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KMID : 1812020230290030335
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Journal of Neurogastroenterology and Motility
2023 Volume.29 No. 3 p.335 ~ p.342
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Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study
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Sebastian S Zeki
Ismail Miah
Pierfrancesco Visaggi
Anna Wolak
Minerva deSilva
Jason M Dunn
Andrew Davies
James Gossage
Abrie Botha
Cho Hyun-Dong
Jafar Jafari
Terry Wong
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Abstract
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Background/Aims : Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.
Methods : Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher’s exact test, Wilcoxon rank sum test, or Student’s t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.
Results : One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041).
Conclusions : WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.
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KEYWORD
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Diagnosis, Esophageal pH Monitoring, Gastroesophageal reflux
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