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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
- Source :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 14(1)
- Publication Year :
- 2015
-
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.
- 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
Subjects
Details
- ISSN :
- 15427714
- Volume :
- 14
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
- Accession number :
- edsair.doi.dedup.....22792461e61467c3bf7ca221ceb3aaa2