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Evaluation of Baseline Impedance During Water-perfused High Resolution Impedance Manometry in Patients With Symptomatic GERD

Hung, Jui-Sheng, MD*; Wong, Ming-Wun, MD*,†; Liu, Tso-Tsai, MD*; Yi, Chih-Hsun, MD*; Lei, Wei-Yi, MD*; Chen, Chien-Lin, MD, PhD*

Journal of Clinical Gastroenterology: May/June 2019 - Volume 53 - Issue 5 - p 350–354
doi: 10.1097/MCG.0000000000001147
ALIMENTARY TRACT: Original Articles

Goals: We aimed to investigate the hypothesis whether baseline impedance measured during water-perfused high resolution impedance manometry (HRIM) can help discriminate patients with reflux symptoms from the controls and predict the response to the proton pump inhibitors (PPIs).

Background/Aim: Baseline impedance measured during solid-state HRIM can reliably discriminate patients with gastroesophageal reflux disease (GERD) from controls.

Study: We enrolled consecutive patients with typical reflux symptoms and healthy controls for the measurement of baseline impedance during the landmark period of HRIM. All patients were given PPIs and PPI response was assessed after 8 weeks of the treatment.

Results: Baseline mucosa impedance measured during HRIM was lower in GERD patients than the controls (1861±183 vs. 3371±250 Ω; P<0.001). Baseline impedance during water-perfused HRIM had moderate diagnostic accuracy for differentiating symptomatic GERD with an area under the curve of 0.853 on receiver operating characteristics analysis. A threshold of 2530 Ω for baseline impedance had a sensitivity of 88.3% and specificity of 82.4% for GERD with a positive predictive value of 83.4% and negative predictive value of 87.6%. Among symptomatic GERD patients, poor PPI responders had higher baseline impedance than those without it (2340±260 vs. 1479±189 Ω; P=0.02). BMI negatively correlated to base impedance in either controls (r=−0.59; P=0.012) or GERD patients (r=−0.47; P=0.047).

Conclusions: Baseline impedance measurement during water-perfused HRIM helps differentiate patients with typical reflux symptoms from controls and also serves as a potential utility in predicting PPI response.

*Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University

PhD program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan

Supported by the grant TCRD106-5-E-106 from the Hualien Tzu Chi Hospital Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.

Part of this study has been accepted as a poster presentation at the DDW 2018 in Washington, DC.

The authors declare that they have nothing to disclose.

Address correspondence to: Chien-Lin Chen, MD, PhD, Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan (e-mail:

Received July 10, 2018

Accepted September 29, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.