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The Diagnostic Yield of Novel Parameters in Reflux Monitoring

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Diagnosis and Endoscopic Management of Digestive Diseases

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Abstract

Impedance-pH monitoring is the most complete reflux test, allowing a full assessment of all reflux episodes, independent of their acidity. It allows assessment of esophageal clearance and of mucosal integrity by means of two recently proposed quantitative impedance parameters, namely, the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI). Following a reflux episode, secondary peristalsis removes around 90 % of the refluxate (volume clearance); however, esophageal pH is restored only after a swallow elicited by an esophagosalivary reflex delivering salivary bicarbonate (chemical clearance). The PSPW index allows assessment of chemical clearance following acid as well as weakly acidic refluxes with lower values detected in erosive than in non-erosive reflux disease, both significantly lower than in functional heartburn. Impairment of mucosal integrity, even in the absence of macroscopic damage, determines low diurnal and nocturnal baseline impedance. The MNBI consists of the mean of three 10-min nighttime periods, accurately reflecting the 6-h nocturnal bedtime period: lower values have been found in PPI-responsive heartburn patients with normal conventional impedance-pH parameters when compared to PPI refractory cases. The PSPW index and the MNBI have recently been shown to increase the diagnostic yield of impedance-pH monitoring in patients with reflux disease as compared to healthy controls, affording a significant diagnostic gain over pH-only criteria. PSPW index and MNBI should be assessed at least in doubtful cases, and diagnosis of reflux disease should not be dismissed when abnormal values are found. Whether PSPW index and MNBI can predict positive response to anti-reflux interventions remains open issue to be addressed in future studies.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Paradisa 2, 56124, Pisa, Italy

    Nicola de Bortoli MD

  2. Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy

    Marzio Frazzoni

  3. Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

    Edoardo Savarino

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  1. Nicola de Bortoli MD
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  2. Marzio Frazzoni
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  3. Edoardo Savarino
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Correspondence to Nicola de Bortoli MD .

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Editors and Affiliations

  1. S. Agostino Estense Hospital, Modena, Italy

    Rita Conigliaro

  2. S. Agostino Estense Hospital, Modena, Italy

    Marzio Frazzoni

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de Bortoli, N., Frazzoni, M., Savarino, E. (2017). The Diagnostic Yield of Novel Parameters in Reflux Monitoring. In: Conigliaro, R., Frazzoni, M. (eds) Diagnosis and Endoscopic Management of Digestive Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-42358-6_14

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