Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group

Roman, Sabine; Gyawali, C. Prakash; Savarino, Edoardo; Yadlapati, Rena; Zerbib, Frank; Wu, Justin Che Yuen; Vela, Marcelo F.; Tutuian, Radu; Tatum, Roger P.; Sifrim, Daniel; Keller, Jutta; Fox, Mark; Pandolfino, John E.; Bredenoord, Albert J.

doi:10.1111/nmo.13067

Cited by 314 publications

(397 citation statements)

References 143 publications

(289 reference statements)

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“…1 An increase in frequency, duration and amount of reflux, and/or an inability to clear refluxed content can lead to gastroesophageal reflux disease (GERD). 1 An increase in frequency, duration and amount of reflux, and/or an inability to clear refluxed content can lead to gastroesophageal reflux disease (GERD).…”

Section: Introductionmentioning

confidence: 99%

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Rogers

Rengarajan

Ghisa

et al. 2019

Neurogastroenterology Motil

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Background Association between proportions of hypomotile swallows on esophageal high‐resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. Methods Clinical data, HRM, and ambulatory pH‐impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH‐impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100‐450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. Key Results Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤ .01) and MNBI (P ≤ .03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P < .05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤ .009), and ≥50% weak sequences did not (P = .14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P = .02), and >70% ineffective sequences trended strongly (P = .069); >70% ineffective sequences predicted abnormal MNBI (P = .046), and >70% fragmented sequences trended strongly (P = .076). Conclusions and Inferences Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.

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Section: Introductionmentioning

confidence: 99%

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Rogers

Rengarajan

Ghisa

et al. 2019

Neurogastroenterology Motil

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“…The question to be answered by the clinician is when and how to perform reflux monitoring (on or off PPI; pH-metry or pH-impedance), and finally led to the concept of unproven and proven GERD in the consensus statement [16].…”

Section: Definition Of Distinct Clinical Settings Of Unproven and Promentioning

confidence: 99%

“…Kandulski/Moleda/Müller-Schilling Visc Med 2018;34:97-100 98 in the field updated the recommendations regarding indications, interpretation, diagnosis, and classification of GERD subtypes [16,17]. One of the most important advances in clinical decision making and management is the differentiation of patients with unproven GERD and proven GERD in patients with endoscopic or physiological evidence of GERD, which directs esophageal reflux monitoring on or off PPI therapy.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Investigations of Gastroesophageal Reflux Disease: Who and When to Refer and for What Test

2018

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Background: Due to the high prevalence and incidence of patients with gastroesophageal reflux disease (GERD), the diagnostic workup of patients with symptoms of GERD needs to be balanced between empiric antisecretory therapy and further functional assessment including endoscopy and reflux monitoring. Methods: This article is based on a literature review (PubMed, Medline) using the terms ‘gastroesophageal reflux disease' or ‘GERD' and ‘diagnosis', ‘therapy', or ‘PPI' with special and critical analysis of the current ‘Porto' consensus report. Results and Conclusions: Further diagnostics are mandatory in case of alarm symptoms as well as atypical or persistent symptoms under adequate therapy with proton pump inhibitors (PPI). In general, the clinical situation needs to be clarified before sending the patients for reflux monitoring. The question is not only when and whom to test but also how to test: on or off PPI therapy, pH-metry, or combined pH-impedance analysis. These questions have been defined in a recent consensus report of an international panel of experts and are further discussed in this article.

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“…Studies have identified that one of the common clinical manifestations of atypical GERD is chronic cough [5]. There are reports of refractoriness when, in the treatment of GERD, the patient remains symptomatic even when using medication and this is very common in atypical GERD [4]. In some cases the treatment of this disease has a high cost and the patient may present side effects due to the treatment [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The most common symptom of GERD is heartburn, which, while rarely life-threatening, can greatly reduce a patient's quality of life by affecting daily activities, sleep and what they can eat [1,2]. A systematic review found the prevalence of GERD to be 10-20% of the Western world with a lower prevalence in Asia [3,4]. Typically, the diagnosis of GERD is based on heartburn and acid regurgitation; however, research findings suggest that extraesophageal signs and symptoms are frequent in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The Treatment of Chronic Cough by Osteopathy: A Case Study of a Patient with Refractory Gastroesophageal Reflux Disease

Andrade¹

2017

GHOA

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Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group

Abstract: The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled.

Cited by 314 publications

References 143 publications

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

Diagnostic Investigations of Gastroesophageal Reflux Disease: Who and When to Refer and for What Test

The Treatment of Chronic Cough by Osteopathy: A Case Study of a Patient with Refractory Gastroesophageal Reflux Disease

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