The added diagnostic value of postreflux swallow‐induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on‐therapy impedance‐pH monitoring

Frazzoni, Marzio; Bortoli, Nicola de; Frazzoni, Leonardo; Tolone, Salvatore; Furnari, Manuele; Martinucci, Irene; Mirante, V.G.; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

doi:10.1111/nmo.12947

Cited by 116 publications

(186 citation statements)

References 35 publications

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“…Postreflux swallow induced peristaltic wave index and MNBI are two novel MII‐pH parameters, which evaluate esophageal chemical clearance and esophageal mucosal integrity, respectively. Previous multicenter studies have shown that PSPW index and MNBI can increase our ability to diagnose GERD . What's more, low PSPW index and low MNBI are demonstrated to independently predict response to PPI therapy and antireflux therapy in GERD .…”

Section: Discussionmentioning

confidence: 95%

Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low‐grade esophagitis with low reflux burden

Zhang

Tan

et al. 2019

Neurogastroenterology Motil

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Background & aims The Lyon Consensus defines LA grades C&D erosive esophagitis (EE) or acid exposure time (AET) >6% as the conclusive evidence for gastro‐esophageal reflux disease (GERD). However, most of EE is LA grade A&B and the rate of AET exceeding 6% is low in China. We aimed to evaluate patients with EE in the Chinese population based on the Lyon Criteria. Methods A retrospective study was performed among patients with EE who had esophageal function tests performed in a tertiary hospital from 2013 to 2017. Erosive esophagitis was staged according to the Los Angeles classification. Their motor profiles from high‐resolution manometry (HRM), reflux profiles from multichannel intraluminal impedance‐pH (MII‐pH) monitoring and proton pump inhibitor (PPI) efficacy were analyzed. Patients were categorized as conclusive or inconclusive GERD. Results Among 112 patients with EE who underwent esophageal function tests, EE of LA grade C&D was found in only 4.46% (N = 5). Almost 35% (N = 37) of patients with LA grade A&B EE had AET exceeded 6%, who had good PPI response similar to those with LA grade C&D EE (77.42% vs 100%, P = .559). The remaining 70 patients (62.50%) were inconclusive GERD, of whom 56.25% responded to PPI. Inconclusive GERD patients had a wide range (7.14%‐97.14%) of positive adjunctive evidences from HRM and MII‐pH monitoring without significant correlation to PPI response rate. Conclusions The reflux burden within patients with EE is predominantly low in China, and adjunctive HRM and MII‐pH profiles from Lyon criteria do not segregate PPI response.

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Section: Discussionmentioning

confidence: 95%

Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low‐grade esophagitis with low reflux burden

Zhang

Tan

et al. 2019

Neurogastroenterology Motil

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“…Normal values have been reported as higher than 2292 Ohms. MNBI is low in erosive and nonerosive GERD, compared to reflux hypersensitivity, FH, or normal controls . A low MNBI correlates with high AET, and can predict successful outcome from antireflux therapy .…”

Section: Discussionmentioning

confidence: 93%

“…Two novel metrics can be extracted from pH‐impedance studies, and are gaining importance as supplementary indicators of pathological GERD when abnormal. The first is baseline impedance, which can be accurately measured over three 10‐min periods during sleep (mean nocturnal baseline impedance, MNBI) . Baseline impedance is thought to be a marker of esophageal mucosal integrity, as values are low when there is mucosal inflammation, and recover when the mucosa heals.…”

Section: Discussionmentioning

confidence: 99%

Indications and interpretation of esophageal function testing

Gyawali¹,

Bortoli

Clarke

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms are common, and can arise from mucosal, motor, functional, and neoplastic processes, among others. Judicious use of diagnostic testing can help define the etiology of symptoms and can direct management. Endoscopy, esophageal high-resolution manometry (HRM), ambulatory pH or pH-impedance manometry, and barium radiography are commonly used for esophageal function testing; functional lumen imaging probe is an emerging option. Recent consensus guidelines have provided direction in using test findings toward defining mechanisms of esophageal symptoms. The Chicago Classification describes hierarchical steps in diagnosing esophageal motility disorders. The Lyon Consensus characterizes conclusive evidence on esophageal testing for a diagnosis of gastroesophageal reflux disease (GERD), and establishes a motor classification of GERD. Taking these recent advances into consideration, our discussion focuses primarily on the indications, technique, equipment, and interpretation of esophageal HRM and ambulatory reflux monitoring in the evaluation of esophageal symptoms, and describes indications for alternative esophageal tests.

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“…PSPW consists of a primary peristaltic wave bringing salivary bicarbonate to neutralize mucosal esophageal acidification within 30 s of a reflux episode detected on pH impedance monitoring, and the PSPW index reflects the proportion of reflux episodes followed by a PSPW . This metric is a marker of the efficacy of esophageal chemical clearance, and initial studies have reported excellent performance characteristics in differentiating functional esophageal syndromes (RH and FH) from GERD . However, further study and validation, and inclusion in software packages associated with ambulatory reflux monitoring is needed before universal utilization.…”

Section: Discussionmentioning

confidence: 99%

Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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The added diagnostic value of postreflux swallow‐induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on‐therapy impedance‐pH monitoring

Abstract: At on-therapy impedance-pH monitoring, PSPW index and MNBI efficiently distinguish PPI-refractory NERD from FH. The PSPW index represents an independent predictor of PPI-refractory GERD.

Cited by 116 publications

References 35 publications

Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low‐grade esophagitis with low reflux burden

Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low‐grade esophagitis with low reflux burden

Indications and interpretation of esophageal function testing

Nonerosive reflux disease: clinical concepts

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