PMID- 28550489
OWN - NLM
STAT- MEDLINE
DCOM- 20170905
LR  - 20220317
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 62
IP  - 8
DP  - 2017 Aug
TI  - Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives.
PG  - 1881-1889
LID - 10.1007/s10620-017-4625-8 [doi]
AB  - Heartburn is the most specific symptom of gastroesophageal reflux disease (GERD). 
      In clinical practice, heartburn relief by a proton pump inhibitor (PPI) trial 
      does suffice to confirm GERD. However, an objective diagnosis of GERD is required 
      before anti-reflux endoscopic or surgical interventions, independently from PPI 
      response. Thus, since normal findings at upper endoscopy are detected in the 
      majority of patients with heartburn, reflux monitoring is often required. When 
      traditional catheter-based or wireless pH tests are used, reflux episodes are 
      conventionally identified by pH drops below 4.0 units. Combined impedance-pH 
      monitoring has the advantage to provide a comprehensive assessment of both 
      physical and chemical properties of refluxate and the distinction between acid 
      and weakly acidic refluxes, both proven to cause heartburn. Unfortunately, the 
      conventional impedance-pH parameters, namely acid exposure time and number of 
      reflux events, are characterized by suboptimal diagnostic sensitivity, and the 
      reliability of symptom-reflux association indexes remains questionable. 
      Therefore, novel impedance parameters, namely the post-reflux swallow-induced 
      peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), 
      have recently been proposed in order to achieve a better diagnostic yield. In 
      fact, they proved to be highly accurate in distinguishing reflux-related from 
      reflux-unrelated heartburn, off- as well as on-PPI therapy. Currently, manual 
      review of impedance-pH tracings is needed because of the modest accuracy of 
      available software tools for automated analysis. PSPW index and MNBI are highly 
      applicable and reproducible, and their calculation requires a few additional 
      minutes during the manual review of impedance-pH tracings. So far, we believe 
      that PSPW index and MNBI are ready for prime time and should become part of the 
      standard analysis of impedance-pH tracings for GERD diagnosis in patients with 
      endoscopy-negative heartburn.
FAU - Frazzoni, Marzio
AU  - Frazzoni M
AUID- ORCID: 0000-0002-8608-1563
AD  - Digestive Pathophysiology Unit, Baggiovara Hospital, Viale Giardini 1355, 41100, 
      Modena, Italy. marziofrazzoni@gmail.com.
FAU - de Bortoli, Nicola
AU  - de Bortoli N
AD  - Department of Translational Research and New Technology in Medicine and Surgery, 
      University of Pisa, Pisa, Italy.
FAU - Frazzoni, Leonardo
AU  - Frazzoni L
AD  - Digestive Pathophysiology Unit, Baggiovara Hospital, Viale Giardini 1355, 41100, 
      Modena, Italy.
AD  - Department of Medical and Surgical Sciences, University of Bologna, Bologna, 
      Italy.
FAU - Tolone, Salvatore
AU  - Tolone S
AD  - General and Bariatric Surgery Unit, Department of Surgery, 2nd University of 
      Napoli, Naples, Italy.
FAU - Savarino, Vincenzo
AU  - Savarino V
AD  - Gastroenterology Unit, Department of Internal Medicine, University of Genova, 
      Genoa, Italy.
FAU - Savarino, Edoardo
AU  - Savarino E
AD  - Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, 
      University of Padova, Padua, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170526
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - *Electric Impedance
MH  - Esophageal pH Monitoring/*methods
MH  - Esophagus/chemistry/physiopathology
MH  - Gastroesophageal Reflux/complications/*diagnosis/physiopathology
MH  - Heartburn/drug therapy/etiology
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Peristalsis
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Reproducibility of Results
OTO - NOTNLM
OT  - Esophageal baseline impedance
OT  - Esophageal chemical clearance
OT  - GERD
OT  - Impedance-pH monitoring
OT  - NERD
OT  - PPI
OT  - PSPW index
EDAT- 2017/05/28 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/05/28 06:00
PHST- 2017/03/12 00:00 [received]
PHST- 2017/05/19 00:00 [accepted]
PHST- 2017/05/28 06:00 [pubmed]
PHST- 2017/09/07 06:00 [medline]
PHST- 2017/05/28 06:00 [entrez]
AID - 10.1007/s10620-017-4625-8 [pii]
AID - 10.1007/s10620-017-4625-8 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2017 Aug;62(8):1881-1889. doi: 10.1007/s10620-017-4625-8. Epub 2017 
      May 26.