PMID- 24732868
OWN - NLM
STAT- MEDLINE
DCOM- 20140805
LR  - 20220318
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 109
IP  - 6
DP  - 2014 Jun
TI  - Acid-based parameters on pH-impedance testing predict symptom improvement with 
      medical management better than impedance parameters.
PG  - 836-44
LID - 10.1038/ajg.2014.63 [doi]
AB  - OBJECTIVES: pH-impedance testing detects reflux events irrespective of pH, but 
      its value in predicting treatment outcome is unclear. We prospectively evaluated 
      subjects treated medically after pH-impedance testing to determine predictors of 
      symptom improvement. METHODS: Subjects referred for pH-impedance testing 
      completed questionnaires in which dominant symptoms and global symptom severity 
      (GSS) were recorded. Acid-reflux parameters (acid-exposure time, AET; symptom 
      association by Ghillebert probability estimate, GPE; symptom index, SI) and 
      impedance reflux parameters (reflux-exposure time, RET; number of reflux events; 
      GPE and SI with impedance data) were extracted. Symptoms and GSS were 
      prospectively reevaluated after medical therapy. Univariate and multivariate 
      analyses determined predictors of GSS improvement following medical management. 
      RESULTS: Over 5 years, 128 subjects (mean 53.3+/-1.3 years, 66.4% female; typical 
      symptoms 57.0%, 53.9% tested on therapy) underwent pH-impedance testing and 
      subsequent medical therapy for reflux symptoms, and completed required 
      questionnaires. On follow-up 3.35+/-0.14 years later, mean GSS declined by 45.0%, 
      with 42.2% patients reporting >/=50% GSS improvement. On univariate analysis, total 
      AET, AET>/=4.0%, and GPE for all reflux events predicted both linear and >/=50% GSS 
      improvement, but RET and number of reflux events did not. On multivariate 
      analysis, controlling for testing on or off therapy, only AET (P=0.003) and GPE 
      for all reflux events (P=0.029) predicted GSS improvement. CONCLUSIONS: 
      Acid-based reflux parameters offer greater value over impedance-based 
      nonacid-reflux parameters in predicting symptomatic responses to proton pump 
      inhibitor (PPI) therapy. Our findings support conducting pH-impedance studies off 
      PPI therapy to maximize clinical utility in predicting outcome.
FAU - Patel, Amit
AU  - Patel A
AD  - Division of Gastroenterology, Washington University School of Medicine, Saint 
      Louis, Missouri, USA.
FAU - Sayuk, Gregory S
AU  - Sayuk GS
AD  - Division of Gastroenterology, Washington University School of Medicine, Saint 
      Louis, Missouri, USA.
FAU - Gyawali, C Prakash
AU  - Gyawali CP
AD  - Division of Gastroenterology, Washington University School of Medicine, Saint 
      Louis, Missouri, USA.
LA  - eng
GR  - T32 DK007130/DK/NIDDK NIH HHS/United States
GR  - 5P30 DK 052574-14-AP/DK/NIDDK NIH HHS/United States
GR  - R21 DK084413/DK/NIDDK NIH HHS/United States
GR  - K23DK84413-4 -GSS/DK/NIDDK NIH HHS/United States
GR  - P30 DK052574/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20140415
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Electric Impedance
MH  - Esophageal pH Monitoring
MH  - Esophagus/*physiopathology
MH  - Female
MH  - Gastroesophageal Reflux/*diagnosis/physiopathology
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
PMC - PMC4104528
MID - NIHMS598843
COIS- CONFLICT OF INTEREST Potential competing interests: None.
EDAT- 2014/04/16 06:00
MHDA- 2014/08/06 06:00
PMCR- 2015/06/01
CRDT- 2014/04/16 06:00
PHST- 2013/09/30 00:00 [received]
PHST- 2014/02/11 00:00 [accepted]
PHST- 2014/04/16 06:00 [entrez]
PHST- 2014/04/16 06:00 [pubmed]
PHST- 2014/08/06 06:00 [medline]
PHST- 2015/06/01 00:00 [pmc-release]
AID - ajg201463 [pii]
AID - 10.1038/ajg.2014.63 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2014 Jun;109(6):836-44. doi: 10.1038/ajg.2014.63. Epub 2014 
      Apr 15.