1. The added diagnostic value of postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on-therapy impedance-pH monitoring
- Author
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Vincenzo Giorgio Mirante, Santino Marchi, Marzio Frazzoni, N. De Bortoli, Manuele Furnari, Irene Martinucci, Edoardo Savarino, Leonardo Frazzoni, Vincenzo Savarino, Salvatore Tolone, Frazzoni, M., de Bortoli, N., Frazzoni, L., Tolone, S., Furnari, M., Martinucci, I., Mirante, V. G., Marchi, S., Savarino, V., Savarino, E., Frazzoni M., de Bortoli N., Frazzoni L., Tolone S., Furnari M., Martinucci I., Mirante V.G., Marchi S., Savarino V., and Savarino E.
- Subjects
Adult ,Male ,Impedance–pH monitoring ,medicine.medical_specialty ,Esophageal baseline impedance ,Esophageal chemical clearance ,Impedance-pH monitoring ,Refractory GERD ,Physiology ,Endocrine and Autonomic Systems ,Gastroenterology ,Esophageal pH Monitoring ,medicine.drug_class ,Nerd ,Peristalsi ,Proton-pump inhibitor ,Endocrine and Autonomic System ,03 medical and health sciences ,esophageal baseline impedance ,esophageal chemical clearance ,impedance-pH monitoring ,refractory GERD ,0302 clinical medicine ,Heartburn ,Retrospective Studie ,Internal medicine ,Electric Impedance ,Humans ,Medicine ,Reflux esophagitis ,Retrospective Studies ,business.industry ,Area under the curve ,Reflux ,Middle Aged ,medicine.disease ,digestive system diseases ,Deglutition ,030220 oncology & carcinogenesis ,Gastroesophageal Reflux ,GERD ,Peristalsis ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Human - Abstract
Background: On-therapy impedance-pH monitoring in proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) yielded conflicting results. We aimed to assess the diagnostic value of postreflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) in PPI-refractory heartburn. Methods: On-therapy impedance-pH tracings from 189 consecutive patients with PPI-refractory heartburn were blindly reviewed. Patients were subdivided into refractory reflux esophagitis (RRE), healed reflux esophagitis (HRE), non-erosive reflux disease (NERD), and functional heartburn (FH) according to endoscopic and conventional impedance-pH findings. The diagnostic accuracy of PSPW index and MNBI in separating NERD from FH was assessed with receiver-operating-characteristic (ROC) analysis. Objectively documented persistent reflux remission at 3-year follow-up in 53 patients who underwent laparoscopic fundoplication served to evaluate PSPW index and MNBI as independent predictors of PPI-refractory GERD confirmed by positive surgical outcome. Key Results: Median PSPW index and MNBI values were significantly lower in 39 RRE (16%; 1145Ω) than in 41 HRE (25%; 1741Ω) and in 68 NERD (29%; 2374Ω) patients, and in all three GERD subgroups compared to 41 FH cases (67%; 3488Ω) (P
- Published
- 2016