Interpretation of the Bernstein test: a reappraisal of criteria.

We evaluated the esophageal acid infusion test (Bernstein test) in respect to the following questions: Does chest pain predictably disappear after cessation of acid infusion, and what is the relation between esophageal intraluminal pH and the degree of chest pain relief? Forty patients with subjective and objective evidence of gastroesophageal acid reflux, in whom esophageal acid infusion had reproduced substernal burning in a mean time of 3.1 minutes +/- 0.8 SE, graded pain relief after stopping acid infusion when saline was being infused. Complete pain relief occurred in 47.5% of patients over a 20-minute period. In six patients, esophageal pH was monitored for 30 minutes after administration of saline, antacid, placebo-antacid, and no treatment for a positive acid infusion test. Esophageal pH returned to normal (greater than 4.0) at the same rate (from 5.0 to 8.3 minutes) among patients in the four treatment groups, whereas chest pain continued and esophageal pH did not correlate with pain relief. The grading of pain relief was similar among the treatment groups, except at the 5-minute period when antacids resulted in significantly better relief than no treatment.