Novel impedance‐pH parameters are associated with proton pump inhibitor response in patients with inconclusive diagnosis of gastro‐oesophageal reflux disease according to Lyon Consensus

Summary Background The Lyon Consensus delineates impedance‐pH parameters that can demonstrate/exclude gastro‐oesophageal reflux disease (GERD). In patients with acid exposure time between 4% and 6%, GERD diagnosis has been considered inconclusive. In these cases, mean nocturnal baseline impedance (MNBI) and post‐reflux swallow‐induced peristaltic wave (PSPW) index may either confirm or refute GERD diagnosis and represent predictors of proton pump inhibitor (PPI) response. Aims To investigate the diagnostic yield of MNBI and PSPW index and their relationship with PPI response in patients with inconclusive GERD diagnosis. Methods Review of impedance‐pH tracings from PPI responder/non‐responder patients with typical reflux symptoms. Multivariate regression analysis was performed to determine the association of MNBI and PSPW index to PPI response. Results Among 233 patients evaluated, 145/233 (62.2%) were PPI responders; 62 had conclusive and 65 inconclusive evidence of GERD, 46 had reflux hypersensitivity, and 60 functional heartburn. Abnormal MNBI and PSPW index were significantly more frequent in inconclusive GERD as compared to the functional heartburn group (P