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The Brass Standard

A. R. COLON, MD; J. S. DIPALMA, MD; Kenneth Levin, MD.
Am J Dis Child. 1992;146(8):895-896. doi:10.1001/archpedi.1992.02160200017007.
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Sir.—Gastroesophageal reflux (GER) has become the maladie du jour that is considered responsible for a wide variety of medical miseries. Some are immediately obvious, such as repetitive "spitting-up" in the infant, postprandial esophagodynia, esophagitis, or erosive dysplasia of dental enamel.1 However, others, such as irritability, chest pain, failure to thrive, sleep aberrations, apnea, bradycardia, stridor, hoarseness, aspiration, and reactive airway disease2-6 require correlation and confirmation. To this end, our division has, during the last several years, witnessed a dramatic increase in the number of requests for pH probes, with annotations on the consultation form of "suspect GER, please do gold standard."

It has become a major task to convince our residents and fellow attending physicians that the indications for the use of a pH probe are specific and that the information yielded may not answer the questions asked. In the interest of sparing the patient of unnecessary


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