Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring

Nakagawa, Kenichiro; Sawada, Akinari; Hoshikawa, Yoshimasa; Nikaki, Kornilia; Sonmez, Shirley; Woodland, Philip; Yazaki, Etsuro; Sifrim, Daniel

doi:10.14309/ajg.0000000000000295

Cited by 40 publications

(40 citation statements)

References 36 publications

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“…We analyzed the MII-pH tracings using the dedicated softwares (Diversatek Healthcare or Jinshan Science and Technology) and visual editing based on our standard protocol. 1,19,20 Mean nocturnal baseline impedance…”

Section: Multichannel Intraluminal Impedance Ph-monitoring Protocolmentioning

confidence: 99%

Measurement of Esophageal Nocturnal Baseline Impedance: A Simplified Method

Hoshikawa

Sonmez

Nikaki

et al. 2020

J Neurogastroenterol Motil

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Background/Aims Mean nocturnal baseline impedance (MNBI) during multichannel intraluminal impedance pH-monitoring (MII-pH) reflects the status of esophageal mucosal integrity. MNBI is suggested as an adjunctive method to distinguish patients with true gastroesophageal reflux disease (GERD) from functional heartburn (FH) and might predict outcomes for anti-reflux treatment. However, current methodology for calculation of MNBI is time-consuming and subject to operator-dependent selection bias. We aim to simplify and provide a more objective method to calculate MNBI. Methods We retrospectively analyzed 100 MII-pH tracings from 20 patients with erosive reflux disease, 20 with non-erosive reflux disease (NERD), 20 with reflux hypersensitivity, 20 with functional heartburn (FH), and 20 healthy asymptomatic volunteers. We compared the current "conventional" MNBI analysis with our "simple" MNBI analysis measured by selecting the whole supine period using the impedance average calculation function in the MII-pH software. Results Absolute values were very similar and there was a strong correlation between conventional and simple MNBI values in the most distal channel in all groups (r ≥ 0.8, P < 0.001) including patients with increased supine acid reflux. Distal esophageal simple MNBI negatively correlated with acid exposure time (r =-0.695, P < 0.001). Patients with erosive reflux disease and NERD had lower simple MNBI values in the most distal channel compared to other groups (P < 0.001). With a cutoff value of 1785 ohms, simple MNBI can discriminate patients with GERD from those with reflux hypersensitivity and FH (sensitivity 80.0% and specificity 89.7%). Conclusion Simple MNBI analysis provides very similar values and has an excellent correlation with conventional MNBI analysis.

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Section: Multichannel Intraluminal Impedance Ph-monitoring Protocolmentioning

confidence: 99%

Measurement of Esophageal Nocturnal Baseline Impedance: A Simplified Method

Hoshikawa

Sonmez

Nikaki

et al. 2020

J Neurogastroenterol Motil

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“…The number of rumination episodes was reported by patients (not by objective testing). In our previous report, 37 24‐hour impedance pH‐metry showed that patients with RS reported their symptoms quite accurately. This study aimed to understand pathophysiological mechanisms in patients with rumination but does not include long term evaluation of the effect of DiaB treatment on vagal tone and rumination events.…”

Section: Discussionmentioning

confidence: 89%

“…14,15,17,32,33 The number of rumination episodes was reported by patients (not by objective testing). In our previous report, 37 24-hour impedance pH-metry showed that patients with RS reported their symptoms…”

Section: Discussionmentioning

confidence: 89%

Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing

Hoshikawa

Fitzke

Sweis

et al. 2020

Neurogastroenterology Motil

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Background: Pathophysiology of rumination syndrome (RS) is not well understood. Treatment with diaphragmatic breathing improves rumination syndrome. The aim of the study was to characterize vagal tone in patients with rumination syndrome during and after meals and during diaphragmatic breathing. Methods: We prospectively recruited 10 healthy volunteers (HV) and 10 patients with RS. Subjects underwent measurement of vagal tone using heart rate variability. Vagal tone was measured during baseline, test meal and intervention (diaphragmatic (DiaB), slow deep (SlowDB), and normal breathing). Vagal tone was assessed using mean values of root mean square of successive differences (RMSSD), and area under curves (AUC) were calculated for each period. We compared baseline RMSSD, the AUC and meal-induced discomfort scores between HV and RS. Furthermore, we assessed the effect of respiratory exercises on symptom scores, and number of rumination episodes. Key Results: There was no significant difference in baseline vagal tone between HV and RS. During the postprandial period, there was a trend to higher vagal tone in RS, but not significantly (P > .2 for all). RS had the higher total symptom scores than HV (P < .011). In RS, only DiaB decreased the number of rumination episodes during the intervention period (P = .028), while both DiaB and SlowDB increased vagal tone (P < .05 for both). The symptom scores with the 3 breathing exercises showed very similar trends. Conclusions and inferences: Patients with RS do not have decreased vagal tone related to meals. DiaB reduced number of rumination events by a mechanism not related to changes in vagal tone. K E Y W O R D S autonomic nervous system, breathing exercises, gastro-esophageal reflux disease, gastrointestinal diseases, rumination syndrome How to cite this article: Hoshikawa Y, Fitzke H, Sweis R, et al. Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing.

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“…Yadlapati et al 31 reported that the number of nonacid reflux events on PPI was significantly associated with the frequency of rumination episodes. A more recent study using MII-pH off PPI therapy 41 suggested that rumination patients had normal AET in the esophagus but significantly higher numbers of upright nonacid reflux episodes with high proximal extent compared with refractory GERD patients (Fig. 1B).…”

Section: Evaluation Of Rumination Syndrome and Supragastric Belching mentioning

confidence: 89%

New developments in esophageal function testing and esophageal manifestations of connective tissue disorders

Akiyama

Sumida

Nakagawa

et al. 2020

Annals of the New York Academy of Sciences

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This work summarizes new and emerging metrics and tools in esophageal function testing and their potential clinical impact. Because the diagnostic sensitivity and reliability of conventional impedance‐pH variables are suboptimal, several novel impedance parameters, such as the postreflux swallow–induced peristaltic wave index and the mean nocturnal baseline impedance, as well as mucosal impedance, are entering a validation stage prior to general clinical use. The accurate diagnosis of behavioral disorders in patients with rumination syndrome and supragastric belching using ambulatory multiple intraluminal impedance‐pH can lead directly to behavioral interventions in patients with refractory gastroesophageal reflux disease (GERD). New provocative measures, such as multiple rapid swallows and the rapid drink challenge, have been developed to overcome the limitations of standard high‐resolution esophageal manometry, aiming at further clarifying esophageal dysmotility. Furthermore, the current diagnostic and therapeutic challenges in patients with esophageal involvement in Sjogren's syndrome and scleroderma, who tend to have severe forms of GERD, are entering a new investigative and clinical phase.

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Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring

Cited by 40 publications

References 36 publications

Measurement of Esophageal Nocturnal Baseline Impedance: A Simplified Method

Measurement of Esophageal Nocturnal Baseline Impedance: A Simplified Method

Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing

New developments in esophageal function testing and esophageal manifestations of connective tissue disorders

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