Patients With Definite and Inconclusive Evidence of Reflux According to Lyon Consensus Display Similar Motility and Esophagogastric Junction Characteristics

Ribolsi, Mentore; Savarino, Edoardo; Rogers, Benjamin D.; Rengarajan, Arvind; Coletta, Marco; Ghisa, Matteo; Cicala, Michele; Gyawali, C. Prakash

doi:10.5056/jnm20158

Cited by 8 publications

(3 citation statements)

References 43 publications

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“…A recent Italian study also provided evidence that patients with inconclusive GERD show lower MNBI values when compared to patients without. 19 One of the reasons why our cutoff value differs from previous publish data might be the use of another method to measure MNBI.…”

Section: Discussionmentioning

confidence: 91%

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Effect of aging and obesity on esophageal mucosal integrity as measured by baseline impedance

Voulgaris

Hoshino

Sifrim

et al. 2023

Neurogastroenterology Motil

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AimLow mean nocturnal baseline impedance (MNBI) values support gastroesophageal reflux disease (GERD) diagnosis. Recent data denote that age and obesity may affect MNBI. We aimed to evaluate diagnostic MNBI cutoffs as also the effect of aging and body mass index (BMI) on MNBI.MethodsIn total 311 patients (M/F: 139/172, mean age: 47 ± 13) referred for typical GERD symptoms that have undertaken both high‐resolution manometry (HRM) and pH‐Impedance studies off PPI were evaluated. MNBI at 3, 5, and 17 cm over lower esophageal sphincter (LES) were evaluated. GERD was diagnosed if acid exposure time (AET) >6%.ResultsMean BMI was 26.6 ± 5.9 kg/cm2. GERD was diagnosed in 39.2% and 13.5% had inconclusive GERD. MNBI was correlated to patients' age, BMI, AET, and the length of LES‐CD separation and at 3 cm also to the total number of reflux and LES hypotension. In the multivariate analysis MNBI at 3 and 5 cm was independently correlated only to age, BMI, and AET. Patients with definite GERD showed lower MNBI at 3 cm compared with inconclusive GERD though both showed lower values when compared with GERD absence. At 3 cm MNBI ability for diagnosing GERD was good (0.815, p < 0.001 95% CI: 0.766–0.863) with an optimal cutoff point of 1281 Ohm.ConclusionAccording to our study findings age and BMI affect independently lower esophageal MNBI values in patients evaluated for GERD. MNBI significantly aids toward GERD diagnosis though in a real‐life setting MNBI values much lower than the one previously proposed should be used.

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Section: Discussionmentioning

confidence: 91%

“…Additionally once more we provided data that MNBI measured at 3 cm over LES is significantly lower among patients with inconclusive GERD diagnosis in comparison to patients without GERD. A recent Italian study also provided evidence that patients with inconclusive GERD show lower MNBI values when compared to patients without 19 …”

Section: Discussionmentioning

confidence: 93%

Effect of aging and obesity on esophageal mucosal integrity as measured by baseline impedance

Voulgaris

Hoshino

Sifrim

et al. 2023

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…With respect to the latter category, the discriminative ability of MNBI is needed, in order to help the clinician correctly categorize the patient and to propose the proper treatment. According to previously published data, symptomatic patients with inconclusive GERD show higher MNBI values in comparison to patients with conclusive GERD, but lower than symptomatic patients with RH[ 9 , 10 ]. Additionally, patients with RH show lower MNBI values when compared to patients with FH[ 11 ].…”

Section: To the Editormentioning

confidence: 97%

Mean nocturnal baseline impedance in gastro-esophageal reflux disease diagnosis: Should we strictly follow the Lyon 2 Consensus?

Voulgaris,

Karamanolis

2024

World J Gastroenterol

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Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common questions. One of the most important position papers in the field of gastro-esophageal reflux disease (GERD) is the one produced by the Lyon Consensus. Recently an updated second version has been released. Mean nocturnal baseline impedance (MNBI) was proposed by the first Consensus to act as supportive evidence for GERD diagnosis. Originally a cut-off of 2292 Ohms was proposed, a value revised in the second edition. The updated Consensus recommended that an MNBI < 1500 Ohms strongly suggests GERD while a value > 2500 Ohms can be used to refute GERD. The proposed cut-offs move in the correct direction by diminishing the original cut-off, nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value ± 2SD and not in symptomatic patients. However, data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity (RH) show lower MNBI values in comparison to normal subjects or patients with functional heartburn (FH). Moreover, according to the data, MNBI, even among symptomatic patients, is affected by age and body mass index. Also, various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one proposed. Finally, no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now exist. Therefore, even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH, its values should be interpreted with caution.

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Manometry

Omari

2022

Gastroesophageal Reflux in Children

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Patients With Definite and Inconclusive Evidence of Reflux According to Lyon Consensus Display Similar Motility and Esophagogastric Junction Characteristics

Abstract: published online; they have not yet been assigned to a journal issue. When these articles are published in an issue, they will be removed. Online First articles are copy-edited, typeset and approved by the authors before publication.

Cited by 8 publications

References 43 publications

Effect of aging and obesity on esophageal mucosal integrity as measured by baseline impedance

Effect of aging and obesity on esophageal mucosal integrity as measured by baseline impedance

Mean nocturnal baseline impedance in gastro-esophageal reflux disease diagnosis: Should we strictly follow the Lyon 2 Consensus?

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