Role of altered esophageal intraluminal baseline impedance levels in patients with gatroesophageal reflux disease refractory to proton pump inhibitors

Jiang, Liuqin; Ye, Bixing; Lin, Lin; Wang, Ying; Wang, Meifeng

doi:10.1097/md.0000000000004351

Cited by 3 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32 Besides, it showed that MNBI was negatively correlated to acid-related parameters, such as episodes of acid reflux, DeMeester score, and AET. 33 Based on our results, patients with AET 4-6% and AET > 6% both had lower MNBI than patients with AET <4%. ROC curve analysis revealed MNBI had an advantage in diagnosing GERD with high sensitivity and specificity, so MNBI is crucial for GERD diagnosis in suspected patients with AET 4-6%.…”

Section: Despite the Limitations Of Currently Available Esophageal Te...supporting

confidence: 50%

See 1 more Smart Citation

Value of adjunctive evidence from MII-pH monitoring and high-resolution manometry in inconclusive GERD patients with AET 4–6%

Jiang

et al. 2021

Therap Adv Gastroenterol

Self Cite

View full text Add to dashboard Cite

Objectives: Gastro-esophageal reflux disease (GERD) is a common disease in gastroenterology outpatients. However, some patients with typical reflux symptoms does not satisfy diagnostic criteria. This study was to explore the value of adjunctive evidence from multichannel intraluminal impedance-pH (MII-pH) monitoring and esophageal high-resolution manometry (HRM) in inconclusive GERD patients with acid exposure time (AET) 4–6%. Methods: Endoscopy, MII-pH monitoring and esophageal HRM were retrospectively analyzed from consecutive patients with typical reflux symptoms in a tertiary hospital from 2013 to 2019. Patients were categorized as conclusive or inconclusive GERD according to AET. Adjunctive evidence for GERD diagnosis from Lyon Consensus were collected and analyzed. Results: Among 147 patients with typical reflux symptoms, conclusive GERD was found in only 31.97% of patients ( N = 47). The remaining 100 patients (68.03%) were inconclusive GERD, of whom 28% ( N = 28) had AET 4–6%. These patients suffered similar reflux burden and impaired esophageal movement. Inconclusive GERD patients with AET 4–6% had lots of positive adjunctive evidence from HRM and MII-pH monitoring. In receiver operating characteristic analysis, mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWI) had an area under the curve (AUC) of 0.839 (CI: 0.765–0.913, p < 0.001) and 0.897 (CI: 0.841–0.953, p < 0.001), respectively, better than total reflux episode (AUC of 0.55, p = 0.33). When MNBI was combined with PSPWI, the AUC was elevated to 0.910 (CI: 0.857–0.963, p < 0.001). Conclusions: Inconclusive GERD patients with AET 4–6% have similar acid burden and esophagus motility dysfunction to GERD patients. MNBI and PSPWI are pivotal adjunctive evidence for diagnosing GERD when AET is borderline.

show abstract

Section: Despite the Limitations Of Currently Available Esophageal Te...supporting

confidence: 50%

“… 32 Besides, it showed that MNBI was negatively correlated to acid-related parameters, such as episodes of acid reflux, DeMeester score, and AET. 33 …”

Section: Discussionmentioning

confidence: 99%

Value of adjunctive evidence from MII-pH monitoring and high-resolution manometry in inconclusive GERD patients with AET 4–6%

Jiang

et al. 2021

Therap Adv Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients were excluded if they were found to have a tumor, peptic ulcer, or any mucosal abnormality other than esophagitis and superficial gastritis on endoscopy; a history of gastrointestinal surgery; severe organ dysfunction; or primary or secondary severe esophageal motility disorders (eg, achalasia, nutcracker esophagus, scleroderma, and diabetes mellitus). [ 12 ] The study protocol was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University. All patients provided informed consent before the start of the investigation.…”

Section: Methodsmentioning

confidence: 99%

Reflux episodes and esophageal impedance levels in patients with typical and atypical symptoms of gastroesophageal reflux disease

