scholarly journals Can acid exposure time replace the DeMeester score in the diagnosis of gastroesophageal reflux-induced cough?

2021 ◽  
Vol 12 ◽  
pp. 204062232110567
Author(s):  
Yiqing Zhu ◽  
Junjun Tang ◽  
Wenbo Shi ◽  
Shengyuan Wang ◽  
Mingyan Wu ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Exposure Time ◽  
Ph Monitoring ◽  
Diagnostic Value ◽  
Acid Exposure ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Demeester Score ◽  
Symptom Association Probability ◽  
Acid Exposure Time

Background: The objective of this study was to compare the predictive accuracy of the acid exposure time (AET) with the DeMeester score (DMS) for gastroesophageal reflux–induced cough (GERC). Methods: A total of 277 patients who underwent multichannel intraluminal impedance pH monitoring (MII-pH) were enrolled, and their clinical information and laboratory results were retrospectively analyzed. The diagnostic value of AET for GERC was compared with that of the DMS, symptom association probability (SAP), and symptom index (SI). Results: A total of 236 patients met the inclusion criteria, 150 patients (63.65%) were definitely diagnosed with GERC, including 111(74%) acid GERC and 39 (26%) nonacid GERC. The optimal cutoff value of AET for diagnosing GERC was AET > 4.8%, and its diagnostic value was equal to that of DMS > 14.7 (AUC = 0.827 versus 0.818, p = 0.519) and was superior to that of SAP (AUC = 0.827 versus 0.689, p = 0.000) and SI (AUC = 0.827 versus 0.688, p = 0.000). When using both DMS > 14.7 and AET > 4.8% or either of the two for the diagnosis of GERC, the diagnosis rate was not improved over using DMS > 14.7 alone. The diagnostic value of AET and DMS for acid GERC were both high and equivalent (AUC = 0.925 versus 0.922, p = 0.95). The optimal cutoff value of AET for diagnosing acid GERC was AET > 6.2%. Conclusion: AET and DMS are both equal in discriminating GERC. A GERC diagnosis should be considered when AET > 4.8%, whereas an acid GERC diagnosis should be considered when AET > 6.2%.

Lack of Correlation Between Subjective and Objective Measures of Gastroesophageal Reflux Disease: Call for a Novel Validated Assessment Tool

2020 ◽  
pp. 155335062095503
Author(s):  
Brittany L. Kothari ◽  
Andrew J. Borgert ◽  
Kara J. Kallies ◽  
Shanu N. Kothari
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux Disease ◽  
Exposure Time ◽  
Acid Exposure ◽  
Objective Measures ◽  
Demeester Score ◽  
Related Quality ◽  
The Mean ◽  
Acid Exposure Time

Background. Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients’ subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity. Methods. A retrospective review of the medical records of patients who underwent antireflux surgery from 2013-2018 was completed. Patients’ GERD severity was measured preoperatively and postoperatively using the GERD-HRQL. Statistical analysis included the calculation of Spearman correlation coefficients, Wilcoxon rank sum, sign, and chi-square tests. Results. 151 patients were included in the study; 64% were female. The mean age and BMI were 54.6 ± 14.6 years and 30.1 ± 4.1 kg/m2, respectively. The mean preoperative DeMeester score was 43.1 ± 36.1, LES pressure was 19.9 ± 18.4 mmHg, and acid exposure time was 11.4 ± 9.6. Mean GERD-HRQL scores decreased from 27.3 ± 9.2 preoperative to 5.3 ± 4.5 postoperative; P < .0001. Preoperative GERD-HRQL scores were not correlated with the DeMeester score ( r = .11; P = .389), LES pressure ( r = −.20; P = .089), acid exposure time ( r = .05; P = .755), BMI ( r = .10; P = .329), or age ( r = −.16; P = .118). Conclusions. Total GERD-HRQL scores significantly decreased from pre- to postoperative. There was no correlation between subjective and objective GERD scoring. These data indicate the need for both physiologic evaluation and subjective assessment of patient symptoms during preoperative workup. There is a need for a contemporary, validated GERD questionnaire that correlates with objective pH testing.

