Search

BACKGROUND: Sliding hiatal herniation (SHH) and gastroesophageal reflux (GER) commonly occur in French bulldogs. Wireless pH monitoring can quantitatively assess acidic GER in dogs affected by SHH. HYPOTHESIS/OBJECTIVES: Measure acidic GER in French bulldogs with SHH, pre- and post-brachycephalic obstructive airway syndrome (BOAS) surgery, utilizing a wireless pH capsule (Bravo Calibration-free, Medtronic, Minnesota), and correlate with owners observations of regurgitation. ANIMALS: Eleven French bulldogs diagnosed with SHH via swallowing fluoroscopy. METHODS: Prospective cohort study. A pH capsule was endoscopically placed in the esophagus. Up to 96 hours of data were acquired as the owner logged clinical signs. Spearmans correlation and Wilcoxon rank-sum tests evaluated factors correlated with acid exposure time (AET), defined by the % time pH < 4. In 4/11 dogs, Bravo monitoring was repeated 2-4 months after BOAS surgery. RESULTS: Medians (Q1-Q3) for age and weight were 21 months (17-35.5) and 10.0 kg (8.9-11.5). BOAS severity was mild (3), moderate (4), or severe (4). Medians (Q1-Q3) for AET and reflux events were 3.3% (2.6-6.4) and 70 (34-173). Clinical score (P = .82) and BOAS severity (P = .60) were not correlated with AET, but age was negatively correlated (rho = -.66, P = .03). Median probability (Q1-Q3) that regurgitation was associated with a reflux event was 72.5% (0-99). Percent AET numerically improved in all 4 dogs that underwent BOAS surgery although not statistically assessed. CONCLUSIONS AND CLINICAL IMPORTANCE: Wireless pH monitoring documented acidic GER in French bulldogs with SHH, captured subclinical events, and showed improvements after BOAS surgery.

To investigate the features of patients with laryngopharyngeal reflux (LPR) who did not respond to medical treatment., info:eu-repo/semantics/published

BACKGROUND: Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated. AIMS: To utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice METHODS: The RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness. RESULTS: Prolonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease (GERD) and persisting typical reflux symptoms despite once-daily PPI. Acid exposure time (AET) <4.0% on all days of monitoring with negative reflux-symptom association excludes GERD and does not support ongoing PPI treatment. Conversely, AET >6.0% across ≥2 days is conclusive evidence for GERD and supports treatment for GERD, while AET >10% across ≥2 days identifies severe acid burden that supports escalation of anti-reflux treatment. In previously proven GERD, impedance-pH monitoring on PPI is helpful in defining refractory GERD and mechanisms of continued symptoms; the presence of <40 reflux events, AET <2.0% and a negative reflux-symptom association does not support escalation of anti-reflux treatment. In contrast, AET > 4.0% and positive reflux-symptom association support escalation of anti-reflux treatment, including use of invasive therapeutics. CONCLUSIONS: Statements meeting appropriateness for average clinical care have been identified when utilising reflux monitoring in patients with typical reflux symptoms and PPI non-response.

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

BACKGROUND AND AIMS: Proton pump inhibitor (PPI) therapy fails to provide adequate symptom control in up to 50% of patients with gastroesophageal reflux symptoms. Although a proportion do not require ongoing PPI therapy, a diagnostic approach to identify candidates appropriate for PPI cessation is not available. This study aimed to examine the clinical utility of prolonged wireless reflux monitoring to predict the ability to discontinue PPIs. METHODS: This double-blinded clinical trial performed over 3 years at 2 centers enrolled adults with troublesome esophageal symptoms of heartburn, regurgitation, and/or chest pain and inadequate PPI response. Participants underwent prolonged wireless reflux monitoring (off PPIs for ≥7 days) and a 3-week PPI cessation intervention. Primary outcome was tolerance of PPI cessation (discontinued or resumed PPIs). Symptom burden was quantified using the Reflux Symptom Questionnaire electronic Diary (RESQ-eD). RESULTS: Of 128 enrolled, 100 participants met inclusion criteria (mean age, 48.6 years; 41 men). Thirty-four participants (34%) discontinued PPIs. The strongest predictor of PPI discontinuation was number of days with acid exposure time (AET) > 4.0% (odds ratio, 1.82; P < .001). Participants with 0 days of AET > 4.0% had a 10 times increased odds of discontinuing PPI than participants with 4 days of AET > 4.0%. Reduction in symptom burden was greater among the discontinued versus resumed PPI group (RESQ-eD, -43.7% vs -5.3%; P = .04). CONCLUSIONS: Among patients with typical reflux symptoms, inadequate PPI response, and absence of severe esophagitis, acid exposure on reflux monitoring predicted the ability to discontinue PPIs without symptom escalation. Upfront reflux monitoring off acid suppression can limit unnecessary PPI use and guide personalized management. (ClinicalTrials.gov, Number: NCT03202537).

