24-hour esophageal impedance-ph monitoring: technical aspects, indications and results

##plugins.themes.academic_pro.article.sidebar##

Published May 8, 2012
Download
pdf
Vol. 90 No. 5 (2012): Issue May 2012

##plugins.themes.academic_pro.article.main##

Sami Karoui
Hanene Ben Temime
Meriem Serghini
Lilia Zouiten
Jalel Boubaker
Azza Filali

Abstract

Background: Classical techniques like endoscopy and esophageal pH-metry are the gold standard to study patients with symptoms related to gastroesophageal reflux disease. Although these techniques have been useful over the years both for diagnosis and therapeutic guidance, there are still many patients with typical or atypical gastroesophageal reflux disease symptoms with normal endoscopy and pH-metry that do not respond adequately to antisecretory therapy. Ambulatory esophageal impedance-pH monitoring is a new technique that can be used to evaluate all types of gastroesophageal reflux, achieving higher rates of sensitivity and specificity than standard techniques.
Aim: To precise the technical aspects of the esophageal impedancepH monitoring, indications and results of this technique in clinical practice.
Methods: Literature revue of the esophageal impedance - pH monitoring
Results: Combined multichannel intraluminal impedance and pH monitoring is a new technique that can be used to evaluate both bolus transport and all types of reflux (acid, weakly acidic and weakly alkaline), without radiation hazards. With this technique, higher rates of sensitivity and specificity than standard techniques are obtained in the diagnosis of pathological gastroesophageal reflux. The technique has also been used in the evaluation of atypical gastroesophageal reflux symptoms, in the assessment of the association of different patterns of reflux with symptoms, and in the evaluation of therapeutic outcome mainly in patients with refractory gastroesophageal reflux disease.
Conclusion: The esophageal impedance represents real progress in understanding the different mechanisms involved in the pathophysiology of gastroesophageal reflux. This technique should also allow a better understanding of the responsibility of non-acid reflux in special clinical situations, such as patients resistant to antisecretory or extra-intestinal manifestations of gastroesophageal reflux.

Keywords:

Gastroesophageal reflux disease, esophageal pH monitoring, esophageal impedance monitoring

##plugins.themes.academic_pro.article.details##

References

  1. Bommelaer G. Reflux gastro-oesophagien de l'adulte : Définition, épidémiologie, histoire naturelle. Conference de consensus. Gastoenterol Clin Biol 1999; 23 suppl 1 bis: S3-S9.
  2. Fass R. Epidemiology and physiopathology of symptomatic gastro-esophageal reflux disease. Am J Gastroenterol 2003; 98 suppl 3 : 52-57.
  3. Picon L, Bruley Des Varannes S. Recommandations pour la pratique de la pH-métrie oesophagienne chez l'adulte. Gastroenterol Clin Biol 2000; 24: 931-43.
  4. Kahrilas P J, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996; 110: 1982- 96.
  5. Sliny J. Intra luminal multiple electric impedance procedure for measurement of gastrointestinal motility. Gastrointest Motil 1991; 3: 151-62.
  6. Silny J, Knigee KP, Fass J et al. Verification of the intraluminal electrical impedance measurement for the recording of the gastrointestinal motility. J Gastrointest Motil 1993; 5: 107-22.
  7. Sifirm D, Castell D, Dent J et al. Gastro-esophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid and gas reflux. Gut 2004; 53 : 1024-31.
  8. Roman S, Bruley des Varannes S, Pouderoux P et al. Ambulatory 24-h esophageal impedance- pH recording: reliability of automatic analysis for gastro-esophageal reflux assessment. Neurogastroenterol Motil 2006; 18: 978-86.
  9. Shay S, Tutuian R, Sifirm D et al. Twenty-four hours ambulatory simultaneous impedance and pH monitoring : a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 2004; 99: 1037-43.
  10. Zerbib F, Bruley des Varannes S, Roman S et al. Normal values and day- to-day variability of 24-h ambulatory esophageal impedance -pH monitoring in a Belgian-french cohort of healthy subjects. Aliment Pharmacol Ther 2005; 22: 1011-21.
  11. Tutuian R, Mainie I, Agrawal A et al. Normal values for ambulatory 24-h combined impedance-pH monitoring on acid suppressive therapy. Gastroenterology 2006; 130: A171.
  12. Bredenoord AJ, Weusten BL, Timmer R et al. Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy. Am J Gastroenterol 2006; 101: 1956-63.
  13. Zerbib F, Roman S, Ropert A et al. Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 2006; 101: 1956-63.
  14. Galmiche JP, Bruley des Varannes S. Endoscopy-negative reflux disease. Current Gastroenterology Reports 2001; 3: 206-14.
  15. Helsingen N. Esophagitis following total gastrectomy. Acta Chir Scand 1959; 118: 190-201.
  16. Orlando RC, Bozymski EM. Heartburn in pernicious anemia - a consequence of bile reflux. N Engl J Med 1973 ; 289 : 522-3.
  17. Wenzel T, Moroder C, Trachtema M et al. Esophageal pH monitoring and impesdance measurement: a comparaison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2002; 34:519-606.
  18. Vela MF, Camacho-Lobato L, Srinivasan R. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux : effect of omeprazole. Gastroenterology 2001; 120: 1599- 606.
  19. Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure. Am J Gastroenterol 2006; 101:2470-5.
  20. Mainie I, Tutuian R, Shay S, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy : A multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006; 55:1398-402
  21. Benkhaldoun L, Roman S, Ropert A et al. ENT Symptoms and non acid gastro-esophageal reflux. A study with 24-hour ambulatory esophageal pH-impedance in patients off and on PPI therapy. Gastroenterology 2007; 132: A480.
  22. Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 2005; 54:449-54.
  23. Tutuian R, Mainie I, Agrawal A, Adams D, Castell DO. Non acid reflux in patients with chronic cough on acid-suppressive therapy. Chest 2006; 130:386-91.
  24. Blondeau K, Dupont LJ, Mertens V et al. Improved diagnosis of gastroesophageal reflux in patients with unexplained chronic cough. Aliment Pharmacol Ther 2007; 25: 723-32.
  25. Mainie I, Tutuian R, Agrawal A et al. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 2006;93:1483-7.