Nasogastric Feeding Tubes May Not Contribute to Gastroesophageal Reflux in Preterm Infants

2017 ◽  
Vol 35 (07) ◽  
pp. 643-647 ◽  
Author(s):  
Swati Murthy ◽  
Apryle Funderburk ◽  
Sheeja Abraham ◽  
Michele Epstein ◽  
Joan DiPalma ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Preterm Infants ◽  
Ph Monitoring ◽  
Feeding Tube ◽  
Acid Exposure ◽  
Total Fluid Intake ◽  
Nasogastric Feeding ◽  
Intraluminal Impedance ◽  
Significant Difference ◽  
Acid Exposure Time

Objective The objective was to determine if the presence of a nasogastric (NG) feeding tube is associated with increased gastroesophageal reflux (GER) and acid exposure in preterm infants. Study Design This is a retrospective study on preterm infants [gestational age (GA) <37 weeks] who were evaluated by multichannel intraluminal impedance and pH monitoring (MII-pH) between October 2009 and March 2016. Infants were divided into two groups, NG tube present and no feeding tube. GER events per hour and the percent of time with pH <4 during a 24-hour period were then compared. Results Eighty-three infants were included, 41 had an NG tube present and 42 did not. The group without an NG tube had significantly more reflux events per hour (2.3 ± 2.9 vs. 1.3 ± 0.8, p < 0.05) even after adjusting for differences in birth weight, GA, corrected GA, and total fluid intake. There was no significant difference in acidic events per hour and acid exposure time between the two groups. Conclusion The presence of a 5-French NG tube is not associated with an increase in GER or acid exposure in preterm infants. In fact, it appears that infants fed through an NG tube have fewer episodes of GER.

scholarly journals Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes

2011 ◽  
Vol 48 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Gerson Ricardo de Souza Domingues ◽  
Joaquim Prado P. Moraes-Filho ◽  
Aline Gonçalves Leite Domingues
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Diagnostic Yield ◽  
Ph Monitoring ◽  
Esophageal Acid Exposure ◽  
Acid Exposure ◽  
Esophageal Ph ◽  
Symptom Association Probability ◽  
Wireless Capsule

CONTEXT: Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring. OBJECTIVES: To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. METHODS: A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. RESULTS: Successful pH data over 48-h was obtained in 95% of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4%) that would be missed if only day 1 was analyzed. Three patients (18.7%) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4%. CONCLUSION: Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.

Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux

2021 ◽  
pp. 000348942110374
Author(s):  
Grace E. Snow ◽  
Mohamad Dbouk ◽  
Lee M. Akst ◽  
Glenn Ihde ◽  
Rasa Zarnegar ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Gastroesophageal Reflux ◽  
Exposure Time ◽  
Esophageal Acid Exposure ◽  
Acid Exposure ◽  
Hiatal Hernia Repair ◽  
Transoral Incisionless Fundoplication ◽  
Objective Evidence ◽  
Patient Reported ◽  
Acid Exposure Time

Objective: Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. Methods: Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett’s esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. Results: Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P < .001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF ( P < .001). Conclusion: In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. Level of Evidence Level 4

Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance Predict Heartburn Response to Proton Pump Inhibitors Better than Acid Exposure Time in GERD

2017 ◽  
Vol 152 (5) ◽  
pp. S652-S653
Author(s):  
Leonardo Frazzoni ◽  
Marzio Frazzoni ◽  
Nicola de Bortoli ◽  
Salvatore Tolone ◽  
Manuele Furnari ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Exposure Time ◽  
Proton Pump ◽  
Acid Exposure ◽  
Peristaltic Wave ◽  
Acid Exposure Time ◽  
Better Than
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