1. Postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance can link PPI-responsive heartburn to reflux better than acid exposure time
- Author
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Helga Bertani, Edoardo Savarino, Rita Conigliaro, Salvatore Tolone, Vincenzo Savarino, N. De Bortoli, Lorenzo Fuccio, Leonardo Frazzoni, Santino Marchi, Marzio Frazzoni, Manuele Furnari, Irene Martinucci, Frazzoni, L., Frazzoni, M., De Bortoli, N., Tolone, S., Furnari, M., Martinucci, I., Bertani, H., Marchi, S., Conigliaro, R., Fuccio, Lorenzo, Savarino, V., Savarino, E., Frazzoni, L, Frazzoni, M, de Bortoli, N, Tolone, S, Furnari, M, Martinucci, I, Bertani, H, Marchi, S, Conigliaro, R, Fuccio, L, Savarino, V, and Savarino, E
- Subjects
Male ,Proton Pump Inhibitor ,Physiology ,Logistic regression ,Gastroenterology ,0302 clinical medicine ,Heartburn ,Electric Impedance ,Medicine ,Peristalsis ,digestive, oral, and skin physiology ,Area under the curve ,impedance-pH monitoring ,Middle Aged ,Treatment Outcome ,030220 oncology & carcinogenesis ,Gastroesophageal Reflux ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Human ,Impedance–pH monitoring ,medicine.medical_specialty ,Esophageal pH Monitoring ,medicine.drug_class ,Proton-pump inhibitor ,Sensitivity and Specificity ,Endocrine and Autonomic System ,03 medical and health sciences ,esophageal chemical clearance ,esophageal baseline impedance ,GERD ,Endocrine and Autonomic Systems ,Internal medicine ,otorhinolaryngologic diseases ,Humans ,business.industry ,Reflux ,Proton Pump Inhibitors ,medicine.disease ,digestive system diseases ,Surgery ,Deglutition ,business - Abstract
Background Acid exposure time (AET) is considered the most useful parameter to predict response of reflux-related heartburn to medical or surgical treatment. However, recent studies showed high rates of heartburn response to proton pump inhibitor (PPI) therapy in patients with normal AET. We aimed to compare the efficacy of postreflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) with AET in linking PPI-responsive heartburn to reflux. Methods Off-therapy impedance-pH tracings from 425 patients, 317 with PPI-responsive and 108 with PPI-refractory heartburn were blindly re-analyzed. Demographic and endoscopic characteristics, conventional impedance-pH variables, PSPW index, and MNBI were assessed with multivariate logistic regression to identify factors independently associated with PPI responsiveness. Prediction models were developed to assess the strength of reflux linkage with factors independently associated with PPI responsiveness by calculating the area under the curve (AUC) at receiver-operating-characteristic (ROC) analysis. Key Results At multivariate logistic regression analysis, AET, MNBI, and PSPW index were the only factors independently associated with PPI responsiveness, abnormal values found in 60%, 76%, and 92% of PPI-responsive cases (P
- Published
- 2017