24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms
Background The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo ® ) capsule...
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| Veröffentlicht in: | Surgical endoscopy 2015-07, Vol.29 (7), p.1700-1708 |
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| creator | Han, Michelle S. Lada, Michal J. Nieman, Dylan R. Tschoner, Andreas Peyre, Christian G. Jones, Carolyn E. Watson, Thomas J. Peters, Jeffrey H. |
| description | Background
The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo
®
) capsule; however, discrepancies between the two systems exist. In patients with atypical symptoms, MII-pH catheter is often used preferentially. We aimed to elucidate the magnitude of this discrepancy and to assess the diagnostic value of MII-pH and the Bravo wireless capsule in a population of patients with mixed respiratory and typical symptoms.
Methods
The study population consisted of 66 patients tested with MII-pH and Bravo pH testing within 90 days between July 2009 and 2013. All patients presented with laryngo-pharyngo-respiratory (LPR) symptoms. Patient demographics, symptomatology, manometric and endoscopic findings, and pH monitoring parameters were analyzed. Patients were divided into four comparison groups: both pH tests positive, MII-pH negative/Bravo positive, MII-pH positive/Bravo negative, and both pH tests negative.
Results
Nearly half of the patients (44 %) had discordant pH test results. Of these, 90 % (26/29) had a negative MII-pH but positive Bravo study. In this group, the difference in the DeMeester score was large, a median of 29.3. These patients had a higher BMI (28.5 vs. 26.1,
p
= 0.0357), were more likely to complain of heartburn (50 vs. 23 %,
p
= 0.0110), to have a hiatal hernia, (85 vs. 53 %,
p
= 0.0075) and a structurally defective lower esophageal sphincter (LES, 85 vs. 58 %,
p
= 0.0208).
Conclusions
In patients with LPR symptoms, we found a high prevalence of discordant esophageal pH results, most commonly a negative MII-pH catheter and positive Bravo. As these patients exhibited characteristics consistent with GERD (heartburn, defective LES, hiatal hernia), the Bravo results are likely true. A 24-h MII-pH catheter study may be inadequate to diagnose GERD in this patient population. |
| doi_str_mv | 10.1007/s00464-014-3867-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1690209894</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1690209894</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-70524cbbae300494076cc8db8738a3a070bd507924e067f7696c14a50d04da383</originalsourceid><addsrcrecordid>eNp1kc9u1DAQhyMEokvhAbggS1y4BMZ_EsdHVAFFqsQFztHEnt11lTip7YjuM_GSONoWISRO1kjf_MYzX1W95vCeA-gPCUC1qgauatm1uuZPqh1XUtRC8O5ptQMjoRbaqIvqRUq3UHDDm-fVhWik6bgRu-qXUPWRTeuYvT1iCDQyH3LEcZ18wFJMCzkMlurlmk1z8HmOPhzYhCc2EMNQcHR0t2Imlilltp8jc5TJ5o07YMpxpjQvRzxQCYy0H9f70sUWzJ5CTuynz-UL_p4cy6fF20JhcAwfi3SaljxP6WX1bI9jolcP72X14_On71fX9c23L1-vPt7UVmqRaw2NUHYYkOS2sALdWtu5odOyQ4mgYXANaCMUQav3ujWt5QobcKAcyk5eVu_OuUuc79ayUz_5ZGkcMdC8pp63BgSYzqiCvv0HvZ3XWA63UZ1pGgPcFIqfKRvnlMoF-iX6CeOp59BvJvuzyb6Y7DeTPS89bx6S12Ei96fjUV0BxBlIy2aE4l-j_5v6G8k4q9I</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1689559019</pqid></control><display><type>article</type><title>24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Han, Michelle S. ; Lada, Michal J. ; Nieman, Dylan R. ; Tschoner, Andreas ; Peyre, Christian G. ; Jones, Carolyn E. ; Watson, Thomas J. ; Peters, Jeffrey H.</creator><creatorcontrib>Han, Michelle S. ; Lada, Michal J. ; Nieman, Dylan R. ; Tschoner, Andreas ; Peyre, Christian G. ; Jones, Carolyn E. ; Watson, Thomas J. ; Peters, Jeffrey H.</creatorcontrib><description>Background
The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo
®
) capsule; however, discrepancies between the two systems exist. In patients with atypical symptoms, MII-pH catheter is often used preferentially. We aimed to elucidate the magnitude of this discrepancy and to assess the diagnostic value of MII-pH and the Bravo wireless capsule in a population of patients with mixed respiratory and typical symptoms.
