816 Acid-Based Parameters on pH-Impedance Testing Predict Symptom Improvement With Medical Management Better Than Impedance Parameters

Patel, Amit; Sayuk, Gregory S.; Gyawali, C. Prakash

doi:10.1016/s0016-5085(13)60511-9

Cited by 1 publication

(5 citation statements)

References 33 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In several studies both SI and SAP predicted response to medical and surgical treatment independent of AET, but sample sizes were small and there was high risk of bias. 15,[189][190][191][192] In contrast, a recent retrospective analysis of SAP data in 48-h WC-pH off PPI for evaluation of refractory symptoms, found that SAP was not useful to distinguish functional heartburn from reflux hypersensitivity or predict response to fundoplication, and 18% of patients had discordant SAP values between days 1 and 2 of pH-metry; furthermore, SAP did not predict fundoplication outcome. 193 This raised questions about the value of symptom indices for GERD diagnosis.…”

Section: Are Symptom Association Tools (Symptom Index and Symptom Ass...mentioning

confidence: 95%

“…9 Throughout this consensus process, acid exposure time (AET) measured during ambulatory pH-metry was used as the gold standard for diagnosing GERD. 10 AET has been consistently shown to predict response to medical [11][12][13] and surgical [14][15][16] treatment, independently of other diagnostic parameters. 12,15,16 Cut-off points for defining GERD based on AET have varied over time.…”

Section: Introductionmentioning

confidence: 98%

“…10 AET has been consistently shown to predict response to medical [11][12][13] and surgical [14][15][16] treatment, independently of other diagnostic parameters. 12,15,16 Cut-off points for defining GERD based on AET have varied over time. The Lyon consensus suggests that GERD is confirmed if AET is >6.0%, excluded if AET is <4.0%, with a "gray area" of diagnostic uncertainty if AET is between 4% and 6%.…”

Section: Introductionmentioning

confidence: 98%

“…64 C-pH can incorporate one or more pH sensors, but recording is limited to 24 h. WC-pH allows monitoring for up to 96 h. 131 The tolerance, safety, technical difficulties and diagnostic utility of both tests have been evaluated in a systematic review. 132 The quantitative analysis for safety included 10 studies that compared C-pH to WC-pH [11][12][13][14][15][16][17][18][19][20] (Table S12a). Chest pain and foreign body sensation occurred more frequently with WC-pH, while nasal and throat pain, dysphagia, eating difficulties, and interference with daily activities were more frequent with C-pH.…”

Section: Introductionmentioning

confidence: 99%

“…152 Earlier studies regarding the usefulness of the number of reflux episodes measured by MII-pH as a predictor of response to treatment showed mixed results. 15,35,153 Subsequently, analysis of data from a randomized controlled clinical trial in regurgitationpredominant GERD patients, revealed that >80 reflux episodes detected by MII-pH on PPI predicted response to laparoscopic magnetic sphincter augmentation. 154 Despite this, the AGA has not endorsed number of reflux episodes to make treatment decisions in refractory GERD patients.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Latin American consensus on diagnosis of gastroesophageal reflux disease

Olmos,

Pandolfino,

Piskorz

et al. 2024

Neurogastroenterology Motil

View full text Add to dashboard Cite

BackgroundDiagnosing gastroesophageal reflux disease (GERD) can be challenging given varying symptom presentations, and complex multifactorial pathophysiology. The gold standard for GERD diagnosis is esophageal acid exposure time (AET) measured by pH‐metry. A variety of additional diagnostic tools are available. The goal of this consensus was to assess the individual merits of GERD diagnostic tools based on current evidence, and provide consensus recommendations following discussion and voting by experts.MethodsThis consensus was developed by 15 experts from nine countries, based on a systematic search of the literature, using GRADE (grading of recommendations, assessment, development and evaluation) methodology to assess the quality and strength of the evidence, and provide recommendations regarding the diagnostic utility of different GERD diagnosis tools, using AET as the reference standard.Key ResultsA proton pump inhibitor (PPI) trial is appropriate for patients with heartburn and no alarm symptoms, but nor for patients with regurgitation, chest pain, or extraesophageal presentations. Severe erosive esophagitis and abnormal reflux monitoring off PPI are clearly indicative of GERD. Esophagram, esophageal biopsies, laryngoscopy, and pharyngeal pH monitoring are not recommended to diagnose GERD. Patients with PPI‐refractory symptoms and normal endoscopy require reflux monitoring by pH or pH‐impedance to confirm or exclude GERD, and identify treatment failure mechanisms. GERD confounders need to be considered in some patients, pH‐impedance can identify supragrastric belching, impedance‐manometry can diagnose rumination.ConclusionsErosive esophagitis on endoscopy and abnormal pH or pH‐impedance monitoring are the most appropriate methods to establish a diagnosis of GERD. Other tools may add useful complementary information.

show abstract