Empirical trials in treatment of gastroesophageal reflux disease
ABSTRACT The assortment of diagnostic tests that are currently available for detecting gastroesophageal reflux disease (GERD) are invasive, costly and not readily available to community-based physicians. In contrast, a short course of high-dose proton pump inhibitor (PPI) as an empirical trial is an attractive alternative. This simple diagnostic test has been demonstrated to be accurate and cost-effective in patients with symptoms suggestive of GERD and those with noncardiac chest pain. Early studies in patients with extraesophageal manifestations of GERD have yielded promising results. Cost assessment of the PPI empirical trial revealed significant cost savings, mainly due to a marked decrease in utilization of invasive diagnostic tests. Thus the PPI empirical trial should be considered as the initial diagnostic step in patients with the disease spectrum of GERD.
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ABSTRACT: Multichannel intraluminal impedance is a relatively new technology that allows detection of bolus movement in the gastrointestinal tract without the use of radiation. In clinical applica- tions it is combined with manometry, allowing a better evaluation of the functional characteristics (ie, bolus transit) of esophageal motility abnormalities. When combined with pH monitoring, it provides more comprehensive data on both acid and nonacid gastroesophageal reflux.