What is the role of 24-hour pH-metry in patients with atypical gastroesophageal reflux disease (GERD) and in those with classic GERD? At what stage of diagnostic workup should pH-metry be performed?
Peter Malfertheiner: It is a very good question, too. In patients with atypical symptoms – as we just mentioned: chronic cough or laryngitis – when we perform the endoscopy, which is the first step, and we do not find macroscopic lesions of the esophagus, we recommend to perform pH-metry in combination with the so-called impedance measurement, which allows to discriminate between acid and nonacid reflux. pH-metry is certainly the essential to identify an acid reflux.
In the other group of patients that have established GERD and do not respond to proton pump inhibitors (PPIs) in the standard dose, it is advisable to test [while continuing] this PPI treatment to see if we can adapt the PPI dose.