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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

Frazzoni M, de Bortoli N, Frazzoni L, Tolone S, Furnari M, Martinucci I, Mirante VG, Marchi S, Savarino V, and Savarino E

Subjects
Adult, Female, Gastroesophageal Reflux diagnosis, Heartburn diagnosis, Humans, Male, Middle Aged, Retrospective Studies, Deglutition physiology, Electric Impedance, Esophageal pH Monitoring methods, Gastroesophageal Reflux physiopathology, Heartburn physiopathology, Peristalsis physiology
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%; 1145 Ω) than in 41 HRE (25%; 1741 Ω) and in 68 NERD (29%; 2374 Ω) patients, and in all three GERD subgroups compared to 41 FH cases (67%; 3488 Ω) (P<.008). At ROC analysis, comparing NERD to FH the area under the curve was 0.886 with PSPW index and 0.677 with MNBI (P=.005). PSPW index was an independent predictor of PPI-refractory GERD (odds ratio 0.6983, P=.012)., Conclusions & Inferences: At on-therapy impedance-pH monitoring, PSPW index and MNBI efficiently distinguish PPI-refractory NERD from FH. The PSPW index represents an independent predictor of PPI-refractory GERD., (© 2016 John Wiley & Sons Ltd.)

Published
2017
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2. Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease.

Author

Frazzoni M, Savarino E, de Bortoli N, Martinucci I, Furnari M, Frazzoni L, Mirante VG, Bertani H, Marchi S, Conigliaro R, and Savarino V

Subjects
Adult, Animals, Electric Impedance, Female, Humans, Hydrogen-Ion Concentration, Italy, Male, Middle Aged, Prospective Studies, Esophageal pH Monitoring methods, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux pathology, Peristalsis, Swallows
Abstract

Background & Aims: Analyses of impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI) have been proposed to increase the accuracy of diagnosis of reflux disease. We assessed whether these improve the diagnostic yield of impedance pH monitoring of reflux disease., Methods: We performed a prospective study of consecutive patients with proton pump inhibitor-responsive heartburn who underwent 24-hour impedance pH monitoring at hospitals in Italy from January 2011 through December 2013. Reviewers blindly analyzed off-therapy impedance pH tracings from 289 patients with proton pump inhibitor-responsive heartburn, 68 with erosive reflux disease and 221 with non-erosive reflux disease (NERD), along with 50 healthy individuals (controls). The PSPW index, the MNBI, the esophageal acid exposure time, the number of total refluxes, and the bolus exposure were calculated, as well as the symptom association probability (SAP) and the symptom index (SI)., Results: In receiver operating characteristic analysis, the area under curve of the PSPW index (0.977; 95% confidence interval, 0.961-0.993) was significantly greater than that of the other impedance pH parameters in identifying patients with reflux disease (P < .001). The PSPW index and the MNBI identified patients with erosive reflux disease with the highest level of sensitivity (100% and 91%, respectively), as well as the 118 pH-positive (99% and 86%) and 103 pH-negative (77% and 56%) cases of NERD. The PSPW index and the MNBI identified pH-negative NERD with the highest level of sensitivity; values were 82% and 52% for the 65 SAP-positive and/or SI-positive cases and 68% and 63% for the 38 SAP-negative and SI-negative cases. Diagnoses of NERD were confirmed by pH-only criteria, including those that were positive on the basis of the SAP or SI, for 165 of 221 cases (75%) and by impedance pH criteria for 216 of 221 cases (98%) (P = .001)., Conclusions: The PSPW index and the MNBI increase the diagnostic yield of impedance pH monitoring of patients with reflux disease. Analysis of impedance pH data by calculating the PSPW index and the MNBI can increase the accuracy of diagnosis of patients with reflux disease, compared with pH-only data., (Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2016
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3. Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure.

Author

de Bortoli N, Martinucci I, Savarino E, Franchi R, Bertani L, Russo S, Ceccarelli L, Costa F, Bellini M, Blandizzi C, Savarino V, and Marchi S

Subjects
Adult, Esophagus physiopathology, Female, Gastric Acidity Determination, Humans, Male, Manometry methods, Middle Aged, Proton Pump Inhibitors therapeutic use, Statistics as Topic, Symptom Assessment, Esophageal pH Monitoring methods, Gastroesophageal Reflux complications, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux physiopathology, Heartburn diagnosis, Heartburn etiology, Heartburn physiopathology, Heartburn psychology, Hydrogen-Ion Concentration, Pain Perception physiology
Abstract

Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity., (© 2014 International Society for Diseases of the Esophagus.)

Published
2016
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4. Manually calculated oesophageal bolus clearance time increases in parallel with reflux severity at impedance-pH monitoring.