Jiang¹,

Lin²,

Wang³

et al. 2017

Medicine

Self Cite

View full text Add to dashboard Cite

To determine the relationship between baseline impedance levels and gastroesophageal reflux, we retrospectively enrolled 110 patients (54 men and 56 female; mean age, 51 ± 14 years) with suspected gastroesophageal reflux disease (GERD) who underwent 24-h multichannel intraluminal impedance and pH monitoring. Patients were stratified according to symptom (typical or atypical) and reflux types (acid reflux, nonacid reflux [NAR], or no abnormal reflux). Mean nocturnal baseline impedance (MNBI) were measured 3 cm (distal esophagus) and 17 cm (proximal esophagus) above the lower esophageal sphincter. Median distal esophageal MNBI was lower in the acid reflux group (1244 Ω; 647–1969 Ω) than in the NAR (2586 Ω; 1368–3666 Ω) or no abnormal reflux groups (3082 Ω; 2495–4472 Ω; all P < .05). Distal MNBI were negatively correlated with DeMeester score and acid exposure time. Atypical symptoms were more frequently associated with NAR than typical symptoms (P < .01). Among patients with positive symptom-association probability (SAP) for NAR, median proximal MNBI tended to be lower in patients with typical symptoms (median, 3013 Ω; IQR, 2535–3410 Ω) than in those with atypical symptoms (median, 3386 Ω; IQR, 3044–3730 Ω, P = .05). Thus, atypical GERD symptoms were more likely to be associated with NAR. The mucosal integrity of the proximal esophagus might be relatively impaired in GERD patients with typical symptoms for NAR.

show abstract

“…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.…”

mentioning

confidence: 99%

“…[4][5][6] Therefore, esophageal BI is used to predict the therapeutic effect of PPI related to severity of acid exposure. [6][7][8] However, there is still insufficient evidence to standardize this strategy.…”

mentioning

confidence: 99%

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

Jung

Park

2018

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Gastroesophageal reflux disease (GERD) is characterized by reflux of stomach contents and causes unpleasant symptoms and complications. Proton pump inhibitors (PPIs) are widely used to treat GERD and significantly reduce gastric acid secretion. 1 However, despite PPI therapy, up to 40% of patients report persistent GERD symptoms. 2 Some studies have attempted to predict which patients will have a poor response to PPI treatment. A recently published review article reported that poor response to PPI treatment is related to a PPI-metabolizer genotype, CYP, and requires combined adjunctive therapy. 2 Adjusting treatment in patients with the PPI-metabolizer genotype or switching to a CYP2C19-independent PPI is a simple way to increase the PPI response. In addition, the use of adjunctive agents may be considered when the physiological mechanism of PPI nonresponse is suspected. 2 For such patients, recent research focused on whether the diagnosis is truly correct and the degree of treatment response can be predicted. According to the recent implementation of a pH monitoring method combined with baseline impedance (BI), and depending on the degree of acid exposure and esophageal hypersensitivity highlighted in the Rome IV criteria for functional esophageal disorders, patients with suspected GERD with typical chest pain and regurgitation are divided into 4 subtypes: erosive esophagitis, non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn (FH). 3 Especially when using mean nocturnal BI in the distal esophagus for patients with heartburn, several studies showed that the value of BI and degree of reflux showed a negative correlation and the mean BI level was statistically significantly lower in the PPI-responsive group than in the non-responsive group. 4-6 Therefore, esophageal BI is used to predict the therapeutic effect of PPI related to severity of acid exposure. 6-8 However, there is still insufficient evidence to standardize this strategy.Along with the BI, the concept of intercellular space diameter (ISD) has recently been studied. Histologically, dilated intercellular space (DIS) is frequently observed in GERD patients. In addition, JNM

show abstract

Role of altered esophageal intraluminal baseline impedance levels in patients with gatroesophageal reflux disease refractory to proton pump inhibitors

Cited by 3 publications

References 34 publications

Value of adjunctive evidence from MII-pH monitoring and high-resolution manometry in inconclusive GERD patients with AET 4–6%

Value of adjunctive evidence from MII-pH monitoring and high-resolution manometry in inconclusive GERD patients with AET 4–6%

Reflux episodes and esophageal impedance levels in patients with typical and atypical symptoms of gastroesophageal reflux disease

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

Contact Info

Product

Resources

About