Prolonged Gastroesophageal Reflux Monitoring by Impedance-Phmetry: A Review of the Subject Pondered With Our Experience With 1,200 Cases

Abstract

BACKGROUND: Prolonged monitoring increased our knowledge on gastroesophageal reflux (GER), and the disease became known as gastroesophageal reflux disease (GERD). Prolonged reflux monitoring permits the diagnosis of GERD when endoscopic findings are not enough to characterize it. OBJECTIVE: The objective of this paper is to review the current knowledge on impedance-pH monitoring, taking into account the published literature and the authors experience with 1,200 exams. METHODS: The different types of prolonged reflux monitoring, namely: conventional pHmetry, catheter-free pHmetry and impedance-pHmetry will be briefly described. The new possibilities of evaluation with impedance-pHmetry are emphasized, namely: the study of symptomatic patients in use of proton pump inhibitors (PPIs); evaluation of patients with symptoms suggestive of GERD although with normal endoscopy and normal pHmetry, diagnostic elucidation of patients with atypical symptoms or supra-esophageal symptoms, mainly chronic cough, study of patients complaining of belch, differentiating gastric and supra-gastric belching, and the proper work-up before anti-reflux surgery. RESULTS: When impedance was associated to pH monitoring, an impressive technological evolution became apparent, when compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements can be made: the ability of the esophagus in transporting the bolus, the measurement of basal mucosal impedance and the evaluation of primary peristalsis post reflux. CONCLUSION: Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The authors suggest the importance of careful evaluation of each reflux episode by the physician responsible for the examination, necessary for the correct interpretation of the tracings.

Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018

“…An objective diagnosis of GERD before surgery is essential [535455]. The purpose of the preoperative examination is to select patients who will benefit from surgical treatment.…”

Wireless Ph Monitoring and Conventional Esophageal Ph Monitoring: Comparative Study of Discomfort, Limitations in Daily Activities and Complications

“…Wireless pH monitoring is a high cost procedure, limiting its use in daily practice, and it has no ability to identify non-acid reflux. Impedance-pH monitoring is a promising method that detects several types of reflux (acid, non-acid, liquid, gaseous), evaluates other important measures (esophagus ability to transport the bolus, basal mucosal impedance and post-reflux primary peristalsis) and is consolidated as a new gold standard for the diagnosis of gastroesophageal reflux 21,22 .…”

Intra-Esophageal pH Monitoring on Two Consecutive Days in Patients With Gastroesophageal Reflux Symptoms

“…Considering the time the pH was below 4 during the test, two patients had abnormal and normal values on different days. This method is the most reliable measurement for the diagnosis of GERD [16] with normal upper limit varying from 4.0-6.0% in the literature though [11, 16].…”

“…During the study period the most important limitation imposed to patients was the placement of the pH catheter inside the nose. To avoid this limitation, the catheter-free pH-metry has been developed [4, 11, 16], which can reduce the discomfort of the patients during prolonged pH monitoring. Nevertheless, this method is expensive, requires endoscopy and is not frequently used for pH monitoring.…”