Author

de Bortoli N, Martinucci I, Savarino EV, Frazzoni M, Tutuian R, Tolone S, Piaggi P, Furnari M, Russo S, Bertani L, Macchia L, Savarino V, and Marchi S

Subjects
Adult, Aged, Electric Impedance, Endoscopy, Female, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Prospective Studies, Deglutition, Esophageal pH Monitoring, Esophagus physiopathology, Gastroesophageal Reflux physiopathology, Heartburn physiopathology
Abstract

Background: Oesophageal clearance has been scarcely studied., Aims: Oesophageal clearance in endoscopy-negative heartburn was assessed to detect differences in bolus clearance time among patients sub-grouped according to impedance-pH findings., Methods: In 118 consecutive endoscopy-negative heartburn patients impedance-pH monitoring was performed off-therapy. Acid exposure time, number of refluxes, baseline impedance, post-reflux swallow-induced peristaltic wave index and both automated and manual bolus clearance time were calculated. Patients were sub-grouped into pH/impedance positive (abnormal acid exposure and/or number of refluxes) and pH/impedance negative (normal acid exposure and number of refluxes), the former further subdivided on the basis of abnormal/normal acid exposure time (pH+/-) and abnormal/normal number of refluxes (impedance+/-)., Results: Poor correlation (r=0.35) between automated and manual bolus clearance time was found. Manual bolus clearance time progressively decreased from pH+/impedance+ (42.6s), pH+/impedance- (27.1s), pH-/impedance+ (17.8s) to pH-/impedance- (10.8s). There was an inverse correlation between manual bolus clearance time and both baseline impedance and post-reflux swallow-induced peristaltic wave index, and a direct correlation between manual bolus clearance and acid exposure time. A manual bolus clearance time value of 14.8s had an accuracy of 93% to differentiate pH/impedance positive from pH/impedance negative patients., Conclusions: When manually measured, bolus clearance time reflects reflux severity, confirming the pathophysiological relevance of oesophageal clearance in reflux disease., (Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Published
2015
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5. Proton pump inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are they?

Author

de Bortoli N, Martinucci I, Savarino E, Bellini M, Bredenoord AJ, Franchi R, Bertani L, Furnari M, Savarino V, Blandizzi C, and Marchi S

Subjects
Adult, Electric Impedance, Female, Gastroesophageal Reflux physiopathology, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Esophageal pH Monitoring, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy, Proton Pump Inhibitors therapeutic use
Abstract

Background: A short-course of proton pump inhibitors (PPIs) is often used to confirm gastroesophageal reflux disease (GERD). However, some patients with PPI responsive heartburn do not seem to have evidence of GERD on impedance-pH monitoring (MII-pH). The aim of the study was to evaluate patients with reflux symptoms and a negative endoscopy, who well respond to PPIs with MII-pH., Methods: We enrolled 312 patients with GERD symptoms and negative endoscopy: 144 reported well-controlled symptoms after 8-week PPIs and 155 were non-responders. Symptom relief was evaluated with GERD Impact Scale and visual analog scale score. All patients underwent MII-pH off-therapy. Thirteen patients were excluded from analysis. Patients were grouped as follows: non-erosive reflux disease (NERD; increased acid exposure time, AET); hypersensitive esophagus (HE; normal AET, positive symptom association, SI/SAP); MII-pH-/PPI+ (normal AET, negative SI/SAP) in the responder group; MII-pH-/PPI- in non-responders., Key Results: MII-pH in PPI responders (symptom relief during PPI therapy > 75%) showed: 79/144 NERD (54.9%); 37/144 HE (25.7%); 28/144 MII-pH-/PPI+ (19.4%). MII-pH-/PPI+ patients reported the same symptom relief when compared with NERD and HE. In non-responder (symptom relief during PPI therapy < 50%) group, 27/155 patients were NERD (17.4%); 53/155 were HE (34.2%); 75/155 were MII-pH-/PPI- (48.4%). NERD diagnosis was significantly higher in responder group (p < 0.01)., Conclusions & Inferences: In a substantial subgroup of patients responding to PPI with typical reflux symptoms, the diagnosis of GERD cannot be confirmed with pH-impedance monitoring. Proton pump inhibitor response and presence of typical symptoms are thus not reliable predictors of the diagnosis and antireflux surgery should always be preceded by reflux monitoring., (© 2013 John Wiley & Sons Ltd.)

