Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes

Domingues, Gerson; Moraes-Filho, Joaquim Prado P; Domingues, Aline Gonçalves Leite

doi:10.1590/s0004-28032011000100006

Cited by 12 publications

(14 citation statements)

References 30 publications

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“…Foreign body sensation in this study was the most common symptom reported by patients, similar results were showed in some studies based on Bravo pH capsule system [5,19]. Endoscopic removal should be performed when patients have serious symptoms for more than 48 hours [20] or capsule was still attached for more than two weeks.…”

Section: Discussionsupporting

confidence: 85%

Clinical utility and tolerability of JSPH-1 wireless esophageal pH monitoring system

Liu

Xin

2013

BMC Gastroenterol

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BackgroundWireless esophageal pH monitoring system is an important approach for diagnosis of gastroesophageal reflux disease (GERD), the aim of this study is to test the tolerability and utility of the first wireless esophageal pH monitoring system made in China, and evaluate whether it is feasible for clinical application to diagnose GERD.MethodsThirty patients from Department of Gastroenterology of The First Affiliated Hospital of Chongqing Medical University who were suspected GERD underwent JSPH-1 pH capsule. The capsule was placed 5 cm proximal to the squamocolumnar junction (SCJ) by endoscopic determination, the data was recorded consecutively for 48 hours. Then all pH data was downloaded to a computer for analysis. The discomforts reported by patients were recorded.Results30 patients were placed JSPH-1 pH capsule successfully and completed 24-hour data recording, 29 patients completed 48-hour data recording. One patient complained of chest pain and required endoscopic removal. No complications and interference of daily activities were reported during data monitoring or follow-up period. 48-hour pH monitoring detected 15 patients of abnormal acid exposure, on day1 detected 9 patients, the difference had statistical significance (P<0.01). Positive symptom index (SI) was identified in 3 patients with normal pH data in both 24-hours. In total, 48-hour monitoring increased diagnosis of GERD in 9 patients.Conclusion48-hour esophageal pH monitoring with JSPH-1 wireless pH monitoring system is safe, well tolerated and effective. It can be feasible for clinical application to diagnose GERD.

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Section: Discussionsupporting

confidence: 85%

Clinical utility and tolerability of JSPH-1 wireless esophageal pH monitoring system

Liu

Xin

2013

BMC Gastroenterol

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“…However this increment of GER had a minimal effect on the overall interpretation of the BRAVO study. The increase in diagnostic yield of GER and symptom correlation by adding the second day has been well demonstrated in adult studies, (22, 23) however the potential effect of anesthesia on the diagnostic yield has not been thoroughly evaluated. We observed that only 1.3% of children with abnormal acid exposure using 6% cut off on the worse day would have been reclassified as being normal if we exclude the 1 st hour of the study and 2% if we exclude the 1 st 2 hours.…”

Section: Discussionmentioning

confidence: 99%

Effect of anesthesia on gastroesophageal reflux in children: a study using BRAVO wireless pH study measurements

Rodriguez

Morley-Fletcher

Souza

et al. 2015

Neurogastroenterology Motil

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Background Adult studies suggest conscious sedation increases gastroesophageal reflux (GER), but the role of anesthesia on GER in children is unclear. Our aim was to study the anesthesia effects on GER and pH study interpretation in children. Methods Children undergoing BRAVO wireless pH capsule placement under anesthesia and study duration >36 hours were included. We evaluated the pH parameters (number of reflux episodes >5 minutes, duration of longest reflux episode, time pH <4 and fraction time pH <4) at 1, 2, 6-hour and total study duration blocks using 2 cut-off values (5.3% and 6%) for the worst day, average of both days and 1st day alone. We compared time blocks to evaluate the effect of anesthesia on GER and the proportions of studies changing interpretation after excluding the 1st hour and 1st 2-hour blocks to evaluate anesthesia effect on study interpretation. Results A total of 150 children were included. We found a significant increase on the pH parameters in the 1st hour compared to subsequent block times suggesting an effect of anesthesia on GER. We found no significant change in the proportion of studies interpreted as normal vs. abnormal, however, excluding the initial 2 hours of the study would change the study interpretation from abnormal to normal in up to 5% of patients. Conclusions We found an effect of anesthesia increasing the GER parameters mainly in the 1st hour and up to the first 6 hours of the study that may result in a change in the study interpretation.

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“…The 24-hour pH-metry and, when appropriate, the pHmetry-impedance should be performed, considering that the observation time of 24 hours for the pH-metry might possibly be not enough to characterize acid reflux (8) .…”

Section: Discussionmentioning

confidence: 99%

“…As such, before attributing the reflux to a nonacid component, it should be remembered that these patients may really have acid reflux that was not characterized by the conventional 24-hour pH-metry test. The patient may present normal findings one day and abnormal findings the next day: 25% of the cases monitored by a telemetric capsule ("Bravo" system) that were previously considered normal by conventional 24-hour pH-metry test, when studied for 48 hours showed pathological patterns of acid esophageal reflux (8) . Therefore, the ideal condition would be to test the reflux with the telemetric capsule for 48 hours, which is not possible in an everyday situation.…”

Section: Prolonged Ph-metrymentioning

confidence: 99%

Refractory gastroesophageal reflux disease

Moraes-Filho

2012

Arq. Gastroenterol.

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-Context -Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. Results -In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. Conclusions -The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis. HEADINGS -Gastroesophageal reflux, drug therapy. Proton pump inhibitors.

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Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes

Cited by 12 publications

References 30 publications

Clinical utility and tolerability of JSPH-1 wireless esophageal pH monitoring system

Clinical utility and tolerability of JSPH-1 wireless esophageal pH monitoring system

Effect of anesthesia on gastroesophageal reflux in children: a study using BRAVO wireless pH study measurements

Refractory gastroesophageal reflux disease

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