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      Diagnostic Efficacy of 24-hr Esophageal pH Monitoring in Patients with Refractory Gastroesophageal Reflux Disease

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          Abstract

          BACKGROUND:

          Gastric reflux is one of the most important causes of the referral of patients to the internal clinic, which in some cases causes problems for patients due to resistance to common treatments. Therefore, timely diagnosis and treatment of this group of patients are very important.

          AIM:

          The purpose of the present study was to determine the off-proton pump inhibitor (off-PPI) 24 h pH-impedance analyses in patients with refractory gastroesophageal reflux disease (GERD) attending to Taleghani Hospital since 2009 to 2017.

          METHODS:

          In this observational descriptive-comparative off-PPI study, 572 patients with refractory GERD who were referred to Taleghani Hospital in Tehran from 2009 to 2017 were selected, and the results of 24 h pH Impedance analysis were then assessed.

          RESULTS:

          The results of 24h pH-impedance indicated that 7% of cases belonged to Pure Acid Reflux followed by weakly Acid (1%), non-acid (0.3%), mixed & gas (5.2%), functional (58.4%) and oesophagal hypersensitivity (28%). Furthermore, weakly acid plus acid was also found to be 8% and Weakly Acid + Acid + Non-Acid were determined as 8.3%.

          CONCLUSIONS:

          Our findings suggested that nearly more than half of the patients with refractory GERD would have a functional disorder in the 24h pH-impedance analysis.

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          Most cited references27

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          Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population.

          Elizabeth M. McNally, Nicholas J. Talley, Klaus Jung … (2007)
          Gastro-oesophageal reflux disease (GERD) and irritable bowel syndrome may occur more often than expected by chance, but little community data exists and risk factors are unknown. To determine prevalence and risk factors for overlap of GERD and irritable bowel disease. Population-based, cross-sectional survey was conducted by mailing a valid symptom questionnaire to eligible residents of Olmsted County, MN, aged 30-95 years. Irritable bowel syndrome were defined by Rome III; GERD was defined by weekly or more frequent heartburn and/or acid regurgitation. 2298 questionnaires returned (women 52%, 55% response). Irritable bowel syndrome and GERD occurred together more commonly than expected by chance; the prevalence of irritable bowel syndrome-GERD overlap, GERD alone and irritable bowel syndrome alone were 3%, 15% and 5% in men, and 4%, 14% and 10% in women, respectively. Predictors of irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone, and separately, GERD alone, were insomnia (OR 1.3, 95% CI: 1.06-1.70; OR 1.5, 95% CI: 1.13-1.90, respectively) and frequent abdominal pain (OR 3.9, 2.2-6.7; OR 1.8, 1.02-3.2, respectively). An additional predictor of irritable bowel syndrome-GERD overlap vs. GERD alone was higher somatization (OR 1.7, 1.1-2.4) and for irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone was a higher body mass index (OR 1.0, 1.003-1.07). Irritable bowel syndrome and GERD overlap is common in the population and does not occur by chance.
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            The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease.

            Edoardo Savarino, Elisa Marabotto, Patrizia Zentilin … (2011)
            Functional heartburn is defined by Rome III criteria as an endoscopy-negative condition with normal oesophageal acid exposure time, negative symptom association to acid reflux and unsatisfactory response to proton pump inhibitors. These criteria underestimated the role of non-acid reflux. To assess the contribution of impedance-pH with symptom association probability (SAP) analysis in identifying endoscopy-negative patients with reflux disease and separating them from functional heartburn. Consecutive endoscopy-negative patients treated with proton pump inhibitors (n=219) undergoing impedance-pH monitoring off-therapy were analysed. Distal acid exposure time, reflux episodes, SAP and symptomatic response to proton pump inhibitors were measured. Based on impedance-pH/SAP, 67 (31%) patients were pH+/SAP+, 6 (2%) pH+/SAP-, 83 (38%) hypersensitive oesophagus and 63 (29%) functional heartburn. According to pH-metry alone/response to proton pump inhibitors, 62 (28%) were pH+/SAP+, 11 (5%) pH+/SAP-, 61 (28%) hypersensitive oesophagus and 85 (39%) functional heartburn. In the normal-acid exposure population the contribution of impedance-pH/SAP compared to pH-metry alone/response to proton pump inhibitors in identifying patients with reflux disease and functional heartburn resulted to be 10%. In patients with abnormal-acid exposure, the contribution of impedance-pH/SAP increased by 3%. Comparing impedance-pH testing with pH-metry alone plus the response to proton pump inhibitor therapy demonstrated that the latter ones cause underestimation of reflux disease patients and overestimation of functional heartburn patients. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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              Clinical manifestations and complications of gastroesophageal reflux disease (GERD).

              B Hallerbäck, P Malfertheiner (2005)
              Gastroesophageal reflux-induced diseases are among the most common disorders and are associated with classical oesophageal manifestations of gastroesophageal reflux disease (GERD) including a range of symptoms such as heartburn, acid regurgitation and chest pain, and also organic manifestations such as oesophagitis, oesophageal strictures and ulcerations, Barrett's oesophagus and oesophageal adenocarcinoma. Recognition of its impact on other organ systems, extra-oesophageal reflux diseases, such as the ear, nose and throat (ENT) region and the bronchopulmonary system, as well as its contribution to symptoms such as chest pain and sleep disturbances, is also increasing. This paper addresses the symptoms, diseases and complications in which the abnormal reflux of gastric content to the oesophagus and adjacent organ systems is believed to be a frequent contributory factor.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Maced J Med Sci
                Journal ID (iso-abbrev): Open Access Maced J Med Sci
                Title: Open Access Macedonian Journal of Medical Sciences
                Publisher: Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                ISSN (Electronic): 1857-9655
                Publication date Collection: 20 July 2018
                Publication date (Electronic): 09 July 2018
                Volume: 6
                Issue: 7
                Pages: 1235-1238
                Affiliations
                [1 ] Shahid Modarres Clinical Research and Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [2 ] Department of Gastroenterology, Gastrointestinal and Liver Diseases Research Center (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3 ] Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [4 ] Department of Optometry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [5 ] Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
                [6 ] Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                [* ] Correspondence: Mojgan Forootan. Department of Gastroenterology, Gastrointestinal and Liver Diseases Research Center (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: mforootan2003@ 123456yahoo.com
                Article
                Publisher ID: OAMJMS-6-1235
                DOI: 10.3889/oamjms.2018.268
                PMC ID: 6062276
                SO-VID: f8851f3b-8672-466c-b408-4b97e8113852
                Copyright © Copyright: © 2018 Atoosa Gharib, Mojgan Forootan, Marjan Sharifzadeh, Saied Abdi, Mohammad Darvishi, Ahmad Eghbali
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                Date received : 19 April 2018
                Date revision received : 27 May 2018
                Date accepted : 28 May 2018
                Categories
                Subject: Clinical Science

                Keywords: gastric reflux,ph impedance,acid plus acid,diagnosis
                Data availability:
                Keywords: gastric reflux, ph impedance, acid plus acid, diagnosis

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