Proximal esophageal impedance baseline increases the yield of impedance-pH monitoring for GERD diagnosis and is associated with heartburn response to PPI
© 2023 John Wiley & Sons Ltd..
BACKGROUND: Impairment of esophageal mucosal integrity as assessed by low mean nocturnal baseline impedance (MNBI) measured in the distal esophagus increases the diagnostic yield of impedance-pH in patients with inconclusive GERD diagnosis as defined by Lyon criteria.
AIM: To assess the diagnostic yield of MNBI measurement in the proximal esophagus, and its relationship with PPI response.
METHODS: Expert review of off-therapy impedance-pH tracings from consecutive patients with heartburn, 80 responders and 80 non-responders to label-dose PPI. Data were compared to those from 36 healthy controls using ROC analysis. Multivariate analysis was performed to measure the strength of association of MNBI with PPI response.
RESULTS: A threshold value of 2665 Ω was defined for proximal MNBI by ROC analysis, affording 91.7% sensitivity and 86.5% specificity. Proximal and distal MNBI were significantly lower in non-responder cases as compared to responders. Adding proximal MNBI positivity to pathologic (>6%) acid exposure time (AET) and positive symptom-reflux association, the proportion of patients with abnormal impedance-pH findings increased from 74/160 (46%) to 106/160 (66.3%) (p = 0.0016). Among the 12 patients with pathologic proximal MNBI as the only positive impedance-pH finding, 9 cases (75%) were PPI responders. According to multivariate analysis, AET and pathological distal and proximal MNBI were significantly associated with PPI response, the strongest association observed for proximal MNBI.
CONCLUSIONS: Impedance baseline assessment in the proximal esophagus may increase the diagnostic yield of impedance-pH monitoring. Heartburn response to PPI is directly related to ultrastructural mucosal damage in the distal and in the proximal esophagus as well.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Neurogastroenterology and motility - 35(2023), 8 vom: 31. Aug., Seite e14612 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ribolsi, Mentore [VerfasserIn] |
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| Links: |
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| Themen: |
GERD |
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| Anmerkungen: |
Date Completed 26.07.2023 Date Revised 26.07.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/nmo.14612 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357059921 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Impairment of esophageal mucosal integrity as assessed by low mean nocturnal baseline impedance (MNBI) measured in the distal esophagus increases the diagnostic yield of impedance-pH in patients with inconclusive GERD diagnosis as defined by Lyon criteria | ||
| 520 | |a AIM: To assess the diagnostic yield of MNBI measurement in the proximal esophagus, and its relationship with PPI response | ||
| 520 | |a METHODS: Expert review of off-therapy impedance-pH tracings from consecutive patients with heartburn, 80 responders and 80 non-responders to label-dose PPI. Data were compared to those from 36 healthy controls using ROC analysis. Multivariate analysis was performed to measure the strength of association of MNBI with PPI response | ||
| 520 | |a RESULTS: A threshold value of 2665 Ω was defined for proximal MNBI by ROC analysis, affording 91.7% sensitivity and 86.5% specificity. Proximal and distal MNBI were significantly lower in non-responder cases as compared to responders. Adding proximal MNBI positivity to pathologic (>6%) acid exposure time (AET) and positive symptom-reflux association, the proportion of patients with abnormal impedance-pH findings increased from 74/160 (46%) to 106/160 (66.3%) (p = 0.0016). Among the 12 patients with pathologic proximal MNBI as the only positive impedance-pH finding, 9 cases (75%) were PPI responders. According to multivariate analysis, AET and pathological distal and proximal MNBI were significantly associated with PPI response, the strongest association observed for proximal MNBI | ||
| 520 | |a CONCLUSIONS: Impedance baseline assessment in the proximal esophagus may increase the diagnostic yield of impedance-pH monitoring. Heartburn response to PPI is directly related to ultrastructural mucosal damage in the distal and in the proximal esophagus as well | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a GERD | |
| 650 | 4 | |a PPI | |
| 650 | 4 | |a impedance-pH monitoring | |
| 650 | 4 | |a nocturnal baseline impedance | |
| 650 | 7 | |a Proton Pump Inhibitors |2 NLM | |
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| 700 | 1 | |a Marchetti, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Brigida, Mattia |e verfasserin |4 aut | |
| 700 | 1 | |a Cicala, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Savarino, Edoardo |e verfasserin |4 aut | |
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