Post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance predict PPI response in GERD patients with extra esophageal symptoms

Ribolsi, Mentore; Guarino, Michele Pier Luca; Tullio, A.M. Di; Cicala, Michele

doi:10.1016/j.dld.2019.09.011

Cited by 27 publications

(35 citation statements)

References 27 publications

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“…This study also reported that PSPW index correlated weakly and negatively with heartburn, but did not correlate with extra‐oesophageal symptoms such as, cough, hoarseness or globus (Cho et al, 2017). In a recent study of a cohort of patients with reflux and extra‐oesophageal symptoms, Ribolsi et al reported PSPW indices of 35% in patients with non‐erosive reflux disease (NERD), 42% in patients with reflux hypersensitivity, and 72% in patients with both normal AET and negative symptom association probability (SAP) (Ribolsi et al, 2020). This suggests that the study group of LPR patients had similar abnormalities in post‐reflux chemical clearance to those found in reflux hypersensitivity and NERD previously described by Frazzoni et al Recently, oesophageal pH was shown to incrementally increase following PSPW, with this incremental change being more pronounced in PPI‐responsive GORD than in PPI‐refractory GORD (Frazzoni et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…The cut‐off value of 61% for what is considered abnormal PSPW index is described by Frazzoni et al, PSPW index had a sensitivity of 100% and 89% in erosive reflux disease (ERD) and non‐erosive reflux disease (NERD), respectively (Frazzoni et al, 2016). Ribolsi et al report that abnormal PSPW index was seen in 84% of their cohort of patients with NERD, 72% of patients with reflux hypersensitivity, and 21% of patients classified as non‐GERD (Ribolsi et al, 2020). Hence, the PSPW index cut‐off value described by Frazzoni appears to demonstrate a substantial yield in identifying impaired chemical clearance after a reflux event in patients with LPR symptoms, and excellent yield in those with typical oesophageal GORD.…”

Section: Discussionmentioning

confidence: 99%

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Post‐reflux swallow‐induced peristaltic wave is impaired in laryngopharyngeal and gastro‐oesophageal reflux disease

Park

Wall

Falk

2021

Clin Physio Funct Imaging

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Laryngopharyngeal reflux (LPR) refers to the reflux of gastric contents into the larynx, pharynx and lungs, causing extra-oesophageal symptoms and complications such as hoarseness, chronic cough and voice disorders (Koufman, 1991). LPR is distinct from typical gastrooesophageal reflux disease (GORD), which manifests with typical symptoms such as heartburn, and yet a common pathophysiology of gastric reflux broadly unifies the two diagnoses as reflux phenomena in the Montreal classification (Vakil et al., 2006).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Post‐reflux swallow‐induced peristaltic wave is impaired in laryngopharyngeal and gastro‐oesophageal reflux disease

Park

Wall

Falk

2021

Clin Physio Funct Imaging

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“…41 Abnormal values, that describe the underlying mechanism, are associated with a satisfactory response to acid-suppressive therapy, also in patients with EE syndromes. 42 However, it should be also noted that PPI-refractory esophagitis presents lower values of PSPW index, that explains the pathophysiological reason responsible for the lack of response. 41…”

Section: Symptom-reflux Associationsmentioning

confidence: 99%

The Lyon Consensus: Does It Differ From the Previous Ones?

Ghisa

Barberio

Savarino

et al. 2020

J Neurogastroenterol Motil

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Gastroesophageal reflux disease (GERD) is a complex disorder with heterogeneous symptoms and a multifaceted pathogenetic basis, which prevent a simple diagnostic algorithm or any categorical classification. Clinical history, questionnaires and response to proton pump inhibitor (PPI) therapy are insufficient tools to make a conclusive diagnosis of GERD and further investigations are frequently required. The Lyon Consensus goes beyond the previous classifications and defines endoscopic and functional parameters able to establish the presence of GERD. Evidences for reflux include high-grade erosive esophagitis, Barrett's esophagus, and peptic strictures at endoscopy as well as esophageal acid exposure time > 6% on pH-metry or combined pH-impedance monitoring. Even if a normal endoscopy does not exclude GERD, its combination with distal acid exposure time < 4% on off-PPI pH-impedance monitoring provides sufficient evidence refuting this diagnosis. Reflux-symptom association on pH-monitoring provides supportive evidence for reflux-triggered symptoms and may predict a better treatment outcome, when present. Also recommendations to perform pH-impedance "on" or "off" PPI are well depicted. When endoscopy and pH-metry or combined pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings (eg, microscopic esophagitis), high-resolution manometry (ie, ineffective esophagogastric barrier and esophageal body hypomotility), and novel impedance metrics, such as mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index, can contribute to better identify patients with GERD. Definition of individual patient phenotype, based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the esophagogastric junction, and clinical presentation, will lead to manage GERD patients with a tailored approach chosen among different types of therapy.

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“…The proportion of reflux events that are associated with PSPW on pH‐impedance monitoring is termed the PSPW index (PSPWI). Low PSPWI has been shown to correlate with elevated reflux burden and PPI refractory symptoms 9‐11 …”

Section: Introductionmentioning

confidence: 99%

Postreflux swallow‐induced peristaltic wave index from pH‐impedance monitoring associates with esophageal body motility and esophageal acid burden

Rogers

Rengarajan

Ribolsi

et al. 2020

Neurogastroenterology Motil

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Background Postreflux swallow‐induced peristaltic wave (PSPW) on pH‐impedance monitoring and contraction vigor on high‐resolution manometry (HRM) both assess esophageal peristaltic response. We aimed to evaluate relationships between PSPW and esophageal peristalsis on HRM in the context of reflux disease in this multicenter cohort study. Methods pH‐impedance and HRM studies performed on patients with persisting reflux symptoms were reviewed from 6 centers (5 in Europe and 1 in US). Total, upright and supine acid exposure time (AET) were evaluated from pH‐impedance studies; PSPW index (PSPWI) and mean nocturnal baseline impedance (MNBI) were calculated using standard methodology. Esophageal body contraction vigor was analyzed using distal contractile integral (DCI), and DCI ratio > 1 between single swallows and multiple rapid swallows (MRS) defined presence of contraction reserve. Student's t test, ANOVA, and linear regression were utilized to investigate relationships between PSPW, contraction vigor, and contraction reserve. Key Results Of 296 patients (52.8 ± 0.8 yr, 63% F), median PSPWI was 0.475. Only 24.0% had intact DCI; the remainder had varying degrees of hypomotility. As hypomotility increased, PSPWI and MNBI decreased significantly, while total AET and reflux episodes had an inverse response (P ≤ .002 for each). MRS data were available in 167 (56.4%), 72.5% had contraction reserve. MRS cohorts with normal PSPWI had significantly lower reflux burden compared to low PSPWI, regardless of presence or absence of contraction reserve (P ≤ .001). Conclusions and Inferences PSPWI correlates with esophageal hypomotility and reflux burden, and complements clinical reflux evaluation. Intact PSPW is more relevant to esophageal reflux clearance than contraction reserve.

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Post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance predict PPI response in GERD patients with extra esophageal symptoms

Cited by 27 publications

References 27 publications

Post‐reflux swallow‐induced peristaltic wave is impaired in laryngopharyngeal and gastro‐oesophageal reflux disease

Post‐reflux swallow‐induced peristaltic wave is impaired in laryngopharyngeal and gastro‐oesophageal reflux disease

The Lyon Consensus: Does It Differ From the Previous Ones?

Postreflux swallow‐induced peristaltic wave index from pH‐impedance monitoring associates with esophageal body motility and esophageal acid burden

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