Methods
The study population consisted of 66 patients tested with MII-pH and Bravo pH testing within 90 days between July 2009 and 2013. All patients presented with laryngo-pharyngo-respiratory (LPR) symptoms. Patient demographics, symptomatology, manometric and endoscopic findings, and pH monitoring parameters were analyzed. Patients were divided into four comparison groups: both pH tests positive, MII-pH negative/Bravo positive, MII-pH positive/Bravo negative, and both pH tests negative.
Results
Nearly half of the patients (44 %) had discordant pH test results. Of these, 90 % (26/29) had a negative MII-pH but positive Bravo study. In this group, the difference in the DeMeester score was large, a median of 29.3. These patients had a higher BMI (28.5 vs. 26.1,
p
= 0.0357), were more likely to complain of heartburn (50 vs. 23 %,
p
= 0.0110), to have a hiatal hernia, (85 vs. 53 %,
p
= 0.0075) and a structurally defective lower esophageal sphincter (LES, 85 vs. 58 %,
p
= 0.0208).
Conclusions
In patients with LPR symptoms, we found a high prevalence of discordant esophageal pH results, most commonly a negative MII-pH catheter and positive Bravo. As these patients exhibited characteristics consistent with GERD (heartburn, defective LES, hiatal hernia), the Bravo results are likely true. A 24-h MII-pH catheter study may be inadequate to diagnose GERD in this patient population.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-014-3867-1</identifier><identifier>PMID: 25398192</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Acids ; Catheters ; Data collection ; Electric Impedance ; Endoscopy ; Esophageal pH Monitoring - instrumentation ; Esophageal Sphincter, Lower - metabolism ; Esophageal Sphincter, Lower - physiopathology ; Esophagus ; Female ; Gastroenterology ; Gastroesophageal reflux ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - diagnosis ; Gastroesophageal Reflux - metabolism ; Gastrointestinal surgery ; Gynecology ; Heartburn - diagnosis ; Heartburn - etiology ; Hepatology ; Hiatal hernias ; Humans ; Male ; Manometry ; Medicine ; Medicine & Public Health ; Middle Aged ; Patients ; Proctology ; Surgery</subject><ispartof>Surgical endoscopy, 2015-07, Vol.29 (7), p.1700-1708</ispartof><rights>Springer Science+Business Media New York 2014</rights><rights>Springer Science+Business Media New York 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-70524cbbae300494076cc8db8738a3a070bd507924e067f7696c14a50d04da383</citedby><cites>FETCH-LOGICAL-c372t-70524cbbae300494076cc8db8738a3a070bd507924e067f7696c14a50d04da383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-014-3867-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-014-3867-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25398192$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Han, Michelle S.</creatorcontrib><creatorcontrib>Lada, Michal J.</creatorcontrib><creatorcontrib>Nieman, Dylan R.</creatorcontrib><creatorcontrib>Tschoner, Andreas</creatorcontrib><creatorcontrib>Peyre, Christian G.</creatorcontrib><creatorcontrib>Jones, Carolyn E.</creatorcontrib><creatorcontrib>Watson, Thomas J.</creatorcontrib><creatorcontrib>Peters, Jeffrey H.</creatorcontrib><title>24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo
®
) capsule; however, discrepancies between the two systems exist. In patients with atypical symptoms, MII-pH catheter is often used preferentially. We aimed to elucidate the magnitude of this discrepancy and to assess the diagnostic value of MII-pH and the Bravo wireless capsule in a population of patients with mixed respiratory and typical symptoms.