Published
2014
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6. Postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance can link PPI-responsive heartburn to reflux better than acid exposure time

Author

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

7. 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

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

8. Impairment of chemical clearance and mucosal integrity distinguishes hypersensitive esophagus from functional heartburn

Author

Nicola de Bortoli, Andrea Farioli, Vincenzo Savarino, Lorenzo Fuccio, Leonardo Frazzoni, Santino Marchi, Marzio Frazzoni, Edoardo Savarino, Salvatore Tolone, Manuele Furnari, Irene Martinucci, Frazzoni, M, de Bortoli, N, Frazzoni, L, Furnari, M, Martinucci, I, Tolone, Salvatore, Farioli, A, Marchi, S, Fuccio, L, Savarino, V, Savarino, E., Frazzoni, Marzio, de Bortoli, Nicola, Frazzoni, Leonardo, Furnari, Manuele, Martinucci, Irene, Farioli, Andrea, Marchi, Santino, Fuccio, Lorenzo, Savarino, Vincenzo, and Savarino, Edoardo

Subjects
Adult, Male, medicine.medical_specialty, Esophageal pH Monitoring, Refractory period, medicine.drug_class, Hypersensitive esophagus, Functional heartburn, Hypersensitive esophagu, Proton-pump inhibitor, Gastroenterology, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Esophagus, Heartburn, Predictive Value of Tests, Internal medicine, medicine, Electric Impedance, Humans, Single-Blind Method, Aged, Retrospective Studies, business.industry, Medicine (all), Area under the curve, Reflux, Proton Pump Inhibitors, pH Impedance monitoring, Odds ratio, GERD, Middle Aged, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Gastroesophageal Reflux, 030211 gastroenterology & hepatology, Female, Peristalsis, medicine.symptom, business
Abstract

Background: Hypersensitive esophagus (HE) is defined by endoscopy-negative heartburn with a normal acid exposure time but positive symptom association probability (SAP) and/or symptom index (SI) on impedance–pH monitoring, and proton pump inhibitor (PPI) responsiveness. Functional heartburn (FH) is distinguished by negative SAP/SI and PPI refractoriness. The clinical value of SAP and SI has been questioned. We aimed to investigate whether impairment of chemical clearance and of mucosal integrity, expressed by the postreflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), characterize HE independently of SAP and SI. Methods: Impedance–pH tracings from PPI-responsive endoscopy-negative patients, 125 with nonerosive reflux disease and 108 with HE, distinguished by an abnormal and a normal acid exposure time, and from 70 patients with FH were retrospectively selected and blindly reviewed. Results: The mean PSPW index and MNBI were significantly lower in nonerosive reflux disease (30 %, 1378 Ω) than in HE (51 %; 2274 Ω) and in both of them as compared with FH (76 %; 3445 Ω) (P = 0.0001). Both the PSPW index (adjusted odds ratio 0.863, P = 0.001) and the MNBI (adjusted odds ratio 0.998, P = 0.001) were independent predictors of HE; with their combined assessment, the area under the curve on receiver operating characteristic analysis was 0.957. SAP and/or SI was positive in 67 of the 108 HE patients (62 %), whereas the PSPW index and/or MNBI was abnormal in 99 of the 108 HE patients (92 %; P

Published
2016

9. Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD

Author

N. De Bortoli, John E. Pandolfino, Santino Marchi, Marzio Frazzoni, Salvatore Tolone, Manuele Furnari, Irene Martinucci, Lorenzo Macchia, Massimo Bellini, Sabine Roman, Salvatore Russo, R. Tutuian, Vincenzo Savarino, Edoardo Savarino, Martinucci, I., Savarino, E. V., Pandolfino, J. E., Russo, S., Bellini, M., Tolone, Salvatore, Tutuian, R., Roman, S., Furnari, M., Frazzoni, M., Macchia, L., Savarino, V., Marchi, S., and de Bortoli, N.

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Esophageal pH Monitoring, acid exposure time, gastro-esophageal reflux disease, high-resolution manometry, multiple rapid swallow, Nerd, Manometry, Physiology, Provocative test, Gastroenterology, Endocrine and Autonomic System, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Electric Impedance, Humans, Acid exposure time, Gastro-esophageal reflux disease, High-resolution manometry, Multiple rapid swallow, Endocrine and Autonomic Systems, In patient, Baseline impedance, 610 Medicine & health, High resolution manometry, reproductive and urinary physiology, Peristalsis, business.industry, urogenital system, Reflux, Heartburn, Hydrogen-Ion Concentration, Middle Aged, Deglutition, 030220 oncology & carcinogenesis, embryonic structures, Gastroesophageal Reflux, 030211 gastroenterology & hepatology, Female, medicine.symptom, business
Abstract

