Combined Multi-channel Intraluminal Impedance and pH Testing Compared to pH Testing Alone for Diagnosing Gastro-esophageal Acid Reflux

Objectives. Cough, pain, and desaturation episodes in infants are often ascribed to gastroesophageal reflux, and many are empirically treated with acid suppression medications. The authors hypothesize that most of these symptoms are not related to gastroesophageal reflux. Methods. Retrospective review of 186 combined pH–multichannel intraluminal impedance studies performed in infants at Cincinnati Children’s Hospital. Results. Of 4159 symptoms reported 1504 (36%) were associated with reflux events (27% nonacid and 9% acid). When total number of symptoms and reflux events were taken into consideration, nonacid reflux events were as likely to be associated with a symptom as acid reflux events ( P = .66). Conclusion. The extra-esophageal symptoms commonly attributed to gastroesophageal reflux in infants are most often not associated with a reflux event. Even though causality cannot be definitively proven, in the minority in whom a symptom association is observed, nonacid events are as likely as acid events to cause symptoms.

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Non-Acid Reflux: Detection by Multichannel Intraluminal Impedance and pH, Clinical Significance and Management

The American Journal of Gastroenterology ◽

10.1038/ajg.2008.23 ◽

2009 ◽

Vol 104 (2) ◽

pp. 277-280 ◽

Cited By ~ 32

Author(s):

Marcelo F Vela

Keyword(s):

Clinical Significance ◽

Acid Reflux ◽

Multichannel Intraluminal Impedance ◽

Intraluminal Impedance

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The Effect of Laparoscopic Nissen Fundoplication (LNF) on Acid and Non Acid Reflux. A Prospective Evaluation at 1, 3 and 6 Months Using 24-h pH-Multichannel Intraluminal Impedance (MII-pH)

Gastroenterology ◽

10.1016/s0016-5085(11)64227-3 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-1017-S-1018

Author(s):

Antonio Ramos-De la Medina ◽

Maura Torres-Aguilera ◽

Maria Fernanda Gonzalez-Medina ◽

Alberto Aviles-Calderon ◽

Federico B. Roesch ◽

...

Keyword(s):

Nissen Fundoplication ◽

Acid Reflux ◽

Laparoscopic Nissen Fundoplication ◽

Prospective Evaluation ◽

Multichannel Intraluminal Impedance ◽

Intraluminal Impedance ◽

Laparoscopic Nissen

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Critical Analysis of Esophageal Multichannel Intraluminal Impedance Monitoring 20 Years Later

ISRN Gastroenterology ◽

10.5402/2012/903240 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 9

Author(s):

Fernando A. M. Herbella

Keyword(s):

Critical Analysis ◽

Acid Reflux ◽

Clinical Applications ◽

Multichannel Intraluminal Impedance ◽

Esophageal Diseases ◽

Esophageal Function ◽

Bolus Transit ◽

Intraluminal Impedance ◽

Esophageal Physiology ◽

Impedance Monitoring

Multichannel intraluminal impedance (MII) for the evaluation of esophageal diseases was created in 1991 trying to solve previous limitations of esophageal function test. MII-pH is able to determine the physical characteristics of the refluxate (liquid, gas, or mixed) and nonacidic GER. MII-manometry can determine the presence of bolus and its relation with peristalsis. This paper makes a critical analysis of the clinical applications of MII 20 years after its creation. Literature review shows that MII made great contributions for the understanding of esophageal physiology; however, direct clinical applications are few. MII-pH was expected to identify patients with normal acid reflux and abnormal nonacidic reflux. These patients are rarely found off therapy, that is, nonacidic reflux parallels acid reflux. Furthermore, the significance of isolated nonacidic reflux is unclear. Contradictory MII-manometry and conventional manometry findings lack better understanding and clinical implication as well as the real significance of bolus transit.

