Impedance technology for the management of esophageal disorders

Abstract

Zusammenfassung. Grundlagen: Impedanzmessungen im Ö sophagus werden zunehmend häufiger zur Erkennung und Quantifizierung der Präsenz von Flüssigkeiten in der Speiseröhren eingesetzt.Methodik: Ü bersicht der klinischen Anwendungen von Impedanzmessungen, insbesondere kombinierte Impedanz-Manometrie und Impedanz-pH-Metrie.Ergebnisse: Kombinierte Impedanz-Manometrie ermöglicht die Quantifizierung des Bolustransites und klärt, inwiefern ösophageale Motilitätsabnormalitäten von einer Bolustransitstörung begleitet sind. Dies ist von besonderem Interesse für Patienten mit nicht-obstruktiver (i.e. funktioneller) Dysphagie und Patienten mit post-operativer Dysphagie.Kombinierte Impedanz-pH-Metrie identifiziert Refluxepisoden unabhängig vom Säuregehalt (i.e. pH). Dieses ist wichtig fü r Patienten mit persistierenden Beschwerden trotz säurehemmender Therapie. Die Möglichkeit Refluxepisoden mit pH > 4 zu identifizieren, bringt neue Fragen betreffend der optimalen Therapie fü r Patienten mit symptomatischem nicht-saurem Reflux.Schlussfolgerungen: Impedanzmessungen ermög-lichen uns Flü ssigkeitsbewegungen in der Speiseröhre zu identifizieren. Die klinische Wertigkeit dieser zusätz-lichen Information dü rfte durch zukü nftige Studien geklärt werden.Schlüsselwörter: Ö sophagusmanometrie, ösophageale pH-Metrie, Impedanzmessungen, kombinierte Impedanz-Manometrie, kombinierte Impedanz-pH-Metrie.Summary. Background: Esophageal impedance measurements are increasingly used to identify and quantify the presence of fluids in the esophagus.Method: A review of the available literature on clinical applications of impedance including combined impedance-manometry testing and combined impedance-pH monitoring is done.Results: Combined impedance-manometry testing offers the opportunity to quantify esophageal bolus transit and clarifies the implications of esophageal motility abnormalities on esophageal function. This is of particular interest in patients with non-obstructive dysphagia and in patients with post-fundoplication dysphagia.Combined impedance-pH monitoring allows the detection of gastroesophageal reflux episodes independent of pH. This is of particular importance when evaluating patients with persistent symptoms on acid suppressive therapy. The ability to detect gastroesophageal reflux episodes with pH> 4 unfolds new questions on the optimal approach to patients with symptomatic nonacid reflux.Conclusions: Impedance technology allows the detection of fluid movements in the esophagus; further studies will determine the clinical utility of this new information.

Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders?

“…Many invasive and non-invasive techniques, such as endoscopy, manometry [3], 24-h pH-metry [4] and impedance measurements [5] are used for the objective evaluation of these problems, whereas endoscopy should initially be performed in patients with dysphagia to rule out malignancies [6]. The most common radiographic method is videofluoroscopy, which allows precise assessment of pharyngeal and oesophageal functions [7][8][9].…”

Solving discrepancies in GERD and Barrett's esophagus

“…Over time, CLE extends proximally. Classical pH monitoring and combined impedance pH-monitoring assess pH changes 5 and 3-5 cm above the lower esophageal sphincter, respectively [1,7]. Thus, some of the discrepancies observed between morphology and function test data outlined by Tutuian [1] and Triadafilopoulos [4] may be explained by different sites of reflux action (distal lower esophageal sphincter) and function test probe placement (5-8 cm proximal to the point of action) [6,[7][8][9][10][11][12][13][14].…”

“…Tutuian [1] presents the novel developments of esophageal impedance technology including combined impedance pH monitoring and the fascinating combination of impedance and high-resolution manometry [2]. On the basis of published evidence (most of it being his work), Tutuian gives a detailed account of fascinating aspects of novel GERD diagnosis and its management.…”

“…Finally, Tutuian points out the clear indications for impedance pH monitoring: persons under proton pump inhibitor therapy, atypical symptoms (proximal refluxes?) and non-or weakly acidic refluxes [1].…”

Roboterassistierte laparoskopische Cardiomyotomie

“…The main symptoms are dysphagia for liquid and solid food, regurgitation of indigested food, and heartburn. The condition therefore has to be differentiated from reflux [5,6]. Diagnosis is made by taking an exact history, upper GI endoscopy, radiographic studies and esophageal manometry [7,8] as the gold standard.…”