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Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux.
Clin Gastroenterol Hepatol 2007; 5(2):172-7CG

Abstract

BACKGROUND & AIMS

Twenty-four-hour multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring detects reflux episodes at all pH levels, including acid reflux and weakly acidic reflux (WAR). The aim of this study was to assess the accuracy of pH monitoring alone in detecting acid reflux and WAR compared with MII-pH.

METHODS

For the detection of acid reflux: 60 consecutive MII-pH studies of patients off acid suppression were included. All studies initially were read by exclusively analyzing pH tracing for acid reflux episodes. Subsequently, all studies were blindly read again analyzing MII-pH-detected acid reflux episodes (pH decrease of <4 and MII-detected reflux). For the detection of weakly acidic reflux 40 MII-pH studies were included. Each study initially was read by identifying WAR on the pH tracing. Subsequently, studies were re-analyzed using MII tracings, classifying MII-detected reflux episodes into acid, WAR, or nonacid reflux.

RESULTS

For the detection of acid reflux the pH alone compared with MII-pH yielded a specificity of 68%, 67%, and 58%, respectively, for either abnormal percentage time of pH less than 4, positive symptom index, or both. The percentage time that the pH was less than 4 was significantly higher using pH alone compared with MII-pH. Eighty-one percent of acid gastroesophageal reflux episodes exclusively detected by pH were associated with MII-detected swallow. For the detection of WAR compared with MII, pH alone had a sensitivity of only 28%. Eighty-three percent of WAR episodes detected by pH were not associated with MII-detected reflux.

CONCLUSIONS

The use of pH alone for the detection of acid reflux is very sensitive but lacks specificity compared with MII-pH. pH alone may overdiagnose abnormal acid reflux in up to 22% of tested patients. Also, the use of pH for the detection of WAR has poor sensitivity.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA. hila@uhs.netNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17296528

Citation

Hila, Amine, et al. "Combined Multichannel Intraluminal Impedance and pH Esophageal Testing Compared to pH Alone for Diagnosing Both Acid and Weakly Acidic Gastroesophageal Reflux." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 5, no. 2, 2007, pp. 172-7.
Hila A, Agrawal A, Castell DO. Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clin Gastroenterol Hepatol. 2007;5(2):172-7.
Hila, A., Agrawal, A., & Castell, D. O. (2007). Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 5(2), pp. 172-7.
Hila A, Agrawal A, Castell DO. Combined Multichannel Intraluminal Impedance and pH Esophageal Testing Compared to pH Alone for Diagnosing Both Acid and Weakly Acidic Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2007;5(2):172-7. PubMed PMID: 17296528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. AU - Hila,Amine, AU - Agrawal,Amit, AU - Castell,Donald O, PY - 2007/2/14/pubmed PY - 2007/3/28/medline PY - 2007/2/14/entrez SP - 172 EP - 7 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 5 IS - 2 N2 - BACKGROUND & AIMS: Twenty-four-hour multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring detects reflux episodes at all pH levels, including acid reflux and weakly acidic reflux (WAR). The aim of this study was to assess the accuracy of pH monitoring alone in detecting acid reflux and WAR compared with MII-pH. METHODS: For the detection of acid reflux: 60 consecutive MII-pH studies of patients off acid suppression were included. All studies initially were read by exclusively analyzing pH tracing for acid reflux episodes. Subsequently, all studies were blindly read again analyzing MII-pH-detected acid reflux episodes (pH decrease of <4 and MII-detected reflux). For the detection of weakly acidic reflux 40 MII-pH studies were included. Each study initially was read by identifying WAR on the pH tracing. Subsequently, studies were re-analyzed using MII tracings, classifying MII-detected reflux episodes into acid, WAR, or nonacid reflux. RESULTS: For the detection of acid reflux the pH alone compared with MII-pH yielded a specificity of 68%, 67%, and 58%, respectively, for either abnormal percentage time of pH less than 4, positive symptom index, or both. The percentage time that the pH was less than 4 was significantly higher using pH alone compared with MII-pH. Eighty-one percent of acid gastroesophageal reflux episodes exclusively detected by pH were associated with MII-detected swallow. For the detection of WAR compared with MII, pH alone had a sensitivity of only 28%. Eighty-three percent of WAR episodes detected by pH were not associated with MII-detected reflux. CONCLUSIONS: The use of pH alone for the detection of acid reflux is very sensitive but lacks specificity compared with MII-pH. pH alone may overdiagnose abnormal acid reflux in up to 22% of tested patients. Also, the use of pH for the detection of WAR has poor sensitivity. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/17296528/Combined_multichannel_intraluminal_impedance_and_pH_esophageal_testing_compared_to_pH_alone_for_diagnosing_both_acid_and_weakly_acidic_gastroesophageal_reflux_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(06)01193-1 DB - PRIME DP - Unbound Medicine ER -