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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 8/2017

01-08-2017 | Review

Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives

Authors: Marzio Frazzoni, Nicola de Bortoli, Leonardo Frazzoni, Salvatore Tolone, Vincenzo Savarino, Edoardo Savarino

Published in: Digestive Diseases and Sciences | Issue 8/2017

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Abstract

Heartburn is the most specific symptom of gastroesophageal reflux disease (GERD). In clinical practice, heartburn relief by a proton pump inhibitor (PPI) trial does suffice to confirm GERD. However, an objective diagnosis of GERD is required before anti-reflux endoscopic or surgical interventions, independently from PPI response. Thus, since normal findings at upper endoscopy are detected in the majority of patients with heartburn, reflux monitoring is often required. When traditional catheter-based or wireless pH tests are used, reflux episodes are conventionally identified by pH drops below 4.0 units. Combined impedance-pH monitoring has the advantage to provide a comprehensive assessment of both physical and chemical properties of refluxate and the distinction between acid and weakly acidic refluxes, both proven to cause heartburn. Unfortunately, the conventional impedance-pH parameters, namely acid exposure time and number of reflux events, are characterized by suboptimal diagnostic sensitivity, and the reliability of symptom–reflux association indexes remains questionable. Therefore, novel impedance parameters, namely the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), have recently been proposed in order to achieve a better diagnostic yield. In fact, they proved to be highly accurate in distinguishing reflux-related from reflux-unrelated heartburn, off- as well as on-PPI therapy. Currently, manual review of impedance-pH tracings is needed because of the modest accuracy of available software tools for automated analysis. PSPW index and MNBI are highly applicable and reproducible, and their calculation requires a few additional minutes during the manual review of impedance-pH tracings. So far, we believe that PSPW index and MNBI are ready for prime time and should become part of the standard analysis of impedance-pH tracings for GERD diagnosis in patients with endoscopy-negative heartburn.
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Metadata
Title
Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives
Authors
Marzio Frazzoni
Nicola de Bortoli
Leonardo Frazzoni
Salvatore Tolone
Vincenzo Savarino
Edoardo Savarino
Publication date
01-08-2017
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 8/2017
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-017-4625-8

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