Safety and Efficacy of Wireless pH Monitoring in Patients Suspected of Gastroesophageal Reflux Disease

Kessels, S.; Newton, Skye; J, Morona; Merlin, Tracy

doi:10.1097/mcg.0000000000000843

Cited by 18 publications

(11 citation statements)

References 43 publications

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“…However, atypical symptoms or extra-esophageal symptoms such as cough, sinusitis and pharyngitis can predominate and confuse the issue (6). The severity can only be assessed objectively by 24 or 48 hours ambulatory pH study or by a wireless pH Bravo monitoring device which can be utilized for up to 96 hours (7). Untreated GERD can result in reflux erosive esophagitis (EE), necrosis, ulceration, strictures and Barrett's esophagus (BE) (8).…”

Section: The Latest Centers For Disease Control and Prevention Datamentioning

confidence: 99%

Bariatric surgery and gastroesophageal reflux disease

Ashrafi¹,

Osland²,

Memon³

2020

Ann Transl Med

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With the rapidly increasing prevalence of obesity globally, the practice of bariatric surgery is being adopted routinely to prevent the development of chronic conditions as well as some forms of cancers associated with obesity. Gastroesophageal reflux disease (GERD) is one of those chronic conditions. Furthermore, there is accumulating data that obesity is associated with complications related to longstanding GERD such as erosive esophagitis (EE), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC).Central obesity, rather than body mass index (BMI), appears to be more closely associated with these complications. It should be expected, therefore, that weight loss procedures should result in improvement in GERD symptoms and its associated complications. However, in reality the different bariatric surgical procedures have unpredictable effects on an established GERD and may even produce GERD symptoms for the very first time (de novo). In this review, we explore the literature studying the effects of bariatric surgical operations on GERD. Roux-en-Y gastric bypass appears to have the most beneficial effect on GERD. On the other hand, laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding (LAGB) are linked with long-term increased prevalence of GERD. We argue that GERD is an extremely important preoperative consideration for any patient undergoing bariatric surgery and therefore should be thoroughly investigated objectively (with 24-hour pH study and high-resolution manometry) to select the most suitable bariatric procedure for patients for their long-term success.

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Section: The Latest Centers For Disease Control and Prevention Datamentioning

confidence: 99%

Bariatric surgery and gastroesophageal reflux disease

Ashrafi¹,

Osland²,

Memon³

2020

Ann Transl Med

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“…(21) The main methods of reflux testing include a wireless telemetry capsule attached to the esophageal mucosa during endoscopy and trans-nasal catheter-based testing. (26, 27) Similarly, high resolution manometry (HRM) is recommended for patients that may need anti-reflux surgery. (28) These tests are invasive, and expensive.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive, MultiOmic and MultiCompartmental Biomarkers of Reflux Disease: A Systematic Review

Farooqi

Podury

Crowley

et al. 2022

Preprint

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Background and AimsGastroesophageal reflux disease (GERD) is a prevalent GI disorder which may complicate conditions such as obstructive airways disease (OAD). Our group has identified predictive biomarkers of GERD in particulate exposed 1st responders with OAD. Additionally, GERD diagnosis and treatment is costly, and invasive. In light of these clinical concerns our aim was to systematically review studies identifying non-invasive, multiOmic and multi-compartmental biomarkers of GERD.MethodsA systematic review of PubMed and EMBASE was performed on February 22, 2022 utilizing keywords focusing on reflux disease and biomarkers. The study was registered with PROSPERO (2022-CRD42022301543). We included: original human studies in English, published after December 31, 2009 focusing on non-invasive biomarkers of GERD. Reflux related conditions included Nonerosive Reflux Disease (NERD) Laryngopharyngeal Disease (LPR), Erosive Esophagitis (EE) and Barretts Esophagus (BE). Predictive measures were synthesized and bias assessed.ResultsPrimary search identified 241 studies. After removing duplicates and applying inclusion/exclusion criteria n=15 articles were identified. Salivary pepsin was the most studied biomarker (n=5) with a significant sensitivity and specificity for GERD and LPR detection. Studies showed that for GERD diagnosis, miR-203 downregulation had the highest area under curve the receiver operator curve(ROCAUC) 0.94(95% CI; 0.90-0.7). An oral microbiome model including Lautropia, Streptococcus and Bacteroidetes showed the greatest discrimination between BE and controls vs Lautropia alone; sensitivity of 96.9%, specificity of 88.2% and ROCAUC of 0.94(0.81-1.00).ConclusionPrior studies identified significant multiOmic, multi-compartmental non-invasive biomarker risks for GERD and its complications such as BE. However, due to study limitations and to further ascertain the reliability and accuracy of these biomarkers more studies are warranted.WHAT YOU NEED TO KNOWBACKGROUNDGastroesophageal reflux disease (GERD) is a prevalent GI disorder which may complicate conditions such as obstructive airways disease (OAD). GERD diagnosis and treatment is costly, and invasive. In light of these clinical concerns our aim was to systematically review studies identifying non-invasive, multiOmic and multi-compartmental biomarkers of GERD.FINDINGSSalivary pepsin was the most studied biomarker with a significant sensitivity and specificity for GERD detection. Studies showed that for GERD diagnosis, miR-203 downregulation had the highest ROCAUC. An oral microbiome model including Lautropia, Streptococcus and Bacteroidetes showed the greatest discrimination between Barrette’s Esophagus and controls vs Lautropia alone.IMPLICATIONS FOR PATIENT CAREPrior studies identified significant multiOmic, multi-compartmental non-invasive biomarker risks for GERD and its complications such as BE. However, due to study limitations and to further ascertain the reliability, accuracy and clinical utility of these biomarkers more studies are warranted.

