 clinical referrals to a regional service for ambulatory oesophageal pH monitoring. In addition, the cost per case where management was influenced and cost of pH monitoring were assessed. Design and methods Retrospective review by two independent clinicians of the hospital charts of consecutive patients (n=102) who were referred for pH monitoring between November 1988 and November 1990. Results Oesophageal pH monitoring was normal in 46 (45%) patients, abnormal in 54 (53%) and two studies (2%) were unsuccessful. Eighty-six patients (84%) had undergone upper gastrointestinal endoscopy prior to monitoring, of which 44 were normal and 42 showed oesophagitis (11 grade I, 24 grades II-III and seven grade IV). Of the 44 patients with normal endoscopic findings, 18 (41%) had an abnormal monitoring result compared with 71% of those with endoscopic evidence of reflux disease (P= 0.0012). Management was influenced by monitoring in 68% of patients with normal endoscopy compared with 43% of those with oesophagitis (P= 0.032). Each pH monitoring study cost £24.96 and the overall cost per case where management was influenced by monitoring was £45.46. When divided into three groups according to prior endoscopy results, the cost per case where management was influenced was £36.61 in those with prior normal endoscopy, £49.92 in the group of 16 patients who did not have endoscopy, and £58.24 in those who had previously demonstrated oesophagitis. Conclusion Ambulatory oesophageal pH monitoring is a clinically useful and cost-effective test in patients with gastro-oesophageal reflux disease, particularly those with no endoscopic evidence of oesophagitis.