Gastroesophageal Reflux in Infants: Evaluation of a New Intraluminal Impedance Technique

Skopnik, H.; Silny, Jiri; Heiber, Oliver; Schulz, Jörn; Rau, G.; Heimann, G.

doi:10.1097/00005176-199612000-00014

Cited by 149 publications

(151 citation statements)

References 23 publications

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“…The combined impedance and pH catheter technique can record all types of reflux episodes, i.e., air, liquid, acid, and neutral (16,18,19,(22)(23)(24)(25). The technique is based on the measurement of electrical impedance between closely spaced electrodes positioned in the esophagus.…”

mentioning

confidence: 99%

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Tipnis

Liu²,

Puckett³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

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Tipnis, Neelesh A., Jianmin Liu, James L. Puckett, and Ravinder K. Mittal. Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging. Am J Physiol Gastrointest Liver Physiol 290: G1149-G1156, 2006. First published January 26, 2006 doi:10.1152/ajpgi.00361.2005.-An increase in intraesophageal pressure during transient lower esophageal sphincter (LES) relaxation [referred to as common cavity (CC) pressure] is thought to be a marker of gastroesophageal reflux (GER). Multiluminal impedance (MII) measurement is a sensitive marker of reflux entry into the esophagus during GER. We recorded GER using esophageal pressure, pH, impedance, and intraluminal ultrasound (US) images to understand the genesis of the esophageal CC pressure. Nine normal subjects underwent simultaneous MII/pH/pressure and US image recording of the esophagus for 2 h following a standardized meal. MII and pressure transducers were located at 5 and 15 cm above the LES. The US transducer and pH sensors were also placed at 5 cm above the LES. Refluxate entry into the esophagus by MII criteria was determined relative to the onset of CC pressure wave. Esophageal lumen cross-sectional area (CSA) and muscle CSA during GER were determined from the US images. Eighty liquid GER episodes identified using MII criteria, of which 55 were clearly associated with CC pressure waves, were analyzed. The GER reached 15 cm above LES in 49 of 55 (89%) by MII criteria, but the CC pressure wave was observed at 5 and 15 cm during all episodes. The propagation of the CC pressure wave was simultaneous between 5 and 15 cm during 49 of 55 (89%) of the GER episodes, but reflux entry by MII criteria was retrograde during 53 of 55 (96%) of these episodes. During 5 airreflux episodes, MII showed a simultaneous reflux entry between the 5-and 15-cm site, however, the CC pressure preceded reflux entry during all of these episodes. There was poor correlation between the luminal CSA and the magnitude of CC pressure (R2 ϭ 0.144). US images revealed a close temporal correlation between CC pressure and the increase in esophageal muscle thickness and muscle CSA (markers of longitudinal muscle contraction). Disassociation between CC pressure and MII-detected reflux suggests that the onset of CC pressure is not due to GER. We speculate that longitudinal muscle contraction plays an important role in the genesis of CC pressure.

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confidence: 99%

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Tipnis

Liu²,

Puckett³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…14 Impedance has been proposed as a non-radiological tool for studying oesophageal volume clearance after reflux 15 but specific validation studies are not available.…”

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Relevance of ineffective oesophageal motility during oesophageal acid clearance

Simrén

Silny

Holloway

et al. 2003

Gut

216

185

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Background: Oesophageal clearance of acid reflux consists of an initial volume clearance followed by neutralisation of the acidified mucosa by swallowed saliva (chemical clearance). Ineffective oesophageal motility (IOM), a frequent finding in patients with gastro-oesophageal reflux disease (GORD), has been claimed to underlie prolonged acid clearance by affecting oesophageal emptying and saliva transport. Intraluminal impedance allows non-radiological monitoring of movement of oesophageal liquids. Aims: To evaluate the relevance of IOM during oesophageal volume and chemical clearance using combined pH impedance measurements. Subjects: Impedance was validated with fluoroscopy to study volume clearance in three healthy subjects. Acid clearance tests were performed in 10 healthy subjects in the upright and supine positions, before and after oesophageal peristaltic disruption with sildenafil 50 mg. Methods: After instillation of an acid bolus, simultaneous manometry, pH, and impedance were used to study oesophageal motility, chemical clearance, and volume clearance, respectively. Results: Impedance allowed assessment of volume clearance accurately, showing a strong correlation with fluoroscopy (r 2 =0.89). Sildenafil provoked a graded impairment in oesophageal motility in healthy subjects without affecting saliva secretion. In the upright position, volume clearance was slightly prolonged only with severe IOM (>80% abnormal peristaltic sequences). In the supine position, severe IOM significantly prolonged chemical and volume clearance. Moderate IOM (30-80% abnormal peristalsis) had no effect. With normal peristalsis and moderate IOM, clearance times were similar in the upright and supine positions. Severe IOM however had a greater impact on clearance in the supine than in the upright position. Conclusion: Ineffective oesophageal motility has little effect on oesophageal clearance during upright acid reflux. With supine reflux, only severe IOM is associated with prolonged oesophageal clearance.

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“…The commonly used tests such as videofluoroscopic swallowing studies and radionuclide scintigraphy have been found to be quite insensitive (5). Gastroesophageal reflux can be diagnosed by using these techniques and also by 24-h esophageal pH monitoring (17), echo-Doppler ultrasound (18), and esophageal intraluminal impedance (19). However, these tests are of no use in diagnosing aspiration.…”

Section: Discussionmentioning

confidence: 99%

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

et al. 2005

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Gastroesophageal Reflux in Infants: Evaluation of a New Intraluminal Impedance Technique

Cited by 149 publications

References 23 publications

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Common cavity pressure during gastroesophageal reflux: reassessment using simultaneous pressure, impedance, and ultrasound imaging

Relevance of ineffective oesophageal motility during oesophageal acid clearance

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

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