Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients

Savarino, Edoardo; Zentilin, Patrizia; Tutuian, Radu; Pohl, Daniel; Gemignani, Lorenzo; Malesci, Alberto; Savarino, Vincenzo

doi:10.1007/s00535-011-0480-0

Cited by 104 publications

(72 citation statements)

References 46 publications

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“…20 Accordingly, we found the following 3 results. First, FH/PPI-responders had similar AET, total reflux number, acid reflux number, proximal reflux number, as well as similar baseline impedance values and PSPW index to HE.…”

Section: Discussionmentioning

confidence: 77%

Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

Bortoli

Martinucci

Savarino

et al. 2015

Clinical Gastroenterology and Hepatology

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124

139

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Section: Discussionmentioning

confidence: 77%

Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

Bortoli

Martinucci

Savarino

et al. 2015

Clinical Gastroenterology and Hepatology

Self Cite

124

139

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“…It has been revealed that 37%-60% of NERD patients have normal acid reflux, and the proportion of FH and RH can vary from less than 10% to 75% and to 36%, respectively. [14][15][16][17][18][19][20][21][22][23][24][25] One factor that has contributed to the variation is the changing definitions of heartburn phenotypes. For example, the Rome III committee used to define those with normal reflux but positive symptom-reflux association as NERD, but these patients were then isolated as a single group named RH in the updated criteria.…”

Section: Discussionmentioning

confidence: 99%

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Zhang

Chen

Peng

et al. 2017

United European Gastroenterology Journal

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Background: The phenotypes of heartburn patients are heterogeneous. Objective: The objective of this study was to investigate the proportion of heartburn phenotypes in a Chinese population and to compare the Rome IV and III criteria for heartburn diagnosis. Methods: A retrospective study was performed among heartburn patients referred for upper endoscopy and esophageal function tests in a tertiary hospital. Their symptoms fulfilled Rome IV and III criteria. Results: A total of 233 patients were included. Fifty-nine patients (25%) were diagnosed with esophagitis, 96 (41%) with non-erosive reflux disease (NERD) and 78 (34%) with functional heartburn (FH) based on Rome III criteria. Approximately 70% of the Rome III NERD patients were changed based on Rome IV criteria, with 36 patients (15%) diagnosed with reflux hypersensitivity (RH) and 32 patients (14%) who didn't fulfill the criteria considered unclassified. The FH and RH patients showed higher esophagogastric junction-contractile integral (EGJ-CI) and less hiatal hernia than did Rome IV NERD patients. The unclassified had more hiatal hernias than the FH and RH (p < 0.05). The EGJ-CI was similar between Rome III NERD and FH cases. Conclusion: The Rome IV criteria were stricter for heartburn diagnosis and superior in distinguishing NERD from functional disorders on motility patterns than Rome III. KeywordsHeartburn, gastroesophageal reflux disease, function esophageal disorders, Rome III criteria, Rome IV criteria, screening and diagnosis non-erosive reflux disease (NERD) cases, among whom approximately 34% had functional heartburn (FH) and 15% had reflux hypersensitivity (RH). . The Rome IV criteria were superior to the Rome III criteria in distinguishing NERD from FH and RH according to motility characteristics. Approximately 14% of the patients didn't fit the updated criteria.

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“…Several recent studies, using pH-impedance monitoring evaluated the prevalence of reflux hypersensitivity. Savarino et al 7 assessed 329 endoscopy negative patients with a pH-impedance monitoring off PPI treatment. The authors demonstrated that 40% of the patients had NERD, 24% functional heartburn, and 36% reflux hypersensitivity.…”

Section: Epidemiologymentioning

confidence: 99%

“…Studies have produced conflicting results regarding the role of non-acidic reflux or proximal esophageal migration of gastroesophageal reflux in reflux hypersensitivity. Savarino et al 7 demonstrated that an increased number of weakly acidic reflux events and a high rate of proximal reflux are the main causes of symptoms in reflux hypersensitivity patients who were evaluated with multichannel impedance (MII)-pH monitoring. In contrast, Tamura et al 16 reported that the total and proximal acid reflux events were significantly higher in NERD patients with abnormal esophageal acid exposure as compared with reflux hypersensitivity patients.…”

Section: Pathophysiologymentioning

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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Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients

Cited by 104 publications

References 46 publications

Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

Reflux Hypersensitivity: A New Functional Esophageal Disorder

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