How valuable is Bernstein's test ?
D.O. Castell (Philadelphia)
The Bernstein test has been a clinical tool used to identify symptoms as potentially due to acid reflux for approximately 30 years . It has been primarily recommended, however, in the assessment of esophageal sensitivity in patients with a history of heartburn, or with other symptoms more typical of reflux.
The usefulness of this test in patients with angina-like chest pain is questionable : in one study from our laboratory of 910 patients with noncardiac chest pain seen over a three year period, only 7 p. cent had their typical pain reproduced during intra-esophageal acid infusion . Of these, more than half also had a positive edrophonium response, making the acid perfusion test of little additional value.
More recently, we have compared the positive pain response during the Bernstein test with other evidence of reflux disease, including an ambulatory 24-hour pH study with a « symptom index ». Only 48 p. cent of the patients in whom the Bernstein test was positive had definite acid reflux-mediated chest pain demonstrated with the pH monitor  .