Methods
The study population consisted of 66 patients tested with MII-pH and Bravo pH testing within 90 days between July 2009 and 2013. All patients presented with laryngo-pharyngo-respiratory (LPR) symptoms. Patient demographics, symptomatology, manometric and endoscopic findings, and pH monitoring parameters were analyzed. Patients were divided into four comparison groups: both pH tests positive, MII-pH negative/Bravo positive, MII-pH positive/Bravo negative, and both pH tests negative.
Results
Nearly half of the patients (44 %) had discordant pH test results. Of these, 90 % (26/29) had a negative MII-pH but positive Bravo study. In this group, the difference in the DeMeester score was large, a median of 29.3. These patients had a higher BMI (28.5 vs. 26.1,
p
= 0.0357), were more likely to complain of heartburn (50 vs. 23 %,
p
= 0.0110), to have a hiatal hernia, (85 vs. 53 %,
p
= 0.0075) and a structurally defective lower esophageal sphincter (LES, 85 vs. 58 %,
p
= 0.0208).
Conclusions
In patients with LPR symptoms, we found a high prevalence of discordant esophageal pH results, most commonly a negative MII-pH catheter and positive Bravo. As these patients exhibited characteristics consistent with GERD (heartburn, defective LES, hiatal hernia), the Bravo results are likely true. A 24-h MII-pH catheter study may be inadequate to diagnose GERD in this patient population.</description><subject>Abdominal Surgery</subject><subject>Acids</subject><subject>Catheters</subject><subject>Data collection</subject><subject>Electric Impedance</subject><subject>Endoscopy</subject><subject>Esophageal pH Monitoring - instrumentation</subject><subject>Esophageal Sphincter, Lower - metabolism</subject><subject>Esophageal Sphincter, Lower - physiopathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - complications</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Gastroesophageal Reflux - metabolism</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Heartburn - diagnosis</subject><subject>Heartburn - etiology</subject><subject>Hepatology</subject><subject>Hiatal hernias</subject><subject>Humans</subject><subject>Male</subject><subject>Manometry</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Proctology</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc9u1DAQhyMEokvhAbggS1y4BMZ_EsdHVAFFqsQFztHEnt11lTip7YjuM_GSONoWISRO1kjf_MYzX1W95vCeA-gPCUC1qgauatm1uuZPqh1XUtRC8O5ptQMjoRbaqIvqRUq3UHDDm-fVhWik6bgRu-qXUPWRTeuYvT1iCDQyH3LEcZ18wFJMCzkMlurlmk1z8HmOPhzYhCc2EMNQcHR0t2Imlilltp8jc5TJ5o07YMpxpjQvRzxQCYy0H9f70sUWzJ5CTuynz-UL_p4cy6fF20JhcAwfi3SaljxP6WX1bI9jolcP72X14_On71fX9c23L1-vPt7UVmqRaw2NUHYYkOS2sALdWtu5odOyQ4mgYXANaCMUQav3ujWt5QobcKAcyk5eVu_OuUuc79ayUz_5ZGkcMdC8pp63BgSYzqiCvv0HvZ3XWA63UZ1pGgPcFIqfKRvnlMoF-iX6CeOp59BvJvuzyb6Y7DeTPS89bx6S12Ei96fjUV0BxBlIy2aE4l-j_5v6G8k4q9I</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Han, Michelle S.</creator><creator>Lada, Michal J.</creator><creator>Nieman, Dylan R.</creator><creator>Tschoner, Andreas</creator><creator>Peyre, Christian G.</creator><creator>Jones, Carolyn E.</creator><creator>Watson, Thomas J.</creator><creator>Peters, Jeffrey H.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150701</creationdate><title>24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms</title><author>Han, Michelle S. ; Lada, Michal J. ; Nieman, Dylan R. ; Tschoner, Andreas ; Peyre, Christian G. ; Jones, Carolyn E. ; Watson, Thomas J. ; Peters, Jeffrey H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-70524cbbae300494076cc8db8738a3a070bd507924e067f7696c14a50d04da383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Surgery</topic><topic>Acids</topic><topic>Catheters</topic><topic>Data collection</topic><topic>Electric Impedance</topic><topic>Endoscopy</topic><topic>Esophageal pH Monitoring - instrumentation</topic><topic>Esophageal Sphincter, Lower - metabolism</topic><topic>Esophageal Sphincter, Lower - physiopathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Gastroesophageal Reflux - metabolism</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Heartburn - diagnosis</topic><topic>Heartburn - etiology</topic><topic>Hepatology</topic><topic>Hiatal hernias</topic><topic>Humans</topic><topic>Male</topic><topic>Manometry</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Proctology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Han, Michelle S.