Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease

Frazzoni, Marzio; Savarino, Edoardo; Bortoli, Nicola de; Martinucci, Irene; Furnari, Manuele; Frazzoni, Leonardo; Mirante, V.G.; Bertani, Helga; Marchi, Santino; Conigliaro, Rita; Savarino, Vincenzo

doi:10.1016/j.cgh.2015.06.026

Cited by 243 publications

(376 citation statements)

References 17 publications

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“…22 This may be related to the fact that AET assesses cross-sectional acid burden accurate for the day of the study, while MNBI reflects longitudinal reflux burden impairing mucosal integrity; while the two do not always correlate with each other, both predict symptom improvement from antireflux therapy. We evaluated MNBI at both the 3-cm and 5-cm locations above the LES; most existing MNBI data relates to the 3-cm location, 19,36 although the 5-cm location could correlate better with AET measured at the same location. 11 Similar to our results, others have demonstrated failed peristalsis to impair refluxate clearance more than weak swallows, 26 with clinically relevant end-organ damage.…”

Section: Discussionmentioning

confidence: 99%

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Rogers

Rengarajan

Ghisa

et al. 2019

Neurogastroenterology Motil

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Background Association between proportions of hypomotile swallows on esophageal high‐resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. Methods Clinical data, HRM, and ambulatory pH‐impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH‐impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100‐450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. Key Results Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤ .01) and MNBI (P ≤ .03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P < .05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤ .009), and ≥50% weak sequences did not (P = .14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P = .02), and >70% ineffective sequences trended strongly (P = .069); >70% ineffective sequences predicted abnormal MNBI (P = .046), and >70% fragmented sequences trended strongly (P = .076). Conclusions and Inferences Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.

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Section: Discussionmentioning

confidence: 99%

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Rogers

Rengarajan

Ghisa

et al. 2019

Neurogastroenterology Motil

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“…This result supported that there was a good correlation between short-time and long-time measurement. 13 Frazzoni et al 24 found that MNBI could be used to segregate different phenotypes of patients with PPI responsive heartburn from healthy controls. This was in line with our study, but the cutoff value was a little higher than ours.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Xie

Sifrim

et al. 2018

J Neurogastroenterol Motil

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Background/AimsEsophageal baseline impedance, which is decreased in gastroesophageal reflux disease (GERD) patients, is related to the severity of acid reflux and the integrity of the esophageal mucosa. The study aims to compare the baseline impedance and the dilated intercellular spaces (DIS) within patients with typical reflux symptoms and to evaluate the correlation of baseline impedance with DIS, esophageal acid exposure, as well as the efficacy of proton pump inhibitor (PPI) treatment. MethodsNinety-two patients and 10 healthy controls were included in the study. Erosive esophagitis (EE) was defined by esophageal mucosal erosion under upper endoscopy. Patients without mucosa erosion were divided into groups with pathologic acid reflux (nonerosive reflux disease [NERD]) or with hypersensitive esophagus. The biopsies of esophageal mucosa were taken 2-4 cm above the gastroesophageal junction Z-line during upper endoscopy for DIS measurement. All the patients received esomeprazole 20 mg twicedaily treatment for 8 weeks. The efficacy of esomeprazole was evaluated among all patients. ResultsThe intercellular spaces were dilated in both EE and NERD patients (P < 0.05). The value 0.73 mm could be used as the cut-off DIS value to distinguish patients from controls (area under the curve [AUC] = 0.849, P < 0.01). One thousand seven hundred sixty-four ohms could be used as the cut-off impedance values to distinguish patients from controls (AUC = 0.794, P < 0.01). The baseline impedance was decreased in both EE patients and NERD patients, and negatively correlated to the acid exposure time (r = -0.527, P < 0.05). There was a weak correlation between DIS and baseline impedance (r = -0.230, P < 0.05). "Baseline impedance > 1764 Ω" was an independent predictor for PPI failure (OR, 11.9; 95% CI, 2.4-58.9; P < 0.01). ConclusionsThe DIS and decreased baseline impedance was observed in patients with mucosa erosion or pathological acid reflux. The baseline impedance reflected the mucosal integrity, it was more sensitive to esophageal acid exposure. Patients with high impedance might not benefit from the PPI treatment.

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“…de Bortoli et al [29] reported that the cutoff value of the BI was 2,446 Ω, and the value was similar between PPI responder patients with FH and non-PPI responder. Frazzoni et al [30] blindly analyzed off-therapy impedance pH tracings from 289 patients with PPI responsive heartburn, 68 with erosive reflux disease, and 221 with NERD, along with 50 healthy individuals (controls). MII-pH monitoring was performed after withdrawal of PPI lasting for at least 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Convenient Method of Measuring Baseline Impedance for Distinguishing Patients with Functional Heartburn from those with Proton Pump Inhibitor-Resistant Endoscopic Negative Reflux Disease

Yoshimine¹,

Funaki²,

Kawamura³

et al. 2018

Digestion

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Background: Combined 24-h intraesophageal pH-multichannel intraluminal impedance (24MII-pH) used for assessing gastroesophageal reflux disease by measuring baseline impedance (BI) requires a 24-h measuring period. In the present study, we developed a quick method of measuring BI and evaluated its usefulness in classifying patients with proton pump inhibitor (PPI)-refractory non-erosive reflux diseases (NERD) as having functional heartburn (FH) or endoscopic-negative reflux disease (ENRD). Methods: Ninety-one NERD patients without esophageal motility disorder underwent 24MII-pH monitoring while on a PPI. The measurements of the mean nocturnal BI (MNBI) and short MNBI were assessed at 3 times (at about 1: 00, 2: 00, and 3: 00 am) for 10 min and 30 s respectively. The measurement of the simple mean BI (MBI) was performed once 30 s at about 11: 00 am. Results: Ninety-one patients were divided into 2 groups: 59 with ENRD and 32 with FH. The cutoff, specificity, and sensitivity for distinguishing patients with FH were as follows: MNBI, 2,874.1 Ω, 72%, and 72%; short MNBI, 2,857.6 Ω, 74%, and 84%; and simple MBI, 2,874.1 Ω, 86%, and 78% respectively. Conclusion: Measuring the simple MBI is a quick method and is useful for distinguishing patients with FH from those in a cohort with PPI-refractory NERD.

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Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease

Cited by 243 publications

References 17 publications

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Convenient Method of Measuring Baseline Impedance for Distinguishing Patients with Functional Heartburn from those with Proton Pump Inhibitor-Resistant Endoscopic Negative Reflux Disease

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