BACKGROUND Multiple rapid swallowing (MRS) during high-resolution manometry (HRM) is increasingly utilized as provocative test to assess esophageal peristaltic reserve. The aim of this study was to evaluate the correlation between MRS response and impedance and pH (MII-pH) parameters in endoscopy negative heartburn (ENH) patients. METHODS We enrolled consecutive ENH patients, who underwent HRM and MII-pH study, with a selected MII-pH profile: abnormal MII-pH (pH+/MII+); normal MII-pH (pH-/MII-). HRM was performed with 10 wet swallows (WS) and one MRS. Mean distal contractile integral (DCI) during WS and MRS were calculated. MII-pH parameters including acid exposure time (AET), reflux events, baseline impedance levels (BI) and the efficacy of chemical clearance evaluated with the postreflux swallow-induced peristaltic wave (PSPW) index were measured. KEY RESULTS We analyzed 103 patients: 49 MII+/pH+ (27 male), and 54 MII-/pH- (19 male). Mean age was similar between the two groups. As expected, mean AET and number of refluxes were higher in pH+/MII+ (p < 0.05). HRM was normal in all selected patients. Mean DCI-WS was similar between two groups (p = n.s.). Mean DCI-MRS- was higher in MII-/pH- vs MII+/pH+ (p < 0.05). The increase in DCI-MRS was inversely correlated with AET (-0.699; p < 0.001) and directly correlated with BI values (0.631; p < 0.001) and PSPW index (0.626; p < 0.001). CONCLUSIONS & INFERENCES Following MRS, patients with abnormal impedance-pH test showed suboptimal contraction response as compared with those with normal impedance-pH test. Moreover, MRS response was inversely correlated with AET and directly correlated with BI values and PSPW index.

Published
2016

10. Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease

Author

Irene Martinucci, Vincenzo Giorgio Mirante, Santino Marchi, Marzio Frazzoni, Nicola de Bortoli, Leonardo Frazzoni, Vincenzo Savarino, Rita Conigliaro, Manuele Furnari, Helga Bertani, Edoardo Savarino, Frazzoni M., Savarino E., de Bortoli N., Martinucci I., Furnari M., Frazzoni L., Mirante V.G., Bertani H., Marchi S., Conigliaro R., and Savarino V.

Subjects
Impedance–pH monitoring, Adult, Male, medicine.medical_specialty, Esophageal pH Monitoring, Esophageal Baseline Impedance, Nerd, Peristalsi, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Heartburn, Internal medicine, Electric Impedance, Medicine, Animals, Humans, Prospective Studies, Impedance pH Monitoring, Hepatology, Receiver operating characteristic, Animal, business.industry, digestive, oral, and skin physiology, Reflux, Esophageal Chemical Clearance, GERD, ROC AUC, Hydrogen-Ion Concentration, Middle Aged, medicine.disease, Confidence interval, Prospective Studie, Italy, Swallows, 030220 oncology & carcinogenesis, Gastroesophageal Reflux, 030211 gastroenterology & hepatology, Female, Peristalsis, medicine.symptom, Bolus (digestion), business, Human
Abstract

Background & Aims: Analyses of impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI) have been proposed to increase the accuracy of diagnosis of reflux disease. We assessed whether these improve the diagnostic yield of impedance pH monitoring of reflux disease. Methods: We performed a prospective study of consecutive patients with proton pump inhibitor-responsive heartburn who underwent 24-hour impedance pH monitoring at hospitals in Italy from January 2011 through December 2013. Reviewers blindly analyzed off-therapy impedance pH tracings from 289 patients with proton pump inhibitor-responsive heartburn, 68 with erosive reflux disease and 221 with non-erosive reflux disease (NERD), along with 50 healthy individuals (controls). The PSPW index, the MNBI, the esophageal acid exposure time, the number of total refluxes, and the bolus exposure were calculated, as well as the symptom association probability (SAP) and the symptom index (SI). Results: In receiver operating characteristic analysis, the area under curve of the PSPW index (0.977; 95% confidence interval, 0.961-0.993) was significantly greater than that of the other impedance pH parameters in identifying patients with reflux disease (P < .001). The PSPW index and the MNBI identified patients with erosive reflux disease with the highest level of sensitivity (100% and 91%, respectively), as well as the 118 pH-positive (99% and 86%) and 103 pH-negative (77% and 56%) cases of NERD. The PSPW index and the MNBI identified pH-negative NERD with the highest level of sensitivity; values were 82% and 52% for the 65 SAP-positive and/or SI-positive cases and 68% and 63% for the 38 SAP-negative and SI-negative cases. Diagnoses of NERD were confirmed by pH-only criteria, including those that were positive on the basis of the SAP or SI, for 165 of 221 cases (75%) and by impedance pH criteria for 216 of 221 cases (98%) (P = .001). Conclusions: The PSPW index and the MNBI increase the diagnostic yield of impedance pH monitoring of patients with reflux disease. Analysis of impedance pH data by calculating the PSPW index and the MNBI can increase the accuracy of diagnosis of patients with reflux disease, compared with pH-only data.

Published
2015

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