</creatorcontrib><creatorcontrib>Lada, Michal J.</creatorcontrib><creatorcontrib>Nieman, Dylan R.</creatorcontrib><creatorcontrib>Tschoner, Andreas</creatorcontrib><creatorcontrib>Peyre, Christian G.</creatorcontrib><creatorcontrib>Jones, Carolyn E.</creatorcontrib><creatorcontrib>Watson, Thomas J.</creatorcontrib><creatorcontrib>Peters, Jeffrey H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Han, Michelle S.</au><au>Lada, Michal J.</au><au>Nieman, Dylan R.</au><au>Tschoner, Andreas</au><au>Peyre, Christian G.</au><au>Jones, Carolyn E.</au><au>Watson, Thomas J.</au><au>Peters, Jeffrey H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>29</volume><issue>7</issue><spage>1700</spage><epage>1708</epage><pages>1700-1708</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo
®
) capsule; however, discrepancies between the two systems exist. In patients with atypical symptoms, MII-pH catheter is often used preferentially. We aimed to elucidate the magnitude of this discrepancy and to assess the diagnostic value of MII-pH and the Bravo wireless capsule in a population of patients with mixed respiratory and typical symptoms.
Methods
The study population consisted of 66 patients tested with MII-pH and Bravo pH testing within 90 days between July 2009 and 2013. All patients presented with laryngo-pharyngo-respiratory (LPR) symptoms. Patient demographics, symptomatology, manometric and endoscopic findings, and pH monitoring parameters were analyzed. Patients were divided into four comparison groups: both pH tests positive, MII-pH negative/Bravo positive, MII-pH positive/Bravo negative, and both pH tests negative.
Results
Nearly half of the patients (44 %) had discordant pH test results. Of these, 90 % (26/29) had a negative MII-pH but positive Bravo study. In this group, the difference in the DeMeester score was large, a median of 29.3. These patients had a higher BMI (28.5 vs. 26.1,
p
= 0.0357), were more likely to complain of heartburn (50 vs. 23 %,
p
= 0.0110), to have a hiatal hernia, (85 vs. 53 %,
p
= 0.0075) and a structurally defective lower esophageal sphincter (LES, 85 vs. 58 %,
p
= 0.0208).
Conclusions
In patients with LPR symptoms, we found a high prevalence of discordant esophageal pH results, most commonly a negative MII-pH catheter and positive Bravo. As these patients exhibited characteristics consistent with GERD (heartburn, defective LES, hiatal hernia), the Bravo results are likely true. A 24-h MII-pH catheter study may be inadequate to diagnose GERD in this patient population.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>25398192</pmid><doi>10.1007/s00464-014-3867-1</doi><tpages>9</tpages></addata></record> |
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| ispartof | Surgical endoscopy, 2015-07, Vol.29 (7), p.1700-1708 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Acids Catheters Data collection Electric Impedance Endoscopy Esophageal pH Monitoring - instrumentation Esophageal Sphincter, Lower - metabolism Esophageal Sphincter, Lower - physiopathology Esophagus Female Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - complications Gastroesophageal Reflux - diagnosis Gastroesophageal Reflux - metabolism Gastrointestinal surgery Gynecology Heartburn - diagnosis Heartburn - etiology Hepatology Hiatal hernias Humans Male Manometry Medicine Medicine & Public Health Middle Aged Patients Proctology Surgery |
| title | 24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms |
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