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The utility of intraluminal impedance in patients with gastroesophageal reflux disease-like symptoms but normal endoscopy and 24-hour pH testing.
Clin Gastroenterol Hepatol 2008; 6(8):880-5; quiz 836CG

Abstract

BACKGROUND & AIMS

Fifty percent of patients with gastroesophageal reflux disease-like symptoms and negative endoscopy have negative 24-hour pH testing, suggesting that symptoms are not caused by abnormal esophageal acid exposure. Multichannel intraluminal impedance (MII)-24-hour pH allows the recognition of major acid, minor acid, nonacid, and gas reflux. Recorded symptoms can be correlated with all reflux events (eg, acid, minor acid, nonacid, and gas) and a symptom score can be generated. We aimed to determine whether the Symptom Index (SI) obtained using MII-pH identified an association of symptoms with reflux events in nonclassic acid-reflux disease.

METHODS

Thirty-seven patients with heartburn or regurgitation, negative endoscopy, and 24-hour pH were enlisted. Acid suppression was stopped, a 24-hour MII-pH test was performed, and an SI was calculated for major acid reflux alone and for all reflux episodes including major, minor, and nonacid. On this basis patients were divided into 4 groups: (1) standard acid reflux: positive standard pH test; (2) acid sensitive: positive SI for major acid but normal pH test; (3) general reflux: positive SI for major, minor, and nonacid combined, but not for major acid alone; and (4) no reflux: negative SI.

RESULTS

Six patients (16%) had standard reflux, 10 patients (27%) had acid-sensitive esophagus, 14 patients (38%) had general reflux, and 7 patients (19%) had a negative SI.

CONCLUSIONS

Fifty-seven percent of patients received a diagnosis unachievable with standard pH testing (38% had symptoms associated with general reflux and 19% had no reflux symptom associations). These findings support a potential role for MII-pH testing in this difficult group.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. mkline@usc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18424190

Citation

Kline, Michael M., et al. "The Utility of Intraluminal Impedance in Patients With Gastroesophageal Reflux Disease-like Symptoms but Normal Endoscopy and 24-hour pH Testing." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 6, no. 8, 2008, pp. 880-5; quiz 836.
Kline MM, Ewing M, Simpson N, et al. The utility of intraluminal impedance in patients with gastroesophageal reflux disease-like symptoms but normal endoscopy and 24-hour pH testing. Clin Gastroenterol Hepatol. 2008;6(8):880-5; quiz 836.
Kline, M. M., Ewing, M., Simpson, N., & Laine, L. (2008). The utility of intraluminal impedance in patients with gastroesophageal reflux disease-like symptoms but normal endoscopy and 24-hour pH testing. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 6(8), pp. 880-5; quiz 836. doi:10.1016/j.cgh.2008.01.016.
Kline MM, et al. The Utility of Intraluminal Impedance in Patients With Gastroesophageal Reflux Disease-like Symptoms but Normal Endoscopy and 24-hour pH Testing. Clin Gastroenterol Hepatol. 2008;6(8):880-5; quiz 836. PubMed PMID: 18424190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The utility of intraluminal impedance in patients with gastroesophageal reflux disease-like symptoms but normal endoscopy and 24-hour pH testing. AU - Kline,Michael M, AU - Ewing,Mark, AU - Simpson,Nicole, AU - Laine,Loren, Y1 - 2008/04/18/ PY - 2007/10/03/received PY - 2007/12/28/revised PY - 2008/01/28/accepted PY - 2008/4/22/pubmed PY - 2008/10/24/medline PY - 2008/4/22/entrez SP - 880-5; quiz 836 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 6 IS - 8 N2 - BACKGROUND & AIMS: Fifty percent of patients with gastroesophageal reflux disease-like symptoms and negative endoscopy have negative 24-hour pH testing, suggesting that symptoms are not caused by abnormal esophageal acid exposure. Multichannel intraluminal impedance (MII)-24-hour pH allows the recognition of major acid, minor acid, nonacid, and gas reflux. Recorded symptoms can be correlated with all reflux events (eg, acid, minor acid, nonacid, and gas) and a symptom score can be generated. We aimed to determine whether the Symptom Index (SI) obtained using MII-pH identified an association of symptoms with reflux events in nonclassic acid-reflux disease. METHODS: Thirty-seven patients with heartburn or regurgitation, negative endoscopy, and 24-hour pH were enlisted. Acid suppression was stopped, a 24-hour MII-pH test was performed, and an SI was calculated for major acid reflux alone and for all reflux episodes including major, minor, and nonacid. On this basis patients were divided into 4 groups: (1) standard acid reflux: positive standard pH test; (2) acid sensitive: positive SI for major acid but normal pH test; (3) general reflux: positive SI for major, minor, and nonacid combined, but not for major acid alone; and (4) no reflux: negative SI. RESULTS: Six patients (16%) had standard reflux, 10 patients (27%) had acid-sensitive esophagus, 14 patients (38%) had general reflux, and 7 patients (19%) had a negative SI. CONCLUSIONS: Fifty-seven percent of patients received a diagnosis unachievable with standard pH testing (38% had symptoms associated with general reflux and 19% had no reflux symptom associations). These findings support a potential role for MII-pH testing in this difficult group. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/18424190/The_utility_of_intraluminal_impedance_in_patients_with_gastroesophageal_reflux_disease_like_symptoms_but_normal_endoscopy_and_24_hour_pH_testing_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(08)00129-8 DB - PRIME DP - Unbound Medicine ER -