24-Hour esophageal pH monitoring before and after medical therapy for reflux esophagitis

Medical treatment of gastroesophageal reflux disease often results in improvement of symptoms. The purpose of this study was to determine if improvement in symptoms and endoscopic appearance after treatment was associated with a reduction in reflux, as measured with 24-hr pH recordings. Twenty patients with severe chronic reflux esophagitis participated in an eight-week double-blind trial of medical therapy with metoclopramide and cimetidine versus placebo and cimetidine. Significant symptom score improvement was noted in 11 patients. Eleven patients also had improvement in the endoscopic appearance of the esophageal mucosa, and eight of these patients had significant symptom improvement. Initial 24-hr pH recordings were abnormal in all patients, evidenced by an esophageal pH<4 during 20% of the study period. Improvement in 24-hr results was noted in only five patients-three with clinical and endoscopic improvement, and two with no improvement. In conclusion, there was no relationship between clinical improvement and the results of 24-hr pH recordings. Successful symptom relief and endoscopie healing of esophagitis during medical treatment may occur despite persistent reflux of gastric contents.