False Positives in Esophageal pH Monitoring: The Pitfalls of Single-Value Interpretation

Background/Objectives: Esophageal pH monitoring is a key diagnostic modality in the evaluation of gastroesophageal reflux disease (GERD) and employs either a traditional transnasal catheter or wireless probe. In clinical practice, findings from these studies are often represented by a single metric, such as acid exposure time (AET), designed to quantitatively summarize reflux burden. However, these composite scores are susceptible to error derived from sensor position, patient diet and posture, transient pH fluctuations, anatomical variations, and esophageal motility. This study sought to identify false-positive mechanisms in esophageal pH testing.

Methods

We retrospectively identified institutional logs of false-positive pH findings from a single medical center from January 2019 to January 2025, and in conjunction with expert opinion, we classified false-positive patterns based on the original clinical interpretation.