Prospective Assessment of Patient Selection for Antireflux Surgery by Combined Multichannel Intraluminal Impedance pH Monitoring

Genio, Gianmattia del; Tolone, Salvatore; Genio, Federica del; Aggarwal, Rajesh; D’Alessandro, Antonio; Allaria, Alfredo; Rossetti, Gianluca; Brusciano, Luigi; Genio, A. Del

doi:10.1007/s11605-008-0583-y

Cited by 80 publications

(43 citation statements)

References 15 publications

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“…Reasons to refer GERD patients for surgery may include desire to discontinue medical therapy, non-compliance, side-eff ects associated with medical therapy, the presence of a large hiatal hernia, esophagitis refractory to medical therapy, or persistent symptoms documented to be caused by refractory GERD. With the introduction of esophageal pH-impedance monitoring, patients found to have abnormal amounts of non-acid refl ux on PPI therapy with good symptom correlation may be considered for surgery ( 85 ). Refractory dyspeptic symptoms including nausea, vomiting , and epigastric pain are less likely to demonstrate symptomatic response.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,533

1,430

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Section: Summary Of the Evidencementioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,533

1,430

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“…In a third study, a group of Italian investigators prospectively assessed the outcomes of laparoscopic Nissen fundoplication in 62 patients who were PPI non-responsive or non-compliant. 47 All surgically treated patients had a positive MII-pH monitoring. The overall patient satisfaction rate was 98.3% and no differences were found in clinical outcomes based on their preoperative MII-pH or manometry results.…”

Section: Antireflux Surgerymentioning

confidence: 97%

“…[46][47][48][49] The first study by Mainie et al followed 19 patients who were refractory to a double-dose PPI and underwent a successful laparoscopic Nissen fundoplication. 48 Prior to surgery, 18 of the 19 patients were found to have a positive SI on Multichannel Intraluminal Impedance (MII)-pH monitoring (14 with non-acid and 4 with acid reflux).…”

Section: Antireflux Surgerymentioning

confidence: 99%

Therapeutic options for refractory gastroesophageal reflux disease

Fass

2012

J of Gastro and Hepatol

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Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics. In patients with evidence of reflux as the direct trigger of their symptoms, endoscopic treatment or antireflux surgery may be helpful in remitting symptoms. The role of psychological interventions, as well as non-traditional therapeutic strategies remains to be further elucidated.

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“…Patients so diagnosed would be candidates to GERD treatments such as baclofen or anti-reflux surgery, as are proton pump inhibitor-refractory conventional GERD patients whose symptoms are due to persistent refluxes as demonstrated as well with MII-pH monitoring done on-therapy with proton pump inhibitor. 4,5 …”

mentioning

confidence: 99%

Symptomatic Non-acidic Reflux in a Patient With Chronic Autoimmune Atrophic Gastritis Successfully Treated With Anti-reflux Surgery

Teruel

Higes

Luengo

et al. 2018

J Neurogastroenterol Motil

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TO THE EDITOR:We present the case of a patient with chronic autoimmune atrophic gastritis (CAAG) with non-acidic gastroesophageal reflux disease (GERD) demonstrated with 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring who was successfully treated with laparoscopic antireflux surgery. Written and oral informed consent was obtained from the patient for the communication of this case.A 56-year-old woman with no relevant medical history was referred to our Motility Unit because of refractory gastroesophageal reflux. She complained of a 2-year history of daily alimentary nonacidic regurgitation that occurred mainly in the recumbent position and interfered with her sleep. She had also frequent heartburn, belching, and chronic dry cough, also predominant in the recumbent position. She had previously received treatment with esomeprazole 40 mg twice a day but reported no improvement. A previous esophagogastroduodenoscopy (EGD) revealed a 5 cm axial hiatal hernia with no esophagitis. Serum vitamin B12 levels were low in the blood analysis (134 pg/mL), that were otherwise unremarkable. A water-perfused conventional esophageal manometry revealed a normal upper esophageal sphincter, normal peristalsis and a very hypotensive lower esophageal sphincter (2 mmHg mean expiratory pressure). Twenty-four-hour off-therapy esophageal pH monitoring detected no acid reflux (0 acid refluxes, 0% acid exposure time). With the suspicion of CAAG and associated non-acidic GERD, a new EGD, an autoimmune panel, and a 24-hr MII-pH monitoring were undertaken. EGD detected no new macroscopic findings, but biopsy specimens revealed chronic gastritis with glandular atrophy and intestinal metaplasia that was more intense in the body, with no dysplasia. Anti-parietal cells antibodies and anti-intrinsic factor antibodies were positive. MII-pH monitoring detected 366 total refluxes (365 non-acidic, 32% proximal extent) and a bolus exposure time of 7.2%. She marked during the study 12 regurgitation and 2 heartburn episodes, all of which were preceded by reflux, and 37 coughs, 26 preceded by reflux. Symptom association probability and symptomatic index were positive (> 95% and > 50% respectively) for all 3 symptoms.The patient was offered surgery, which she accepted, and underwent laparoscopic Nissen fundoplication with associated hiatal repair. She experienced great improvement, with remission of all symptoms (regurgitation, cough, dysphagia, and belching). Postsurgical manometry and MII-pH monitoring revealed objective improvement: lower esophageal sphincter mean resting pressure of 11 mmHg, 79 non-acidic refluxes, and bolus exposure time of 1.2%.This case report represents, to our knowledge, the first communication of a patient with objectively proven GERD due to nonacidic reflux in the context of CAAG who was satisfactorily treated with fundoplication, with improvement in symptoms and in objective parameters. Old reports described patients with achlorhydria with esophagitis that was attributed hypothetically to biliary reflux, but w...

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Prospective Assessment of Patient Selection for Antireflux Surgery by Combined Multichannel Intraluminal Impedance pH Monitoring

Cited by 80 publications

References 15 publications

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Therapeutic options for refractory gastroesophageal reflux disease

Symptomatic Non-acidic Reflux in a Patient With Chronic Autoimmune Atrophic Gastritis Successfully Treated With Anti-reflux Surgery

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