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Does Combined Multichannel Intraluminal Impedance and pH Help with the Diagnosis of Refractory GERD?

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Maqbool, Sabba, M.D.; Park, Woosuk, M.D.; Shay, Steven, M.D.; Vaezi, Michael F., M.D., Ph.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S29–S30
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH.

Purpose: Persistent acid or non-acid reflux has been implicated as a cause of typical or atypical gastroesophageal reflux (GERD) symptoms refractory to aggressive acid suppression. Combined multichannel intraluminal impedance and pH (MII-pH) allows evaluation of both acid and non-acid reflux events. However the clinical utility of MII-pH in this patient population has not been well established.

Methods: A prospective cohort study of patients with refractory GERD symptoms was performed. Patients with typical symptoms of heartburn and regurgitation or atypical symptoms of hoarseness, throat clearing, sore throat, cough, chest pain and globus who are unresponsive to twice-daily (BID) proton pump inhibitor (PPI) therapy were included. All patients underwent MII-pH on therapy. The impedance measuring segments were positioned at 3, 5, 7, 9, 15, and 17 cm above LES and the pH sensor at 5 cm above LES. Normal values for MII-pH: Distal reflux events - total ≤73, acid ≤55, non-acid ≤1; Proximal reflux events - total ≤31, acid ≤28, non-acid ≤1.

Results: Total of 42 patients were enrolled. 15 patients had atypical symptoms only and 27 had typical symptoms with or without atypical symptoms. Symptom prevalence: hoarseness (53.3%), chest pain (33.3%), cough (13.3%), throat symptoms (40%), heartburn (70.3%) and regurgitation (66.7%). None of the patients with only atypical symptoms (0 of 15, 0%) had abnormal MII-pH. In contrast, 9 of 27 (33%) patients with typical symptoms had abnormal MII-pH. (p < 0.02) In this group, the predominant symptom in patients with abnormal MII-pH was regurgitation (7 of 9, 78%) while regurgitation was present in 6 of 18 (33%) patients with normal MII-pH. (p < 0.05). Additionally, 5 of 9 (56%) patients with abnormal MII-pH (4 had symptom of regurgitation) underwent surgical fundoplication and had complete symptom resolution post fundoplication.

Conclusions: MII-pH is unlikely to be clinically useful in patients with atypical symptoms refractory to aggressive acid suppression. However, it may be useful in those who have typical symptoms. In this group, regurgitation may be predictive of abnormal MII-pH.

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