Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring

Kawamura, Osamu; Kohata, Yukie; Kawami, Noriyuki; Iida, Hiroshi; Kawada, Akira; Hosaka, Hiroko; Sugiyama, Yasuyuki; Kuribayashi, Shiko; Fujiwara, Yasuhiro; Iwakiri, Katsuhiko; Inamori, Masahiko; Kusano, Motoyasu; Hongo, M

doi:10.5056/jnm15195

Cited by 12 publications

(22 citation statements)

References 22 publications

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“…Impedance monitoring was initially believed to provide improved accuracy of reflux evidence, but impedancebased parameters have generally not been predictive of reflux treatment out comes 81,82 . Although infrequent reflux episodes (<40) could indicate physiological reflux, there is variability in the association of reflux episodes with oesophageal reflux burden [83][84][85][86][87][88] . High numbers of episodes (>80) could suggest pathological reflux burden, whereas border line values (40-80) require alternate reflux evidence.…”

Section: Symptom Reflux Associationmentioning

confidence: 99%

Advances in the physiological assessment and diagnosis of GERD

Savarino

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

184

156

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GERD is a common condition worldwide. Key mechanisms of disease include abnormal oesophagogastric junction structure and function, and impaired oesophageal clearance. A therapeutic trial of acid-suppressive PPI therapy is often the initial management, with endoscopy performed in the setting of alarm symptoms and to exclude other conditions. If symptoms persist and endoscopy does not reveal evidence of GERD, oesophageal function tests are performed, including oesophageal manometry and ambulatory reflux monitoring. However, reflux episodes can be physiological, and some findings on endoscopy and manometry can be encountered in asymptomatic individuals without GERD symptoms. The diagnosis of GERD on the basis of functional oesophageal testing has been previously reported, but no updated expert recommendations on indications and the interpretation of oesophageal function testing in GERD has been made since the Porto consensus over a decade ago. In this Consensus Statement, we aim to describe modern oesophageal physiological tests and their analysis with an emphasis on establishing indications and consensus on interpretation parameters of oesophageal function testing for the evaluation of GERD in clinical practice. This document reflects the collective conclusions of the international GERD working group, incorporating existing data with expert consensus opinion.

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Section: Symptom Reflux Associationmentioning

confidence: 99%

Advances in the physiological assessment and diagnosis of GERD

Savarino

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

184

156

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“…The definition and inclusion criteria of healthy individuals varied substantially among studies, an important source of heterogeneity. Some studies based their inclusion criteria on the presence or absence of typical esophageal symptoms of GERD, [10][11][12]15,20,25 which are, in practice, often absent in patients presenting for the evaluation of LPR. 1,32 In other words, some LPR patients may present with primarily laryngeal symptoms alone, with little to no esophageal GERD symptoms, and they may, consequently, be misclassified as healthy controls in studies that used esophageal symptoms as inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][14][15][16]20 The composition of reflux events, including gas, liquid, and mixed compositions, was clearly provided/defined in 10 studies. [10][11][12][14][15][16][17]20,21,23 Overall, comprehensive information inclusive of clear definitions of reflux events, acidity of episodes, and composition of PRE/HRE was fully available in 3 studies. [14][15][16] Device and Ambulatory Reflux Monitoring System…”

Section: Study Characteristics and Level Of Evidencementioning

confidence: 99%

Normative Ambulatory Reflux Monitoring Metrics for Laryngopharyngeal Reflux: A Systematic Review of 720 Healthy Individuals

Lechien

Chan

Akst³

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To review the normative data for acid, weakly acid, and nonacid proximal esophageal (PRE) and hypopharyngeal reflux (HRE) events in diagnosing laryngopharyngeal reflux (LPR) using ambulatory reflux monitoring. Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A literature search was conducted about the normative data for PRE and HRE on multichannel intraluminal impedance–pH monitoring (MII-pH), hypopharyngeal-esophageal MII-pH (HEMII-pH), or oropharyngeal pH monitoring using PICOTS (population, intervention, comparison, outcome, timing, and setting) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statements. Outcomes reviewed included device characteristics, impedance/pH sensor placements, study duration, number/average and percentiles of PRE or HRE occurrence, and the event characteristics (pH, composition, and position). Results Of 154 identified studies, 18 met criteria for analysis, including 720 healthy individuals. HEMII-pH, MII-pH, and oropharyngeal pH monitoring were used in 7, 6, and 5 studies, respectively. The definition and inclusion/exclusion criteria of healthy individuals varied substantially across studies, with 6 studies considering only digestive symptoms to exclude potential LPR patients. Substantial heterogeneity across studies was noted, including impedance/pH sensor placements/configurations and definitions of composition (liquid, gas, mixed) and type (acid, weakly acid, nonacid) of PRE/HRE. The 95th percentile thresholds were 10 to 73 events for PRE, 0 to 10 events for HRE on HEMII-pH, and 40 to 128 for events with pH <6.0 on oropharyngeal pH monitoring. Most HREs were nonacid and occurred upright. The mean HRE among healthy individuals was 1. Conclusion The low number of studies and the heterogeneity in inclusion criteria, definitions, and characterization of PRE and HRE limit the establishment of consensual normative criteria for LPR on ambulatory reflux monitoring. Future large multicenter studies are needed.

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“…6 To determine the range of normal values for Asians, a metaanalysis was performed based on the AET (%) of asymptomatic subjects presented in 19 Asian studies (Supplementary Table 3). [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107] As a result of the analysis, the upper normal limit of AET calculated through meta-analysis was 3.2% (95% CI, 2.70-3.90%) (Supplementary Fig. 9).…”

Section: Twenty-four-hour Ambulatory Ph-impedance Monitoring For Gastroesophageal Reflux Diseasementioning

confidence: 99%

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

Jung

Tae

Song

et al. 2021

J Neurogastroenterol Motil

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Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

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Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring

Cited by 12 publications

References 22 publications

Advances in the physiological assessment and diagnosis of GERD

Advances in the physiological assessment and diagnosis of GERD

Normative Ambulatory Reflux Monitoring Metrics for Laryngopharyngeal Reflux: A Systematic Review of 720 Healthy Individuals

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

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