Low‐impedance Baseline Values Predict Severe Esophagitis

Sabban, Judith Cohen; Bertoldi, Gabriela Donato; Ussher, Federico; Christiansen, Stefan; Lifschitz, Carlos; Orsi, Marina

doi:10.1097/mpg.0000000000001496

Cited by 17 publications

(21 citation statements)

References 16 publications

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“…BI values have a close relationship with time of acid exposure, trans-epithelial resistance (functional) and dilation of intercellular spaces, all of which are reflected in various transformations of the stability (structure) of the esophageal mucosa (10, 11). Specifically, mucosal inflammation has been associated with lower BI, with values <900 Ωs indicating severe inflammation and >2000 Ωs indicating normal integrity (12). Correlation between baseline impedance values and several reflux parameters in children has been recognized previously (13), as well as a correlation with macroscopic esophagitis (12)…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, mucosal inflammation has been associated with lower BI, with values <900 Ωs indicating severe inflammation and >2000 Ωs indicating normal integrity (12). Correlation between baseline impedance values and several reflux parameters in children has been recognized previously (13), as well as a correlation with macroscopic esophagitis (12)…”

Section: Introductionmentioning

confidence: 99%

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Differentiation of esophageal pH-impedance characteristics classified by the mucosal integrity marker in human neonates

et al. 2018

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BACKGROUND: In adults, distal baseline impedance (BI) is a determinant of esophageal mucosal integrity with values <900Ω indicating inflammation. Relationships between acid gastroesophageal reflux (GER) and BI in neonates are unclear. METHODS: NICU infants (N=198, 30.4±0.3 weeks gestation) were evaluated at 43±0.4 weeks postmenstrual age using 24-hour pH-impedance. Ten randomly selected one-minute windows during rest from the distal impedance channel (Z6) were averaged. Chi-square, t-tests, and ANOVA were used to compare pH-impedance and symptom characteristics by BI severity (BI<900Ω, BI 900-2000Ω, BI>2000Ω). Regression analysis was used to identify potential contributing factors of BI. RESULTS: In BI<900Ω: 1) pH-impedance characteristics were increased (acid reflux event frequency, duration, and severity, all P<0.05 vs. BI>2000Ω), and 2) positive symptom correlations were noted with bolus (73%) and acid events (55%). Significant predictors of BI included chronological age, acid reflux index, and BPD diagnosis (all P<0.05). CONCLUSIONS: Low BI is associated with prolonged acid exposure, delayed clearance, and greater aerodigestive symptom prevalence, likely associated with inflammation and or increased mucosal permeability. BI>2000Ω likely involves little or no inflammation because acid exposure is minimal. Combination of SAP, pH-impedance metrics and BI along with clarification of dysmotility mechanisms provides the rationale for personalized anti-reflux therapies as needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Differentiation of esophageal pH-impedance characteristics classified by the mucosal integrity marker in human neonates

et al. 2018

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“…Their findings may be different from the other studies, and this may be due to the studied neonatal population, which is unique with rapidly changing physiology and pathophysiology. In a different study, the loss of mucosal integrity was associated with possible inflammation resulting from high acid reflux index and prolonged acid clearance among older children who underwent endoscopy, baseline impedance, biopsy and pH‐Impedance tests . Validation and categorisation of the distal oesophageal baseline impedance correlated with 100% prediction with grade 3 and macroscopic esophagitis .…”

mentioning

confidence: 95%

“…In a different study, the loss of mucosal integrity was associated with possible inflammation resulting from high acid reflux index and prolonged acid clearance among older children who underwent endoscopy, baseline impedance, biopsy and pH‐Impedance tests . Validation and categorisation of the distal oesophageal baseline impedance correlated with 100% prediction with grade 3 and macroscopic esophagitis . Similarly, studies in adults using endoscopy and baseline impedance and biopsy diagnosis along with implanted mucosal electrodes to detect impedance have been carried out that yielded highly significant correlations between lower baseline impedance and oesophagitis, nonerosive oesophagitis, pathological acid exposure or GORD .…”

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confidence: 99%

Understanding the neonatal oesophageal mysteries of gastro‐oesophageal reflux disease using baseline impedance

Jadcherla

2018

Acta Paediatrica

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“…However, not only macroscopic changes, but also subtle changes such as dilatation of intercellular spaces seen in non-erosive reflux disease (NERD) result in low BI (54). Some authors suggest that BI can replace multiple endoscopies in patients with reflux esophagitis (58). PSPW (the number of refluxes followed within 30s by swallow-induced peristaltic waves divided by the number of total refluxes) expresses chemical clearance and improves the diagnostic efficacy of pH-MII monitoring (59,60).…”

Section: The Role Of Ph-mii Parameters In Prediction Of Reflux Esophamentioning

confidence: 99%

The significance of different methods for detection of gastroesophageal reflux in children

Ristic¹,

Kisić-Tepavčević²,

Milovanović³

2018

Medicinski podmladak

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Symptom-based diagnosis of gastroesophageal reflux disease (GERD) is not specific due to high prevalence of disorders that can mimic GERD. Conventional pH monitoring, combined pH-MII (multiple intraluminal impedance) monitoring and esophagogastroduodenoscopy are diagnostic methods most frequently used in children.Combined pH-MII monitoring is the most accurate diagnostic method for detecting GERD in children, which tends to become the gold standard. In infants and probably in children with extraesophageal symptoms, MII gives the greatest contribution to the validity of pH-MII monitoring. High prevalence of functional heartburn, in children older than 8 years, suggests the importance of pH-MII monitoring in this age group as well. The majority of studies showed age differences in the chemical composition of refluxate. Weakly acid reflux is more common in infants and is often associated with symptoms, whereas acid reflux is more common in older children and adolescent. Sensitivity of endoscopy is very low compared to pH-MII monitoring as a reference test. Although endoscopy is the method of choice for the confirmation of reflux esophagitis, pH-MII parameters are promising indicators of mucosal integrity, but further studies are needed.The major problem with pH-MII monitoring is a lack of normative data for children. Therefore, the standardization is mandatory. For the present pH-MII monitoring has limited impact on treatment due to the absence of effective therapy for weakly acid reflux, suggesting that further studies should be directed in this direction.

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Low‐impedance Baseline Values Predict Severe Esophagitis

Cited by 17 publications

References 16 publications

Differentiation of esophageal pH-impedance characteristics classified by the mucosal integrity marker in human neonates

Differentiation of esophageal pH-impedance characteristics classified by the mucosal integrity marker in human neonates

Understanding the neonatal oesophageal mysteries of gastro‐oesophageal reflux disease using baseline impedance

The significance of different methods for detection of gastroesophageal reflux in children

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