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

Abstract

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.

Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use

“…Therefore, of course, the appropriate indications of PPIs therapy should be confirmed as a first step when we decide the potential administration of PPIs. 153,154 When deciding when to administer any medicine, it is important to re-confirm that the beneficial effects will outweigh any potential adverse events. The beneficial therapeutic effects of PPIs for the treatment of GERD, gastroduodenal ulcers, and H. pylori eradication are quite clear, while their effects for symptomatic improvement in patients with functional dyspepsia and for patients with esophageal hypersensitivity are limited.…”

Is There a Role for pH Impedance Monitoring in Identifying Eosinophilic Esophagitis in Children with Esophageal Atresia?

“…It must be noted that this effect could be related to the presence of mucosal inflammation as well as to the increased AET values observed in this group. [19][20][21][22] Increased AET was indeed significantly related to EoE. This finding is of particular interest because it attests that these patients are at increased risk of having pathological pH-impedance investigations, thus, exposing them to the risk of being misdiagnosed of having GERD rather than having concomitant EoE.…”

Can Esophageal Baseline Impedance Predict Proton Pump Inhibitor Response in Gastroesophageal Reflux Disease?

“…This result shows a cut-off value of 0.73 μm in the intercellular space and can be used to distinguish the control group (sensitivity 78.3% and specificity 90%). 12 In addition, this study showed that DIS and acid exposure time negatively correlated with BI. Furthermore, the simple clinical interpretation that checking BI levels alone could predict the therapeutic effect of a PPI without performing invasive tissue examination was a meaningful finding.…”

“…In this study, they confirmed that BI level is lowest in ERD and that BI levels were low in both ERD and NERD, as previously reported. [4][5][6][7][8][9]12 In particular, in a comparison with the control group, the authors showed cut-off values for sensitivity and specificity of 55.4% and 100%, respectively, based on 1764 ohm.…”