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“…Wireless pH study uses a radio‐telemetric capsule temporarily attached to the oesophageal mucosa. It allows for a prolonged recording and has been shown to be generally better tolerated by patients, thereby increasing sensitivity for detecting reflux events 12‐15 . Intuitively, it is presumed that this improved sensitivity extends to nocturnal reflux.…”

Section: Introductionmentioning

confidence: 99%

“…It allows for a prolonged recording and has been shown to be generally better tolerated by patients, thereby increasing sensitivity for detecting reflux events. 12 , 13 , 14 , 15 Intuitively, it is presumed that this improved sensitivity extends to nocturnal reflux. In this study, we aimed to explore this concept.…”

Section: Introductionmentioning

confidence: 99%

Characterisation of patients with supine nighttime reflux: observations made with prolonged wireless oesophageal pH monitoring

Nijhuis

Sweis

Abdul-Razakq

et al. 2021

Aliment Pharmacol Ther

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Summary Background Although nighttime reflux symptoms are common, the presence of nocturnal reflux is seldom confirmed with a standard 24 hours pH study. Aim To study patients with supine nighttime reflux symptoms using prolonged wireless pH monitoring. Methods In this retrospective study, patients with typical acid reflux symptoms were studied using 96‐h pH monitoring. Patients with nighttime reflux symptoms were compared to those without. Night‐to‐night variability and diagnostic accuracy of 24‐, 48‐ and 72‐hours pH studies compared to the 96‐hours “gold standard” were evaluated. Results Of the 105 included patients (61.9% females; mean age 46.8 ± 14.4 years), 86 (81.9%) reported nighttime reflux symptoms, of which 67.4% had pathological supine nocturnal acid exposure in at least one night. There was high variance in night‐to‐night acid exposure (94% [IQR0‐144]), which was larger than the variance in upright acid exposure (58% [IQR32‐88]; P < 0.001). When analysing the first 24 hours of the pH study, 32% of patients were diagnosed with pathological supine nighttime acid exposure versus 51% of patients based upon the 96‐hours pH‐test. The diagnostic accuracy and yield improved with study duration (P < 0.001). Reflux episodes with a lower nadir pH or longer acid clearance time were more prone to provoke nightly symptoms. Conclusions The majority of patients with nocturnal reflux symptoms had pathological acid exposure in at least one night of the prolonged pH recording. A high night‐to‐night variability in acid exposure reduces the clinical value and diagnostic yield of pH monitoring limited to 24 hours. Prolonged testing is a more appropriate diagnostic tool for patients with nocturnal reflux symptoms.

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Safety and Efficacy of Wireless pH Monitoring in Patients Suspected of Gastroesophageal Reflux Disease

Cited by 18 publications

References 43 publications

Bariatric surgery and gastroesophageal reflux disease

Bariatric surgery and gastroesophageal reflux disease

Non-Invasive, MultiOmic and MultiCompartmental Biomarkers of Reflux Disease: A Systematic Review

Characterisation of patients with supine nighttime reflux: observations made with prolonged wireless oesophageal pH monitoring

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