Esophageal pH-Impedance Monitoring in Patients With Therapy-Resistant Reflux Symptoms: ‘On’ or ‘Off’ Proton Pump Inhibitor?

In order to demonstrate or exclude GERD in patients with PPI-resistant symptoms, ambulatory 24-h pH-impedance monitoring should preferably be performed after cessation of PPI therapy because this approach seems to offer the best chance to assess a relationship between symptoms and reflux episodes.