Esophageal high resolution manometry in a community practice

Gyawali, C. Prakash; Bredenoord, Albert J.; Conklin, Jeffrey L.; Fox, Mark; Pandolfino, John E.; Peters, Jeffrey H.; Roman, Sabine; Staiano, Annamaria; Vaezi, Michael F.

doi:10.1111/nmo.12175

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Additionally, a type 3 morphology of the EGJ (i.e., separation between LES and crural diaphragm ≥ 3 cm) at HRM could support the diagnosis of GERD [27,43]. Accordingly, the incompetence of the EGJ impairs the anti-reflux barrier and represents a mechanism of GERD [27,44,45]. The fourth iteration of the Chicago Classification [46] recently proposed the EGJ contractile integral (EGJ-CI) as a parameter to define the lack of efficacy of the EGJ barrier.…”

Section: Modern Diagnosis Of Gerd: the Lyon Consensusmentioning

confidence: 99%

Clinical use of mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index for the diagnosis of gastro-esophageal reflux disease

et al. 2022

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The clinical diagnosis of gastro-esophageal reflux disease (GERD) is based on the presence of typical esophageal troublesome symptoms. In clinical practice, heartburn relief following a proton pump inhibitor (PPI) trial or endoscopy can confirm a diagnosis of GERD. In cases of diagnostic uncertainty or before anti-reflux interventions, combined impedance-pH monitoring (MII-pH) provides a comprehensive assessment of both physical and chemical properties of the refluxate, allowing to achieve a conclusive diagnosis of GERD. Recently, the Lyon Consensus proposed the use of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I) as novel MII-pH metrics to support the diagnosis of GERD. The calculation of MNBI and PSPW-I currently needs to be performed manually, but artificial intelligence systems for the automated analysis of MII-pH tracings are being developed. Several studies demonstrated the increased diagnostic yield MNBI and PSPW-I for the categorization of patients with GERD at both on- and off-PPI MII-pH monitoring. Accordingly, we performed a narrative review on the clinical use and diagnostic yield of MNBI and PSPW-I when the diagnosis of GERD is uncertain. Based on currently available evidence, we strongly support the evaluation of PSPW-I and MNBI as part of the standard assessment of MII-pH tracings for the evaluation of GERD, especially in patients with endoscopy-negative heartburn.

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