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24 Hour pH-Multichannel Intraluminal Impedance Monitoring in Patients Successfully Treated with Endoluminal Therapy for Reflux


Starpoli, Anthony A. MD; Gualtieri, Nicholas M. MD; Robilotti, James G. MD; Jazwari, Saad MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S41–S42
Abstracts: ESOPHAGUS

Medicine-Gastroenterology, Lenox Hill Hospital, New York, NY and Medicine-Gastroenterology, St.Vincents Catholic Medical Center-Manhattan, New York, NY.

Purpose: pH-multichannel intraluminal impedance monitoring (pH-MII) provides a physiologic assessment and symptom correlation of gastroesophageal reflux disease (GERD) and contributes to understanding mechanisms of reflux. We analyzed pH-MII readings before and after endoluminal therapy (ET) of symptomatic GERD patients experiencing PPI failure.

Methods: Pre and post (mean of 9 mo., range 2–17 mo.) pH-MII tests were performed on 4 symptomatic GERD failing PPI therapy who underwent ET with Enteryx (2) and Plicator (2).

Results: All 4 patients reported elimination of reflux symptoms (see table 1). 3 patients discontinued PPI therapy. 1 patient required PPIs for dyspepsia. Impedance showed decreased total impedance events (reflux) and a reduction in the proximal extent of reflux post-ET (see table 2).



Table. MII

Table. MII

Conclusions: All 4 patients had a symptomatic response to ET associated with a total decrease in reflux events as measured by pH-MII. 2 patients had nonacid reflux pre-ET and a decrease in total reflux events post-ET. Clinical response was directly related to decreased reflux despite decreased esophageal clearance post-ET. The success of endoluminal therapy in these 4 GERD patients who did not respond to medical therapy with PPIs was due to an augmented antireflux barrier leading to a reduction of impedance detected reflux events. Larger studies of such patients will further clarify this mechanical phenomenon.

© The American College of Gastroenterology 2006. All Rights Reserved.