Presentations in GERD: Addition of Esophageal Intraluminal Impedance Recording to EsophageaI pH Monitoring Increases Diagnostic Yield
Esophageal intraluminal impedance recording can be useful for characterizing the components of GERD and for discerning weak or nonacidic GERD, which would be missed by standard esophageal pH monitoring. The current study quantified the diagnostic gain contributed by pH-impedance recording in 220 patients who were undergoing evaluations for typical GERD symptoms (133 patients), respiratory symptoms (44 patients), oropharyngeal symptoms (24 patients), and chest pain (11 patients). GERD, defined as acid exposure of more than 5.8%, was diagnosed in 40.9% of patients. Weakly acidic or nonacidic reflux, defined as having at least 75 GERD events within 24 hours but with less than 5.8% acid exposure, was diagnosed in 12.7% of patients. The study investigated the correlation between symptoms and reflux, defined as symptom association probability (SAP). A SAP of at least 95% indicated an association between symptoms and reflux. Overall, 12.7% of patients had a SAP of less than 95% for acidic GERD and a lack of quantitative GERD, a condition defined as hypersensitive esophagus to acid reflux. Another 9.1% of patients were diagnosed with hypersensitive esophagus to weak/nonacidic reflux, indicating a lack of quantitative GERD and a SAP of less than 95% for weak/nonacidic GERD. The remaining 27.3% included patients with normal pH impedance outcomes. No significant differences were noted between these subgroups in regard to age, gender, indication, or response to PPI therapy. The coupling of impedance to pH monitoring identified 28 cases of weak/nonacidic GERD and 20 cases of hypersensitive esophagus to weak or nonacid reflux, resulting in an overall diagnostic gain of 21%. The investigators added that the diagnostic gain attained with impedance occurred regardless of symptoms. viagra plus