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Advances in the Diagnosis of GERD Using the Esophageal pH Monitoring, Gastro-Esophageal Impedance-pH Monitoring, And Pitfalls

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.410 ◽

2018 ◽

Vol 6 (10) ◽

pp. 1934-1940 ◽

Cited By ~ 2

Author(s):

Mojgan Foroutan ◽

Homayoun Zojaji ◽

Mohammad Javad Ehsani ◽

Mohammad Darvishi

Keyword(s):

Ph Monitoring ◽

Acid Reflux ◽

Weak Acid ◽

Chemical Parameters ◽

Intraluminal Impedance ◽

Physical And Chemical Parameters ◽

Esophageal Impedance ◽

Multichannel Intraluminal Impedance Ph ◽

Physical And Chemical ◽

Normal Acid

PH monitoring is not capable of detecting all types of reflux, especially when the amount of acid is very low or not at all in the refluxate. Multichannel intraluminal impedance-pH monitoring (MII-pH) is used as a new method to assess bolus transport. The types of reflexes including acid, weak acid and weak alkaline MII-pH is capable of distinguishing more reflux episodes based upon use of physical and chemical parameters of the refluxate, leads to a diagnosis of normal acid reflux from abnormal nonacidic reflux. 24-h oesophagal pH monitoring can be effectively used to assess the potential relationship between symptoms and refluxes. MII-pH is capable of distinguishing more reflux episodes based upon use of physical and chemical parameters of the refluxate, leads to a diagnosis of normal acid reflux from abnormal nonacidic reflux. It can be used to confirm gastro-oesophagal reflux episodes, where has a sensitivity and specificity for diagnosing GERD in comparison with endoscopy or pH-metry.

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Strong Intra-Esophageal Reflux May Contribute to the Development of Barrett’s Adenocarcinoma and Affect the Localization

Digestion ◽

10.1159/000502377 ◽

2019 ◽

Vol 101 (6) ◽

pp. 752-760

Author(s):

Masahiro Saito ◽

Tomoyuki Koike ◽

Kenichiro Nakagawa ◽

Yasuaki Abe ◽

Kazuaki Norita ◽

...

Keyword(s):

Ph Monitoring ◽

Acid Reflux ◽

Esophageal Reflux ◽

Multichannel Intraluminal Impedance ◽

Weakly Acid ◽

Intraluminal Impedance ◽

Total Reflux ◽

Barrett’S Adenocarcinoma ◽

Acid Exposure Time ◽

Multichannel Intraluminal Impedance Ph

Background: There has been no study that has directly measured the esophageal reflux factors in Barrett’s adenocarcinoma (BA) using 24-h multichannel intraluminal impedance-pH monitoring (24-h MII-pH). We aimed to clarify the esophageal reflux factors in Barrett’s esophagus (BE) and BA and the factors that determine the location of BA with 24-h MII-pH. Methods: We performed 24-h MII-pH in 26 patients with superficial BA treated endoscopically (BA group) and 13 patients with BE (BE group) and examined the esophageal reflux factors (esophageal acid exposure time [AET], bolus exposure (acid, weakly acid, and alkaline), and number of reflux episodes. In the BA group, there were 16 cases in which the lesions were localized in an area in contact with the esophagogastric junction (EGJ; EGJ group), and 10 cases in which the lesions were proximal to the BE and separated from the EGJ (non-EGJ group). Results: Total reflux in the bolus exposure in the BA group showed higher values compared to that in the BE group. The total of acid and weakly acid reflux of bolus exposure was significantly higher in the BA group than that in the BE group. The BA group also had greater numbers of total reflux episodes than the BE group. As for the cancer locations in BE, the cases in which the lesions were located proximally and separated from the EGJ had more AET and total reflux and acid reflux indicated by bolus exposure compared to the lesions adjacent to the EGJ. Conclusions: Stronger gastro-esophageal reflux appeared to be an important factor in the development of adenocarcinoma from BE. In addition, the cancer location in BE may be related to the intensity of esophageal reflux.

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