Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study.

Autor: Zeki SS; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK.; King's College London, School of Cancer and Pharmaceutical Sciences, London, UK., Miah I; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK., Visaggi P; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK.; Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy., Wolak A; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK., deSilva M; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK., Dunn JM; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK.; King's College London, School of Cancer and Pharmaceutical Sciences, London, UK., Davies A; King's College London, School of Cancer and Pharmaceutical Sciences, London, UK.; Guy's and St. Thomas' Esophago-gastric Center, London, UK., Gossage J; King's College London, School of Cancer and Pharmaceutical Sciences, London, UK.; Guy's and St. Thomas' Esophago-gastric Center, London, UK., Botha A; Guy's and St. Thomas' Esophago-gastric Center, London, UK., Sui G; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK., Jafari J; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK., Wong T; Department of Gastroenterology, Center for Eosophageal Diseases, Guy's and St. Thomas' Hospital, London, UK.
Jazyk: angličtina
Zdroj: Journal of neurogastroenterology and motility [J Neurogastroenterol Motil] 2023 Jul 30; Vol. 29 (3), pp. 335-342.
DOI: 10.5056/jnm22130
Abstrakt: Background/aims: Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.
Methods: Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher's exact test, Wilcoxon rank sum test, or Student's t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.
Results: One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041).
Conclusions: WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.
Databáze: MEDLINE
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