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Combined Multichannel Intraluminal Impedance and pH Ambulatory Reflux Monitoring in Symptomatic GERD Patients on Acid Suppression Therapy

Confusion or Clarification?

65

Jazrawi, Saad F., M.D.; Gualtieri, Nicholas M., M.D.; Starpoli, Anthony A., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S45
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Gastroenterology, St. Vincents Catholic Medical Center-Manhattan New York Medical College, New York, NY.

Purpose: Persistent GERD symptoms despite acid suppression therapy present a diagnostic and therapeutic challenge to the clinician. 24 hrs multi-channel intraluminal impedance combined with pH monitoring (MII-pH) is an important new tool for the GERD evaluation. The goal of the study is to define the symptomatology among patients who are still on PPI.

Methods: A retrospective look of our cohort (10/03–6/05) that had MII-pH. Symptoms were either typical (regurgitation, heartburn and belching) or atypical (the rest). We studied reflux in terms of symptom index (SI+ when >50%), and the more specific symptom association probability (SAP+ when >95%). 30 patients were identified on PPI. 15 men and 15 women, average age (46yr). We noted 6 patients reported one symptom while 12 reported 2 and another 12 patients reported 3 main symptoms for a total 66 symptoms.

Results: Acidic events noted among 7/27 patients (25.9%) with typical symptoms and 4/23 with atypical one (17.4%). SI+ was noted in 31 symptoms while SAP+ was noted in 13. The concordance rate for SAP with SI is 5/15 (33.3%) for acidic reflux vs 9/21 (42.8%) for nonacidic reflux (distribution seen in tables 1 and 2). When comparing typical symptoms to atypical one, SI+ was noted in 21/39 (53.8%) vs 10/27 (37%), while for SAP+ was 11/39 (28.2%) vs 2/27 (7.4%). Heartburn, regurgitation, belching and cough were the only symptoms to have SAP+ among our cohort.

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Conclusions: Our study shows that symptoms can not predict who is refluxing and type of refluxate. Therefore MIIpH is needed to properly select and treat these patients. Future studies are needed on how to approach patients with SAP-/SI+. As for those with SAP-/SI- who continue to have symptoms while on acid suppresssion, an etiology other than GERD should be pursued.

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