What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data?

Lam, H. G. T.; Breumelhof, R.; Roelofs, J. M. M.; Henegouwen, G. P. van Berge; Smout, A. J. P. M.

doi:10.1007/bf02090215

Cited by 132 publications

(83 citation statements)

References 9 publications

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“…For clinical purposes therefore the choice of a single latency period of two minutes would probably be suYcient to establish a relationship between pulmonary symptoms and reflux. 21 In a second sensitivity analysis, thresholds for the total number of coughs and wheezes were varied. Patients with very few events were characterised by extreme R values and extreme fractions of coughs or wheezes associated with reflux.…”

Section: Discussionmentioning

confidence: 99%

Temporal associations between coughing or wheezing and acid reflux in asthmatics

Avidan¹,

Sonnenberg²,

Schnell³

et al. 2000

Am J Gastroenterology

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Background and aims-The pulmonary symptoms of patients with lung disease may be ascribed to gastro-oesophageal reflux although a causal relationship between acid reflux and coughing or wheezing has not been proved. Does cough cause reflux or does reflux cause cough? The aim of this study was to evaluate 24 hour oesophageal pH tracings of asthmatics with gastro-oesophageal reflux to determine the temporal association between acid reflux and coughing or wheezing. Methods-The oesophageal tracings of 128 asthmatics from the outpatient clinics who underwent oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour oesophageal pH monitoring were analysed. Three possible temporal relationships between the occurrence of acid reflux and the occurrence of coughs or wheezes were evaluated: (1) pulmonary symptoms preceding reflux; (2) reflux preceding pulmonary symptoms; and (3) unrelated occurrence of both events. Results-Of 128 asthmatics, 53 recorded five or more coughs and 19 recorded three or more wheezes during the 24 hour recording period. Mean acid contact time was similar in asthmatics with and without pulmonary symptoms (12.2 (1.2)% v 10.4 (0.6)%). Of all coughs and wheezes, 46% and 48%, respectively, were associated with acid reflux. For the individual asthmatic, the likelihood of reflux induced coughing increased as the number of coughs increased. Conclusions-Half of all coughs and wheezes in asthmatics are associated with acid reflux into the oesophagus. While an occasional coughing episode can lead to reflux, it is rather the reflux episode in the vast majority of instances that leads to cough. (Gut 2001;49:767-772)

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Section: Discussionmentioning

confidence: 99%

Temporal associations between coughing or wheezing and acid reflux in asthmatics

Avidan¹,

Sonnenberg²,

Schnell³

et al. 2000

Am J Gastroenterology

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“…A symptom was considered associated with an reflux events if it occurred within a 2-minute time window of its onset (7) . The symptom index (SI) is define as the number of reflux-associated symptoms/total number of symptoms during 24 hours multiply by100 and the symptom sensitivity index (SSI) as the number of reflux-associated symptoms/ total number of reflux events in 24 hours multiply by 100.…”

Section: Methodsmentioning

confidence: 99%

Combined 24-Hours Esophageal Ph Monitoring and Multichannel Intraluminal Impedance for Comparison of Gastroesophageal Reflux in Children With Typical Versus Atypical Symptoms of Gastroesophageal Reflux Disease

Dehghani

Taghavi

Javaherizadeh

et al. 2016

Arq. Gastroenterol.

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-Background -Gastroesophageal reflux disease is the most common esophageal disorder in pediatrics.Objective -The aim of this study was to compare reflux parameters of typical and atypical symptoms of gastroesophageal reflux disease using 24-hour esophageal pH monitoring and multichannel intraluminal impedance in pediatric population. Methods -In this prospective study, 43 patients aged less than 18 year with suspected gastroesophageal reflux disease were enrolled. The patients were divided into two groups based on the main presenting symptoms (typical versus atypical). Twenty four-hour pH monitoring and multichannel intraluminal impedance were performed in all the patients for comparing these two group regarding association of symptoms and reflux. Number of refluxes, pH related reflux, total reflux time, reflux more than 5 minutes, longest time of the reflux, lowest pH at reflux, reflux index were recorded and compared. Data comparison was done using SPSS.Results -The mean age of the patients was 5.7±3.4 years and 65.1% were male. Out of 43 patients 24 cases had typical symptoms and 19 had atypical symptoms. The mean reflux events detected by multichannel intraluminal impedance was more than mean reflux events detected by pH monitoring (308.4±115.8 vs 69.7±66.6) with P value of 0.037, which is statistically significant. The mean symptom index and symptom association probability were 35.01% ± 20.78% and 86.42% ± 25.79%, respectively in multichannel intraluminal impedance versus 12.73% ± 12.48% and 45.16% ± 42.29% in pH monitoring (P value <0.001). Number of acid reflux was 46.26±47.16 and 30.9±22.09 for atypical and typical symptoms respectively. The mean symptom index was 18.12% ± 13.101% and 8.30% ± 10.301% in atypical and typical symptoms respectively (P=0.034). Bolus clearance was longer in atypical symptoms compared typical symptoms(P<0.05). Conclusion -Symptom index was significantly higher in atypical symptoms compared to typical symptoms. Higher number of acid reflux was found in children with atypical symptoms of reflux. Longer duration of bolus clearance was found in group with atypical symptoms of reflux.

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“…The symptom index (SI) was calculated for each chest pain incident in relation to the acid reflux episodes. Chest pain was considered to be associated with reflux if it was preceded by a reflux episode within two minutes (13). A positive SI was defined as >50% of the symptoms being associated with pathological reflux (14).…”

Section: Methodsmentioning

confidence: 99%

Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

Liu

Chen

et al. 2013

Intern. Med.

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Objective To investigate the influence of acid reflux on chest pain and ischemic events and the effects of cardiac drugs on acid reflux in patients with coronary artery disease (CAD) and refractory chest pain. Methods Simultaneous 24-hour esophageal pH monitoring and 24-hour continuous electrocardiogram (ECG) (Holter) results were obtained for 64 patients. Ischemic events and cardiac drug prescriptions were compared between the patients with and without gastroesophageal reflux disease (GERD). Patients fulfilling the GERD criteria received 14-day therapy with omeprazole at a dose of 20 mg bid. The results of the 24-hour pH monitoring, Holter and the SF-36 questionnaire were compared before treatment and again after two weeks of therapy. Results GERD was identified in 38 (69%) patients, with 49% of all chest pain occurring in association with acid reflux. A higher incidence (p=0.033) and longer duration (p=0.040) of ischemic events were observed in the GERD (+) patients. More frequent combined use of cardiac drugs was found in the GERD (+) patients. However, fewer ischemic events and greater total SF-36 survey scores were noted after PPI therapy in the GERD (+) patients. Conclusion Acid reflux is common in patients with CAD and refractory chest pain. Refractory chest pain in patients with CAD can be partially noncardiac chest pain (NCCP) secondary to acid reflux. The combined use of common cardiac drugs may predispose or aggravate GERD. Short-term proton pump inhibitor (PPI) therapy not only restores a normal esophageal pH, but also significantly improves the general health-related quality of life (HRQL) of patients.

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What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data?

Cited by 132 publications

References 9 publications

Temporal associations between coughing or wheezing and acid reflux in asthmatics

Temporal associations between coughing or wheezing and acid reflux in asthmatics

Combined 24-Hours Esophageal Ph Monitoring and Multichannel Intraluminal Impedance for Comparison of Gastroesophageal Reflux in Children With Typical Versus Atypical Symptoms of Gastroesophageal Reflux Disease

Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

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