Combined multichannel intraluminal impedance–pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication

Mainie, Inder; Tutuian, Radu; Agrawal, Amit; Adams, David B.; Castell, Donald O.

doi:10.1002/bjs.5493

Cited by 258 publications

(150 citation statements)

References 21 publications

(13 reference statements)

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“…Small uncontrolled studies have demonstrated a benefi t for baclofen when used for refractory duodeno-gastro-esophageal refl ux in patients with persistent symptoms on PPI therapy ( 81 ). A small observational study with limited follow-up suggested a positive symptom response to surgery in this group, but improvement in refl ux control was not objectively documented ( 161 ). A more recent prospective, uncontrolled study found that 3 months aft er fundoplication, both the number of refl ux episodes and typical symptoms of GERD (heartburn and regurgitation) improved in patients who were PPI-nonresponders ( 162 ).…”

Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,529

1,430

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Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,529

1,430

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“…This observation is very important because aspiration of nonacid reflux can also cause respiratory symptoms. For instance, Mainie et al (13) were able to identify by pH impedance monitoring patients with cough due to nonacid reflux while treated by proton pump inhibitors. A laparoscopic Nissen fundoplication improved or resolved the symptoms in 13 of 14 such patients (93%).…”

Section: Is Surgical Treatment Effective and Does It Alter The Naturamentioning

confidence: 99%

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Soares

Forsythe

Hogarth

et al. 2011

Arq. Gastroenterol.

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-Context -Gastroesophageal reflux disease (GERD) is common in patients with respiratory disorders and interstitial lung fibrosis from diverse disease processes. However, a cause-effect relationship has not been well demonstrated. It is hypothesized that there might be more than a coincidental association between GERD and interstitial lung damage. There is still confusion about the diagnostic steps necessary to confirm the presence of GERD, and about the role of effective control of GERD in the natural history of these respiratory disorders. Objectives -To determine the prevalence of GERD in patients with respiratory disorders and lung involvement; the sensitivity of symptoms in the diagnosis of GERD; and the role of esophageal function tests (manometry and 24-hour pH monitoring) in the diagnosis and treatment of these patients. Methods -Prospective study based on a database of 44 patients (29 females) with respiratory disorders: 16 patients had idiopathic pulmonary fibrosis, 11 patients had systemic sclerosis associated interstitial lung disease, 2 patients had polymyositis associated interstitial lung disease, 2 patients had Sjögren associated interstitial lung disease, 2 patients had rheumatoid artrithis associated interstitial lung disease, 1 patient had undifferentiated connective tissue diseases associated interstitial lung disease and 10 patients had sarcoidosis. The average forced vital capacity (% predicted) was 64.3%. All patients had esophageal function tests. Results -Thirty patients (68%) had pathologic reflux (average DeMeester score: 45, normal <14.7). The average number of reflux episodes recorded 20 cm above the lower esophageal sphincter was 24. Sensitivity and specificity of heartburn were 70% and 57%, of regurgitation 43% and 57%, and of dysphagia 33% and 64%. Twelve patients with GERD underwent a laparoscopic fundoplication which was tailored to the manometric profile: three patients in which peristalsis was normal had a total fundoplication (360°) and nine patients in which the peristalsis was absent had a partial anterior fundoplication (180°). Conclusions -The results of our study show that: (a) abnormal reflux was present in about 2/3 of patients with respiratory disorders (idiophatic pulmonary fibrosis, connective tissue disorders and sarcoidosis), and it extended to the upper esophagus in most patients; (b) the sensitivity and specificity of reflux symptoms was very low; and (c) esophageal function tests were essential to establish the diagnosis of abnormal reflux, to characterize the esophageal function and guide therapy. Long term follow-up will be necessary to determine if control of reflux alters the natural history of these respiratory disorders.

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“…It has been reported that patients with a positive symptom index and SAP who are not responsive to PPI therapy, but demonstrate evidence of persistent non-acid or acid reflux using MII-pH monitoring can be treated successfully with laparoscopic Nissen fundoplication. 35 Surgical anti-reflux management can provide reflux control for carefully selected reflux hypersensitivity patients. 9 Similarly, Broeders et al 36 reported that laparoscopic Nissen fundoplication drastically reduced the incidence of acid and weakly acidic reflux, as well as liquid and mixed reflux episodes.…”

Section: Treatmentmentioning

confidence: 99%

Reflux Hypersensitivity: A New Functional Esophageal Disorder

Yamasaki

Fass

2017

J Neurogastroenterol Motil

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Reflux hypersensitivity, recently introduced by Rome IV as a new functional esophageal disorder, is currently considered as the presence of typical heartburn symptoms in patients with normal upper endoscopy and esophageal biopsies, normal esophageal pH test and with evidence of a close correlation between patients' heartburn and reflux events. Reflux hypersensitivity is very common and together with functional heartburn accounts for more than 90% of the heartburn patients who failed treatment with proton pump inhibitor twice daily. In addition, reflux hypersensitivity affects primarily young to middle aged women, commonly overlaps with another functional gastrointestinal disorders, and is often associated with some type of psychological comorbidity. Diagnosis is made by using endoscopy with esophageal biopsies, pH-impedance, and high-resolution esophageal manometry. Reflux hypersensitivity is primarily treated with esophageal neuromodulators, such as tricyclic anti-depressants and selective serotonin reuptake inhibitors among others. Surgical anti-reflux management may also play an important role in the treatment of reflux hypersensitivity.

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Combined multichannel intraluminal impedance–pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication

Abstract: Patients with a positive symptom index resistant to PPIs with non-acid or acid reflux demonstrated by MII-pH monitoring can be treated successfully by laparoscopic Nissen fundoplication.

Cited by 258 publications

References 21 publications

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Reflux Hypersensitivity: A New Functional Esophageal Disorder

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