ACG Practice Guidelines: Esophageal Reflux Testing

Hirano, Ikuo; Richter, Joel E.; Fass, Ronnie; Baroni, Darren; Bernstein, David; Bharucha, Adil E.; Brugge, William R.; Chang, Lin; Chey, William D.; Cohen, Melvin R.; Cunningham, J. T.; Edmundowicz, Steven A.; Inadomi, John M.; Koch, Timothy R.; Mutlu, Ece; Parkman, Henry P.; Prather, Charlene M.; Pratt, Daniel S.; Roach, Albert C.; Sampliner, Richard E.; Sridhar, Subbaramiah; Vakil, Nimish; Valdovinos, Miguel A.; Wong, Benjamin Chun–Yu; Zfass, Alvin M.

doi:10.1111/j.1572-0241.2006.00936.x

Cited by 312 publications

(162 citation statements)

References 120 publications

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“…Initial screening assessment was conducted without discontinuation of PPIs and consisted of the nine-question GERD health-related quality-of-life (GERD-HRQL) [22], 24-hour ambulatory pH-metry [23,24], upper GI endoscopy, esophageal biopsy, esophageal manometry, medical history, and GERD medication usage as described previously [19,20]. In addition, we assessed each patient's ability to consume foods and beverages commonly associated with triggering GERD symptoms, such as citrus, strawberries, tomatoes, chocolate, fatty foods, deep-fried foods, spicy foods, carbonated drinks, tea, coffee, caffeinated drinks, and alcohol [25].…”

Section: Methodsmentioning

confidence: 99%

“…Patients (n = 14, 50% female) available at 2 years had a median age of 34 (range, 23-55) years and a median BMI of 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) kg/m 2 . Patients had suffered from GERD for a median of 10 (range, 3-15) years and were on continuous daily PPI therapy for a median of 6 (range, 2-13) years before undergoing TIF.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

et al. 2009

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Background A feasibility study (n = 19) evaluated the safety and initial efficacy of transoral incisionless fundoplication (TIF) for the treatment of gastroesophageal disease (GERD). The results at 1 year (n = 17) indicated that TIF was safe and had a significant effect on reducing GERD symptoms, proton pump inhibitor (PPI) usage, acid exposure, and small hiatal hernia. This study was designed to evaluate the long-term safety and durability of TIF. Methods Fourteen patients (50% female; median age, 34 years) completed the 2-year follow-up assessment tests. Three patients were excluded from the study after 1 year because two of them underwent retreatment and one was lost to follow-up. Results At 2 years, no adverse events related to TIF were reported. A C50% improvement in GERD-HRQL scores compared with those at baseline on PPIs was sustained by 64% of patients. TIF was effective in eliminating heartburn in 93% of patients and daily PPI therapy in 71% of patients. Significantly (p \ 0.05) more patients were able to consume reflux-causing foods and maintain lifestyle activities without GERD symptoms compared with baseline on PPIs. Fundoplications were durable and maintained their geometric dimensions. TIF was effective in eliminating hiatal hernia in 60% of patients and esophagitis in 55% of patients. Global assessment of all outcomes in each patient revealed that 79% of patients experienced complete cure (29%) or remission (50%) of GERD at 2 years after TIF. Conclusion The results at 2 years supported the longterm safety and durability of TIF and its sustained effect on the elimination of heartburn, esophagitis, B2 cm hiatal hernia, and daily dependence on PPIs.

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Section: Methodsmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

et al. 2009

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“…Classically, acid reflux is determined by duration, frequency and extent of distal oesophageal acid exposure by the DeMeester score [26], while detecting non-acid reflux is an inherent limitation of pH studies. Multichannel intraluminal impedance testing examines reflux events independently of pH [34].…”

Section: Pulmonary Fibrosis I Noth Et Almentioning

confidence: 99%

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Noth

Zangan

Soares

et al. 2011

European Respiratory Journal

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Hiatal hernia (HH) is associated with gastro-oesophageal reflux (GOR) and/or GOR disease and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesised that HH evaluated by computed tomography is more common in IPF than in asthma or chronic obstructive pulmonary disease (COPD), and correlates with abnormal GOR measured by pH probe testing.Rates of HH were compared in three cohorts, IPF (n5100), COPD (n560) and asthma (n524), and evaluated for inter-observer agreement. In IPF, symptoms and anti-reflux medications were correlated with diffusing capacity of the lung for carbon monoxide (DL,CO) and composite physiologic index (CPI). HH was correlated with pH probe testing in IPF patients (n514).HH was higher in IPF (39%) than either COPD (13.3%, p50.00009) or asthma (16.67%, p50.0139). The HH inter-observer k agreement was substantial in IPF (k50.78) and asthma (k50.86), and moderate in COPD (k50.42). In IPF, HH did not correlate with lung function, except in those on anti-reflux therapy, who had a better DL,CO (p,0.03) and CPI (p,0.04). HH correlated with GOR as measured by DeMeester scores (p,0.04).HH is more common in IPF than COPD or asthma. In an IPF cohort, HH correlated with higher DeMeester scores, confirming abnormal acid GOR. Presence of HH alone was not associated with decreased lung function.

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“…New diagnostic tests (multichannel impedance monitoring, wireless pH monitoring capsules, etc.) have been developed and have become popular over the last decade, especially in leading industrial countries [2] . However, the conventional 24 h ambulatory pH monitoring continues to be the most common diagnostic test for determining pathologic acid reflux in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Accurate positioning of the 24-hour pH monitoring catheter: Agreement between manometry and pH step-up method in two patient positions

Can¹

2007

WJG

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AIM:To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions. METHODS:Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed. RESULTS:In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (≤ 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position. CONCLUSION:In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.

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ACG Practice Guidelines: Esophageal Reflux Testing

Cited by 312 publications

References 120 publications

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Accurate positioning of the 24-hour pH monitoring catheter: Agreement between manometry and pH step-up method in two patient positions

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