PMID- 27620303
OWN - NLM
STAT- MEDLINE
DCOM- 20180215
LR  - 20220317
IS  - 1365-2982 (Electronic)
IS  - 1350-1925 (Linking)
VI  - 29
IP  - 3
DP  - 2017 Mar
TI  - The added diagnostic value of postreflux swallow-induced peristaltic wave index 
      and nocturnal baseline impedance in refractory reflux disease studied with 
      on-therapy impedance-pH monitoring.
LID - 10.1111/nmo.12947 [doi]
AB  - BACKGROUND: On-therapy impedance-pH monitoring in proton pump inhibitor 
      (PPI)-refractory gastroesophageal reflux disease (GERD) yielded conflicting 
      results. We aimed to assess the diagnostic value of postreflux swallow-induced 
      peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) in 
      PPI-refractory heartburn. METHODS: On-therapy impedance-pH tracings from 189 
      consecutive patients with PPI-refractory heartburn were blindly reviewed. 
      Patients were subdivided into refractory reflux esophagitis (RRE), healed reflux 
      esophagitis (HRE), non-erosive reflux disease (NERD), and functional heartburn 
      (FH) according to endoscopic and conventional impedance-pH findings. The 
      diagnostic accuracy of PSPW index and MNBI in separating NERD from FH was 
      assessed with receiver-operating-characteristic (ROC) analysis. Objectively 
      documented persistent reflux remission at 3-year follow-up in 53 patients who 
      underwent laparoscopic fundoplication served to evaluate PSPW index and MNBI as 
      independent predictors of PPI-refractory GERD confirmed by positive surgical 
      outcome. KEY RESULTS: Median PSPW index and MNBI values were significantly lower 
      in 39 RRE (16%; 1145 Omega) than in 41 HRE (25%; 1741 Omega) and in 68 NERD (29%; 2374 Omega) 
      patients, and in all three GERD subgroups compared to 41 FH cases (67%; 3488 Omega) 
      (P<.008). At ROC analysis, comparing NERD to FH the area under the curve was 
      0.886 with PSPW index and 0.677 with MNBI (P=.005). PSPW index was an independent 
      predictor of PPI-refractory GERD (odds ratio 0.6983, P=.012). CONCLUSIONS & 
      INFERENCES: At on-therapy impedance-pH monitoring, PSPW index and MNBI 
      efficiently distinguish PPI-refractory NERD from FH. The PSPW index represents an 
      independent predictor of PPI-refractory GERD.
CI  - (c) 2016 John Wiley & Sons Ltd.
FAU - Frazzoni, M
AU  - Frazzoni M
AD  - Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy.
FAU - de Bortoli, N
AU  - de Bortoli N
AD  - Department of Translational Research and New Technology in Medicine and Surgery, 
      University of Pisa, Pisa, Italy.
FAU - Frazzoni, L
AU  - Frazzoni L
AD  - Department of Medical and Surgical Sciences, University of Bologna, Bologna, 
      Italy.
FAU - Tolone, S
AU  - Tolone S
AD  - General and Bariatric Surgery Unit, Department of Surgery, 2nd University of 
      Napoli, Naples, Italy.
FAU - Furnari, M
AU  - Furnari M
AD  - Gastroenterology Unit, Department of Internal Medicine, University of Genova, 
      Genova, Italy.
FAU - Martinucci, I
AU  - Martinucci I
AD  - Department of Translational Research and New Technology in Medicine and Surgery, 
      University of Pisa, Pisa, Italy.
FAU - Mirante, V G
AU  - Mirante VG
AD  - Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy.
FAU - Marchi, S
AU  - Marchi S
AD  - Department of Translational Research and New Technology in Medicine and Surgery, 
      University of Pisa, Pisa, Italy.
FAU - Savarino, V
AU  - Savarino V
AD  - Gastroenterology Unit, Department of Internal Medicine, University of Genova, 
      Genova, Italy.
FAU - Savarino, E
AU  - Savarino E
AD  - Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, 
      University of Padova, Padova, Italy.
LA  - eng
PT  - Journal Article
DEP - 20160912
PL  - England
TA  - Neurogastroenterol Motil
JT  - Neurogastroenterology and motility
JID - 9432572
SB  - IM
MH  - Adult
MH  - Deglutition/*physiology
MH  - *Electric Impedance
MH  - Esophageal pH Monitoring/*methods
MH  - Female
MH  - Gastroesophageal Reflux/diagnosis/*physiopathology
MH  - Heartburn/diagnosis/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peristalsis/*physiology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - esophageal baseline impedance
OT  - esophageal chemical clearance
OT  - impedance-pH monitoring
OT  - refractory GERD
EDAT- 2016/09/14 06:00
MHDA- 2018/02/16 06:00
CRDT- 2016/09/14 06:00
PHST- 2016/07/01 00:00 [received]
PHST- 2016/08/23 00:00 [accepted]
PHST- 2016/09/14 06:00 [pubmed]
PHST- 2018/02/16 06:00 [medline]
PHST- 2016/09/14 06:00 [entrez]
AID - 10.1111/nmo.12947 [doi]
PST - ppublish
SO  - Neurogastroenterol Motil. 2017 Mar;29(3). doi: 10.1111/nmo.12947. Epub 2016 Sep 
      12.