Mean nocturnal baseline impedance, a novel metric of multichannel intraluminal impedance-pH monitoring in diagnosing gastroesophageal reflux disease

Wu, Yanhong; Guo, Zihao; Zhang, Chuan; Zhan, Yuan

doi:10.1177/17562848221105195

Cited by 4 publications

(5 citation statements)

References 51 publications

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“…The MMS apparatus for example, which is the same device used in our study recorded higher MNBI values especially at 5 cm above the lower esophageal sphincter compared to other medical devices [26]. Lastly, there are different ways of measuring and defining MNBI, some studies measured MNBI just at 3 cm above the lower esophageal sphincter, while others at 5 cm, and some like our study used many references point to calculate an average [25,27,28]. No official guidelines have been published for a correct recording of MNBI.…”

Section: Discussionmentioning

confidence: 56%

The Role of Distal Mean Nocturnal Baseline Impedance in Differentiating GERD Phenotypes

Sararu,

Peagu,

Fierbinteanu-Braticevici

2023

JGLD

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Background and Aims: Gastroesophageal reflux disease (GERD) is one of the most frequent digestive pathologies. The current diagnosis of GERD either by trial of proton pump inhibitors (PPIs), endoscopy or by multichannel impedance pH study (MII/pH) has limitations. Our study aims to show if mean nocturnal baseline impedance (MNBI) can differentiate between the GERD phenotypes. Methods: We recruited 62 patients who underwent upper digestive endoscopy and MII/pH, with some patients undergoing esophageal manometry to exclude motility disorders. Patients were separated into 4 GERD phenotypes: erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH). Proximal MNBI was calculated as the mean value of the proximal 2 channels (Z1 and Z2), and distal MNBI was calculated as the mean value of the distal 4 channels (Z3, Z4, Z5, Z6). Results: Distal MNBI can help distinguish the abnormal acid exposure time (AET) phenotypes (ERD, NERD) from normal AET phenotypes (RH, FH) with a decent performance (AUROC 0.857). Distal MNBI has good accuracy in separating ERD from other phenotypes (AUROC 0.872). Furthermore, distal MNBI can differentiate FH from ERD, NERD, RH with good accuracy (AUROC 0.879), and on top of that is able to separate FH from RH (AUROC 0.817). Conclusions: Our study showed that distal MNBI is a good method of differentiating GERD phenotypes and should be taken into consideration in future studies to assess its validity in helping physicians make the correct diagnosis.

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Section: Discussionmentioning

confidence: 56%

The Role of Distal Mean Nocturnal Baseline Impedance in Differentiating GERD Phenotypes

Sararu,

Peagu,

Fierbinteanu-Braticevici

2023

JGLD

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“…Reflux barrier integrity was evaluated using the DeMeester score, and proximal and distal Acid Exposure Times (AET). Mucosal barrier integrity was assessed using the proximal and distal Mean Nocturnal Baseline Impedance (MNBI) 28 . This is the average of three separate measurements of mucosal impedance during sleep.…”

Section: Methodsmentioning

confidence: 99%

“…Mucosal barrier integrity was assessed using the proximal and distal Mean Nocturnal Baseline Impedance (MNBI). 28 This is the average of three separate measurements of mucosal impedance during sleep.…”

Section: Physiological Evaluation Consisted Of High-resolutionmentioning

confidence: 99%

A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches

Ayres,

Perring,

Nouraei

2024

Neurogastroenterology Motil

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IntroductionGastric inlet patches are often incidental, but can also be a treatable cause of laryngo‐esophageal symptoms.MethodsWe retrospectively reviewed all patients whose gastric inlet patches were diagnosed following assessment for laryngopharyngeal and swallowing symptoms. Improvement following Argon Plasma Coagulation (APC) was assessed using Minimum Clinically‐Important Difference methodology combining voice, throat, and swallowing domains. Correlations between APC response and measures of reflux and mucosal barrier integrity, measured during 24‐h pH‐impedance manometry, were obtained. Proximal and Distal Mean Nocturnal Baseline Impedance (MNBI) values were separately calculated and the novel variable of Mucosal Impedance Gradient was derived as [((Distal MNBI‐Proximal MNBI)/((Distal MNBI + Proximal MMBI)/2)) x 100].Key ResultsInlet patches were detected in 57 of 651 patients who had Transnasal Panendoscopy (8.7 ± 2.2%). There were 34 males. Mean age was 58 years. Mean duration of symptoms was 2 years. The commonest symptoms were hoarseness (n = 33), throat symptoms (n = 24), and dysphagia (n = 21), respectively. APC was used to ablate patches in 34 patients. Treatment response was 71% at a mean followup of 5.5 months. MIG > − 25% predicted response to APC, with area under the receiver operating characteristic curve of 0.875 (Sensitivity = 81%; Specificity = 100%; p < 0.0001).ConclusionsGastric inlet patches are common and under‐recognized. They can cause protracted pharyngo‐esophageal symptoms. Patch ablation is an effective treatment for carefully selected patients. Optimal patient selection requires multidisciplinary teamwork. Mucosal Impedance Gradient could further refine patient selection.

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“…Different MII-pH parameters were recorded: number, duration and type of GER episodes, according to pH, proximal extension of reflux episodes (when reflux reaches the two most proximal channels), bolus clearance time (BCT), reflux index (RI) and bolus exposure index (BEI), defined as percentage of time in which the reflux episodes were acidic and retrograde bolus was present in the esophagus, respectively [29][30][31]. In addition, since low distal, proximal and nocturnal impedance baseline values may provide useful clinical insights and have recently been related to esophagitis, esophageal dysmotility and response to GER treatment, these parameters were also manually calculated and analyzed according to age [30,[35][36][37][38][39][40][41][42]. Symptoms were considered temporally associated with GER if they occurred within 2 min of a reflux episode.…”

Section: Gerd Investigationmentioning

confidence: 99%

Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED)

Carabelli,

Binotto,

Armano

et al. 2024

Children

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Background: Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. Methods: We enrolled all infants (0–12 months) referred for suspected GER disease who underwent esophageal impedance–pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. Results: We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. Conclusions: Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.

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Mean nocturnal baseline impedance, a novel metric of multichannel intraluminal impedance-pH monitoring in diagnosing gastroesophageal reflux disease

Cited by 4 publications

References 51 publications

The Role of Distal Mean Nocturnal Baseline Impedance in Differentiating GERD Phenotypes

The Role of Distal Mean Nocturnal Baseline Impedance in Differentiating GERD Phenotypes

A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches

Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED)

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