PMID- 33687131 OWN - NLM STAT- MEDLINE DCOM- 20220404 LR - 20221003 IS - 1365-2982 (Electronic) IS - 1350-1925 (Print) IS - 1350-1925 (Linking) VI - 33 IP - 10 DP - 2021 Oct TI - Diagnostic yield and reliability of post-prandial high-resolution manometry and impedance-ph for detecting rumination and supragastric belching in PPI non-responders. PG - e14106 LID - 10.1111/nmo.14106 [doi] AB - BACKGROUND: Supragastric belching (SGB) and rumination are behavioral disorders associated with proton pump inhibitor (PPI) non-response and can be diagnosed using multichannel intraluminal impedance-pH (MII-pH) and post-prandial high-resolution impedance manometry (PPHRIM). This pilot study compared diagnostic yield and inter-rater agreement for SGB and rumination using MII-pH and PPHRIM. METHODS: Three esophageal physiologists performed blinded interpretations of MII-pH and PPHRIM in 22 PPI non-responders. Raters selected from 4 diagnostic impressions (normal, GERD, behavioral disorders, GERD+behavioral disorders) without clinical context. Primary outcomes were diagnostic impressions compared against clinical gold standard impression, between raters, and between test modalities. Following a 28-month wash-out period, raters re-interpreted MII-pH with clinical context and under consensus definition of diagnostic criteria. KEY RESULTS: Compared to gold standard, rater accuracy for presence of behavioral disorders ranged from 45 to 77% on MII-pH and 45-59% on PPHRIM. On MII-pH, inter-rater agreement was fair for diagnosis (k0.32, p < 0.01) and suboptimal for presence of behavioral disorders (k0.13, p = 0.14). On PPHRIM, inter-rater agreement was suboptimal for both diagnosis (k0.03, p = 0.34) and presence of a behavioral disorder (k-0.22, p = 0.96). Inter-rater agreement improved in post hoc MII-pH interpretations. Rumination was more frequently identified on PPHRIM (23, 35%) compared to MII-pH (7, 11%). CONCLUSIONS AND INFERENCES: Diagnostic accuracy and inter-rater agreement are higher for MII-pH than PPHRIM, and behavioral disorders are more frequently identified on PPHRIM. Identifying behavioral disorders on MII-pH and PPHRIM has implications for clinical evaluation of PPI non-response; clinical context is essential for accurate study interpretation. Further work is needed to standardize definitions and interpretations. CI - (c) 2021 John Wiley & Sons Ltd. FAU - DeLay, Kelli AU - DeLay K AUID- ORCID: 0000-0002-8137-9782 AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Pandolfino, John E AU - Pandolfino JE AD - Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Roman, Sabine AU - Roman S AUID- ORCID: 0000-0002-7798-7638 AD - Universite de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, Lyon, France. AD - Universite de Lyon, Lyon I University, Digestive Physiology, Lyon, France. AD - Universite de Lyon,, Inserm U1032, LabTAU, Lyon, France. FAU - Gyawali, C Prakash AU - Gyawali CP AUID- ORCID: 0000-0002-3388-0660 AD - Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA. FAU - Savarino, Edoardo AU - Savarino E AD - Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padova, Italy. FAU - Tye, Michael AU - Tye M AD - Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Kaizer, Alexander AU - Kaizer A AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. FAU - Yadlapati, Rena AU - Yadlapati R AUID- ORCID: 0000-0002-7872-2033 AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. AD - UCSD Center for Esophageal Diseases, Division of Gastroenterology, University of California San Diego, San Diego, California, USA. LA - eng GR - R01 DK092217/DK/NIDDK NIH HHS/United States GR - UL1 TR001422/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20210309 PL - England TA - Neurogastroenterol Motil JT - Neurogastroenterology and motility JID - 9432572 RN - 0 (Proton Pump Inhibitors) SB - IM MH - Electric Impedance MH - *Eructation/diagnosis MH - Esophageal pH Monitoring MH - *Gastroesophageal Reflux/complications/diagnosis MH - Humans MH - Hydrogen-Ion Concentration MH - Manometry MH - Pilot Projects MH - Proton Pump Inhibitors/pharmacology MH - Reproducibility of Results PMC - PMC8426416 MID - NIHMS1673459 OTO - NOTNLM OT - behavioral disorders OT - belching disorders OT - gastroesophageal reflux disease COIS- Disclosures and Conflicts of Interest John E. Pandolfino: Consultant for Medtronic, Crospon, Diversatek, Torax, Ironwood, Impleo. Pharmaceuticals S Roman: Consultant for Medtronic, Diversatek C. Prakash Gyawali: Consultant for Medtronic, Diversatek, Ironwood Edoardo Savarino: Consultant for Medtronic, Reckitt Benckiser, Takeda, Merck & Co, Bristol-Myers Squibb, Abbvie, Amgen, Novartis, Fresenius Kabi, Sandoz, Sofar, Malesci, Janssen, Grifols, Aurora Pharma, Innovamedica, Johnson&Johnson, SILA, Unifarco, Alfasigma, Shire, EG Stada Group Rena Yadlapati: Consultant: Medtronic, Ironwood Pharmaceuticals, Diversatek; Research support: Ironwood Pharmaceuticals; Advisory Board: Phathom Pharmaceuticals, RJS Mediadiagnostix Kelli DeLay: No competing interests EDAT- 2021/03/10 06:00 MHDA- 2022/04/05 06:00 PMCR- 2022/10/01 CRDT- 2021/03/09 08:41 PHST- 2021/02/04 00:00 [revised] PHST- 2020/09/30 00:00 [received] PHST- 2021/02/05 00:00 [accepted] PHST- 2021/03/10 06:00 [pubmed] PHST- 2022/04/05 06:00 [medline] PHST- 2021/03/09 08:41 [entrez] PHST- 2022/10/01 00:00 [pmc-release] AID - 10.1111/nmo.14106 [doi] PST - ppublish SO - Neurogastroenterol Motil. 2021 Oct;33(10):e14106. doi: 10.1111/nmo.14106. Epub 2021 Mar 9.