Advances in the Diagnosis of GERD Using the Esophageal pH Monitoring, Gastro-Esophageal Impedance-pH Monitoring, And Pitfalls

Forootan, Mojgan; Zojaji, Homayoun; Ehsani, Mohammad Javad; Darvishi, Mohammad

doi:10.3889/oamjms.2018.410

Cited by 11 publications

(8 citation statements)

References 53 publications

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“…New parameters in pH impedance such as the PSPW index and MNBI can help in evaluating the different phenotypes of GERD. -produces certain inconveniences in patient's daily activity [36] -can reduce food intake due to its placement [36] -interpretation of the test is more complex [15] -more expensive compared to conventional pH-metry [20] Table 2. Parameters utilized in pH and pH-impedance monitoring…”

Section: Discussionmentioning

confidence: 99%

“…MII-pH can distinguish and characterize the pattern of gastroesophageal reflux with much higher accuracy compared to endoscopy or conventional pH-metry [20]. This investigation is useful in differentiating between acid and non-acid reflux, with acid reflux considered a pH <4, weak acid reflux with pH between 4-7 and non-acid reflux with pH> 7.…”

Section: Multichannel Intraluminal Ph-impedance (Mii-ph)mentioning

confidence: 99%

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Advances in the diagnosis of GERD

Săraru

Enciu

Peagu

et al. 2021

Romanian Journal of Internal Medicine

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Gastroesophageal reflux disease (GERD) is considered one of the most frequent chronic gastrointestinal diseases globally with high costs due to treatment and investigations.First line therapy is with proton pump inhibitors, those who do not respond to initial treatment usually require further investigations such as upper gastrointestinal endoscopy or ambulatory 24-hours esophageal pH monitoring. The total time of exposure to acid and the DeMeester score represent the most useful parameters associated with conventional pH-metry, because they can identify gastroesophageal reflux disease.Although pH-metry is considered the gold standard for the evaluation of gastroesophageal reflux disease, new impedance-based parameters have been introduced in recent years with the role of increasing the accuracy of diagnosing gastroesophageal reflux disease and characterizing the type of reflux. The development of multichannel intraluminal pH-impedance has improved the ability to detect and quantify gastroesophageal reflux. New parameters such as post-reflux swallowing peristaltic wave (PSPW) index and the mean nocturnal basal impedance (MNBI) have recently been introduced to assess GERD phenotypes more accurately. This review evaluates current GERD diagnotic tools while also taking a brief look at newer diagnostic parameters like PSPW and MNBI.

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Section: Discussionmentioning

confidence: 99%

Section: Multichannel Intraluminal Ph-impedance (Mii-ph)mentioning

confidence: 99%

Advances in the diagnosis of GERD

Săraru

Enciu

Peagu

et al. 2021

Romanian Journal of Internal Medicine

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“…In the past, we defined abnormal acid exposure only to define the percentage of time with pH <4.0 at a specific location (5 cm above LES), there was no definition of reflux height, reflux intensity, reflux nature, or other parameters. Combined impedance pH monitoring 13,20 can effectively distinguish the height, intensity, and content of reflux. It is expected that more studies in the area would make it possible to comprehensively define the reflux standard for GERD as well as compile the standard differentiation between LPR and GERD.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Based on pH Monitoring

Wang

Huang

et al. 2020

Ear Nose Throat J

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Objectives: Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on it using reflux monitoring. This study was designed to investigate the relationship between GERD and LPR based on pH monitoring. Methods: All patients were scheduled for esophageal manometry and pH monitoring sequentially. They were stratified into 4 groups as no reflux disease, isolated GERD, isolated LPR (iLPR), and GERD combined with LPR (GERD&LPR) according to pH monitoring. Results: The incidence of LPR in GERD was 46.3%, while the probability of combining GERD in LPR was 52.7%. The reflux profile in the laryngopharynx showed a significant difference in the total reflux time (17.82 ± 18.4 vs 9.62 ± 9.58, P = .023) and the percentage of total reflux time (1.31% ± 1.37% vs 0.71% ± .0.73%, P = .023) between the GERD&LPR and iLPR groups. Conclusion: Laryngopharyngeal reflux can be combined with GERD or it can exist as an independent diagnosis. In patients with GERD&LPR, the total reflux time and the percentage of reflux time in the laryngopharynx are higher than those in the iLPR group. Reflux episodes in the laryngopharynx of patients with GERD&LPR may be derived from GERD.

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Section: Introductionmentioning

confidence: 99%

“…Traditionally, assessment of the esophagus and other parts of the gastrointestinal (GI) tract involves endoscopy[25,39], esophageal manometry[40,41], ambulatory acid (pH) probe test[42,43] and/or radioactive imaging[44,45] in both human and small animal[20,46] models. Often these methods involve invasive intubation and ionic radiation, and thus are unsuitable for repeated measurement, physiologically confounding in our particular use case, and provide inadequate anatomic information[47,48].…”

Section: Introductionmentioning

confidence: 99%

Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

Mandal¹,

Budde²,

Lawlor³

et al. 2021

Preprint

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Sudden death in epilepsy, or SUDEP, is a fatal condition that accounts for more than 4000 deaths each year. Limited clinical and preclinical data on sudden death suggests critical contributions from autonomic, cardiac, and respiratory pathways. Recent animal (rat) studies on kainic acid induced seizure models explored a potential mechanism for such sudden and severe cardiorespiratory dysregulation being linked to acid reflux induced laryngospasm. Here, we expand on those previous investigations and utilize a multimodal approach to provide visual evidence of acid reflux-initiated laryngospasm and subsequent fatal cardiorespiratory distress in seizing rats.We used systemic kainic acid to acutely induce seizure activity in Long Evans rats, under urethane anesthesia. We recorded electroencephalography (EEG), electrocardiography (ECG), chest plethysmography and esophageal pH signals during simultaneous fast MRI scans of the rat stomach and esophagus. MRI images, in conjunction with electrophysiology data were used to identify seizure progression, stomach acid movement up the esophagus, cardiorespiratory changes, and sudden death.In all cases of sudden death, esophageal pH recordings alongside MRI images visualized stomach acid movement up the esophagus. Severe cardiac (ST segment elevation), respiratory (intermittent apnea) and brain activity (EEG narrowing due to hypoxia) changes were observed only after acid reached the larynx, which strongly suggests onset of laryngospasm following acid reflux. Additionally, absence of stomach acid in the esophagus of animals that survived acute seizure, provided evidence of a causal relationship between acid reflux and sudden death. The complimentary information coming from electrophysiology and fast MRI scans provided insight into the mechanism of esophageal reflux, laryngospasm, obstructive apnea, and subsequent sudden death in seizing animals. The results carry clinical significance as they outline a potential mechanism that may be relevant to SUDEP in humans.

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Advances in the Diagnosis of GERD Using the Esophageal pH Monitoring, Gastro-Esophageal Impedance-pH Monitoring, And Pitfalls

Cited by 11 publications

References 53 publications

Advances in the diagnosis of GERD

Advances in the diagnosis of GERD

The Relationship Between Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Based on pH Monitoring

Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

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