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Gastric pH monitoring is a technique that measures the acidity of the stomach contents using a probe inserted through the nose or mouth into the stomach. Gastric pH monitoring can be used for diagnostic purposes in critically ill patients with gastrointestinal (GI) dysfunction, gastroesophageal reflux disease (GERD), or achlorhydria. The diagnostic value of gastric pH monitoring depends on the indication, duration, and interpretation of the results. Gastric pH monitoring can help to:

  • Assess the global GI function and motility in patients with feeding intolerance, malabsorption, or bacterial overgrowth1.
  • Confirm or exclude the diagnosis of GERD in patients with refractory symptoms, atypical manifestations, or complications2.
  • Confirm the diagnosis of achlorhydria in patients with no acidic pH in the stomach while off proton pump inhibitors (PPIs)2.

The association of gastric pH monitoring with outcomes in critically ill patients is not well established. Some studies have suggested that gastric pH monitoring may help to:

  • Optimize the dose of acid-suppressive drugs (such as ranitidine) to increase the gastric pH and prevent stress ulcers and bleeding in neonates3.
  • Reduce the risk of ventilator-associated pneumonia by detecting and treating GERD and aspiration in mechanically ventilated patients2.
  • Improve the nutritional status and quality of life by identifying and managing GI dysfunction and malabsorption in patients with enteral feeding1. However, there is only very little and further studies are needed to determine the role of gastric pH monitoring in critical care.

References:

  1. Reintam Blaser A, Starkopf J, Deane AM. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposal. Crit Care. 2020;24(1):224. https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02889-4
  2. Ambulatory pH Monitoring – Gastrointestinal Disorders – MSD Manual Professional Edition [Internet]. [cited 2023 Aug 15]. Available from: https://www.msdmanuals.com/professional/gastrointestinal-disorders/diagnostic-and-therapeutic-gastrointestinal-procedures/ambulatory-ph-monitoring
  3. Ng PC, So KW, Fung KS, Lee CH, Fok TF, Wong E, et al. Long term gastric pH monitoring for determining optimal dose of ranitidine for critically ill preterm and term neonates. Arch Dis Child Fetal Neonatal Ed. 1998;78(2):F151–5. https://fn.bmj.com/content/78/2/F151

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