Background/Aims
Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.
Methods
Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher’s exact test, Wilcoxon rank sum test, or Student’s
t
test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.
Results
One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00,
P
= 0.041).
Conclusions
WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.
IntroductionSmall intestinal bacterial overgrowth (SIBO) negatively affects both the structure and function of the small intestine leading to a number of acute and chronic symptoms. The lactulose hydrogen breath test (LHBT) is commonly used to detect SIBO. However, little is known to what extent the diagnosis made by this method can affect the patient’s clinical state.The aim of this study was to assess whether patients diagnosed with SIBO using LHBT respond clinically to SIBO treatment.MethodsAll the patients who were diagnosed with SIBO by LHBT within the last 12 months prior to December 2016 were retrospectively contacted. A visual analogue scale (VAS) on a scale of 0–10 was used to score the severity of their top 3 symptoms pre and post treatment. 0 being the lowest and 10 being the highest severity of each symptom. Positive LHBT was considered as raise of hydrogen >12 ppm against baseline within the first 60 min of the study. A paired t-test was conducted to evaluate the significance of the differences; P value <0.05 was considered as significant.Results17 patients were included (10 female, median age 40.5, age range 26–70). All these patients were prescribed antibiotics (AB). Reduction of the symptom 1 and 2 were significant pre vs post treatment but not the symptom 3 (P values respectively: <0.006, <0.009, and <0.1). Comparing the total symptom counts also showed significant reduction in the severity of the symptoms (P <).0001). Analysis of the severity of individual types of symptoms, significant improvement was found in bloating (p < 0.0967), flatulence (p < 0.0247), abdominal discomfort/pain (p < 0.0279) and diarrhoea (p < 0.042).ConclusionThe findings of this study suggest that patients diagnosed with SIBO using LHBT effectively respond to treatment (i.e. AB). Using raise of hydrogen >12 ppm against baseline within the first 60 min of the study is a reliable criteria to diagnose SIBO. Further studies with larger number of patients is required to confirm the findings of this study.Disclosure of InterestNone Declared
In the same time period as this study, 1719 patients underwent colonoscopy and biopsy due to unexplained diarrhoea. Conclusions These data confirm that BAM is common but is under-investigated in comparison with microscopic colitis. Although it is not associated with any 'hallmark' symptoms, it is readily identified by experienced clinicians as suggested by the high pick up rate, presumably on the basis of clinical acumen. It occurs in approximately 2% of patients following cholecystectomy, although the true prevalence in this population may be greater. These data also support the BSG guideline audit recommendation of SeHCAT in IBS-D as a quality improvement target.
difference in patients' sensory to rectal distension (p=0.4527), perception urge volume to defecate (p=0.1499) and the maximum rectal capacity (p=0.2332).The anorectal electro-sensory were generally normal in both subtypes of FI and there was no statistical difference in the anal mucosal sensory (p=0.088) or rectal mucosal sensory (p=0.4450). Conclusion This study showed that FI can be subtyped into I and II based on the distinctive pathophysiology findings. The subtyping of FI are likely to link the options for clinical management.
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