The interpretation of the 24-hour gastric pH monitoring for determining gastroduodenal reflux is more complex than its use for acid reflux diagnosis because of the interaction between mucous and acid secretions, ingested food, saliva, and duodenal, pancreatic, and biliary secretions.42 The score proposed by Fuchs et al.43 allows the quantification of duo-denogastric reflux and gastric acid secretion and could be helpful in the assessment of DGER and gastric emptying disorders. The scoring had a sensitivity of 90% and a specificity of 100%. Alkaline reflux is confirmed by measurement of the time during which the esophageal pH is >7, but several considerations must be taken into account. Electrodes made of glass instead of antimony should be used, and extreme caution is exerted with the calibration method. The patient's diet should be restricted to food at a pH < 7, the patient should be examined for dental caries that can raise the salivary pH, and strictures should be dilated to prevent pooling of saliva.13,17,37,43,44 The placement of a second probe in the stomach may be helpful in differentiating acid reflux, mixed, and alkaline reflux.1 Mattioli et al.24 used simultaneous esophageal, fundus, and antrum probes to demonstrate that 18% of patients with abnormal alkaline reflux could be considered normal based solely on standard 24-hour pH monitor-ing.24 However, some authors have found a poor correlation between DGER and measured length of time of esophageal pH < 7, possibly because of increased saliva production or bicar
MANAGING FAILED ANTI-REFLUX THERAPY
bonate production by esophageal mucosal glands.28,45,46
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