Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

Bortoli, Nicola de; Martinucci, Irene; Savarino, Edoardo; Tutuian, Radu; Frazzoni, Marzio; Piaggi, Paolo; Bertani, Lorenzo; Furnari, Manuele; Franchi, Riccardo; Russo, Salvatore; Bellini, Massimo; Savarino, Vincenzo; Marchi, Santino

doi:10.1016/j.cgh.2014.11.035

Cited by 125 publications

(150 citation statements)

References 32 publications

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“…Previous studies have reported similar conclusions. 23,26 This was supported by the result that the PPI effective group had more severe acid exposure. Because pathological acid reflux was not the only cause for DIS, it was not surprising to find that DIS had no impact on the efficacy of PPI treatment.…”

Section: Discussionsupporting

confidence: 72%

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Xie

Sifrim

et al. 2018

J Neurogastroenterol Motil

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Background/AimsEsophageal baseline impedance, which is decreased in gastroesophageal reflux disease (GERD) patients, is related to the severity of acid reflux and the integrity of the esophageal mucosa. The study aims to compare the baseline impedance and the dilated intercellular spaces (DIS) within patients with typical reflux symptoms and to evaluate the correlation of baseline impedance with DIS, esophageal acid exposure, as well as the efficacy of proton pump inhibitor (PPI) treatment. MethodsNinety-two patients and 10 healthy controls were included in the study. Erosive esophagitis (EE) was defined by esophageal mucosal erosion under upper endoscopy. Patients without mucosa erosion were divided into groups with pathologic acid reflux (nonerosive reflux disease [NERD]) or with hypersensitive esophagus. The biopsies of esophageal mucosa were taken 2-4 cm above the gastroesophageal junction Z-line during upper endoscopy for DIS measurement. All the patients received esomeprazole 20 mg twicedaily treatment for 8 weeks. The efficacy of esomeprazole was evaluated among all patients. ResultsThe intercellular spaces were dilated in both EE and NERD patients (P < 0.05). The value 0.73 mm could be used as the cut-off DIS value to distinguish patients from controls (area under the curve [AUC] = 0.849, P < 0.01). One thousand seven hundred sixty-four ohms could be used as the cut-off impedance values to distinguish patients from controls (AUC = 0.794, P < 0.01). The baseline impedance was decreased in both EE patients and NERD patients, and negatively correlated to the acid exposure time (r = -0.527, P < 0.05). There was a weak correlation between DIS and baseline impedance (r = -0.230, P < 0.05). "Baseline impedance > 1764 Ω" was an independent predictor for PPI failure (OR, 11.9; 95% CI, 2.4-58.9; P < 0.01). ConclusionsThe DIS and decreased baseline impedance was observed in patients with mucosa erosion or pathological acid reflux. The baseline impedance reflected the mucosal integrity, it was more sensitive to esophageal acid exposure. Patients with high impedance might not benefit from the PPI treatment.

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Section: Discussionsupporting

confidence: 72%

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Xie

Sifrim

et al. 2018

J Neurogastroenterol Motil

View full text Add to dashboard Cite

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“…5,6 However, recently, novel impedance parameters, manually calculated, evaluating esophageal chemical clearance, the post-reflux swallow-induced peristaltic wave (PSPW) index, and mucosal integrity, the baseline impedance, have been proposed. [7][8][9] The PSPW index is suitable for valuation off as well as on proton pump inhibitor therapy: lower values have been found in erosive than in NERD, in both significantly lower than in FH. 7 Baseline impedance values were found strictly associated with epithelial structural abnormalities and are inversely correlated with AET.…”

Section: To the Editormentioning

confidence: 99%

A More In-depth Evaluation of Impedance-pH Could Assist in Distinguishing Reflux-related From Reflux-unrelated Heartburn

Bortoli

Furnari

Tolone

et al. 2015

J Neurogastroenterol Motil

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“…Therefore, BILs are considered as an indicator of esophageal mucosal integrity. [25][26][27][28] There are, however, limited studies comparing the main manometric features, motility patterns, and reflux parameters in RGERD. Our study explored the use of MII-pH monitoring and HRM to investigate Chinese patients with refractory gastroesophageal reflux symptoms off PPI therapy.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Body Motility for Clinical Assessment in Patients with Refractory Gastroesophageal Reflux Symptoms

Jiang

Wang

et al. 2017

J Neurogastroenterol Motil

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Background/AimsLittle data exists about esophageal body dysmotility and reflux patterns in refractory gastroesophageal reflux disease (RGERD) patients off therapy. We aimed to evaluate effects of esophageal body dysmotility on reflux parameters in RGERD patients by combining impedance-pH monitoring and high-resolution manometry (HRM). MethodsWe retrospectively reviewed the impedance-pH data and HRM metrics in patients with refractory gastroesophageal reflux symptoms. Impedance-pH monitoring and manometric data were compared between 2 groups: ineffective esophageal motility (IEM) and normal motility. ResultsForty-eight patients (30 males, mean age 54.5 years) were included (16 erosive esophagitis, 24 non-erosive reflux disease, and 8 functional heartburn), amongst which 24 subjects showed IEM, and others had normal motility. Number of patients who had a large break in the IEM group was significantly higher than that of normal motility patients. IEM group had more patients with weakly acid reflux and long term acid reflux than the normal group (P = 0.008, P = 0.004, respectively). There was no statistical difference in baseine impedance levels from z4 to z6 between the 2 groups (2911 ± 1160 Ω vs 3604 ± 1232 Ω, 2766 ± 1254 Ω vs 3752 ± 1439 Ω, 2349 ± 1131 Ω vs 3038 ± 1254 Ω, all P > 0.05). Acid exposure time, numbers of long term acid reflux and weakly acid reflux showed strong negative correlation with esophageal body motility and/or lower esophageal sphincter function. ConclusionsIEM was associated more with acid exposure, abnormal weakly acid reflux, and long term acid reflux in RGERD patients. These data suggested the role of esophageal body dysmotility in the pathophysiological mechanisms of RGERD patients.

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Association Between Baseline Impedance Values and Response Proton Pump Inhibitors in Patients With Heartburn

Cited by 125 publications

References 32 publications

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment

A More In-depth Evaluation of Impedance-pH Could Assist in Distinguishing Reflux-related From Reflux-unrelated Heartburn

Esophageal Body Motility for Clinical Assessment in Patients with Refractory Gastroesophageal Reflux Symptoms

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