BACKGROUND: There is a need to identify factors outside of abnormal reflux that contribute to gastroesophageal reflux disease (GERD). Esophageal hypervigilance is a psychological process impacting symptom experience in esophageal disease. However, little is known about the presence of hypervigilance in GERD phenotypes, especially in those with abnormal acid exposure or symptom index scores. The primary aim was to assess differences in self-reported esophageal hypervigilance across different GERD presentations. The secondary aim was to evaluate esophageal hypervigilance as a predictor of symptom severity. METHODS: We conducted retrospective data analyses on a cohort of adult patients with reflux symptoms that underwent 96-hour wireless pH monitoring from 9/2015 to 9/2017. Patients were stratified into groups based on the number of days they exhibited positive acid exposure time (AET; 0 days, 1-2 days, 3+ days), and symptom index scores (SI; 0 days, 1-day, 2+ days). Esophageal hypervigilance and anxiety, and symptom frequency and severity were assessed between groups. KEY RESULTS: A total of 123 AET cases and 116 SI cases were included for analysis. Esophageal hypervigilance and anxiety scores did not significantly differ based on the number of days of positive AET (p = 0.311) or SI (p = 0.118). Symptom severity and perceived symptom frequency differed between groups. Hypervigilance significantly predicted symptom severity, when controlling for symptom-specific anxiety. CONCLUSIONS: Esophageal hypervigilance is persistent across patients with reflux, irrespective of acid burden and symptom index, and significantly predicts symptom severity. Hypervigilance should be considered as an independent factor contributing to esophageal symptom perception.

Gastroesophageal reflux disease (GERD) is a disorder due to the retrograde flow of refluxate into the esophagus. Although GERD is a common clinical diagnosis, its pathogenesis is quite complex. As a result of its multifactorial development, many patients continue to experience adverse symptoms due to GERD despite prolonged acid suppression with proton pump inhibitor therapy. The pathogenesis of GERD involves an interplay of chemical, mechanical, psychologic, and neurologic mechanisms, which contribute to symptom presentation, diagnosis, and treatment. As such, GERD should be approached as a disorder beyond acid. This review will investigate the major factors that contribute to the development of GERD, including factors related to the refluxate, esophageal defenses, and factors that promote pathologic reflux into the esophagus. In reviewing GERD pathogenesis, this paper will highlight therapeutic advances, with mention of future opportunities of study when approaching GERD.

BACKGROUND: Supragastric belching (SGB) and rumination are behavioral disorders associated with proton pump inhibitor (PPI) non-response and can be diagnosed using multichannel intraluminal impedance-pH (MII-pH) and post-prandial high-resolution impedance manometry (PPHRIM). This pilot study compared diagnostic yield and inter-rater agreement for SGB and rumination using MII-pH and PPHRIM. METHODS: Three esophageal physiologists performed blinded interpretations of MII-pH and PPHRIM in 22 PPI non-responders. Raters selected from 4 diagnostic impressions (normal, GERD, behavioral disorders, GERD+behavioral disorders) without clinical context. Primary outcomes were diagnostic impressions compared against clinical gold standard impression, between raters, and between test modalities. Following a 28-month wash-out period, raters re-interpreted MII-pH with clinical context and under consensus definition of diagnostic criteria. KEY RESULTS: Compared to gold standard, rater accuracy for presence of behavioral disorders ranged from 45 to 77% on MII-pH and 45-59% on PPHRIM. On MII-pH, inter-rater agreement was fair for diagnosis (ĸ0.32, p < 0.01) and suboptimal for presence of behavioral disorders (ĸ0.13, p = 0.14). On PPHRIM, inter-rater agreement was suboptimal for both diagnosis (ĸ0.03, p = 0.34) and presence of a behavioral disorder (ĸ-0.22, p = 0.96). Inter-rater agreement improved in post hoc MII-pH interpretations. Rumination was more frequently identified on PPHRIM (23, 35%) compared to MII-pH (7, 11%). CONCLUSIONS AND INFERENCES: Diagnostic accuracy and inter-rater agreement are higher for MII-pH than PPHRIM, and behavioral disorders are more frequently identified on PPHRIM. Identifying behavioral disorders on MII-pH and PPHRIM has implications for clinical evaluation of PPI non-response; clinical context is essential for accurate study interpretation. Further work is needed to standardize definitions and interpretations.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Long-term monitoring increased knowledge about gastroesophageal reflux (GER) and the disease became known as gastroesophageal reflux disease (GERD). Prolonged monitoring of reflux allows the diagnosis of GERD when endoscopic findings are not sufficient to characterize it. The objective of this work is to review the current knowledge on impedance-pH monitoring, taking into account the published literature. The different types of prolonged reflux monitoring will be briefly described, such as: conventional pHmetry, catheterless pHmetry and impedance-pHmetry. The new possibilities of evaluation with impedance-pHmetry are emphasized. When impedance was associated with pH monitoring, an impressive technological evolution became apparent, compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements such as the ability of the esophagus to carry the bolus, measurement of basal mucosal impedance, and assessment of post-reflux primary peristalsis can be performed. Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The importance of a careful evaluation of each episode of reflux by the doctor responsible for the examination, necessary for the correct interpretation of the tracings, is suggested., La monitorización prolongada aumentó el conocimiento sobre el reflujo gastroesofágico (RGE) y la enfermedad se conoció como enfermedad por reflujo gastroesofágico (ERGE). La monitorización prolongada del reflujo permite el diagnóstico de ERGE cuando los hallazgos endoscópicos no son suficientes para caracterizarlo. El objetivo de este trabajo es revisar los conocimientos actuales sobre la monitorización de impedancia-pH, teniendo en cuenta la literatura publicada. Se describirán brevemente los diferentes tipos de monitorización prolongada del reflujo, tales como: pHmetría convencional, pHmetría sin catéter e impedancia-pHmetría. Se enfatizan las nuevas posibilidades de evaluación con impedancia-pHmetría. Cuando la impedancia se asoció a la monitorización del pH, se hizo evidente una evolución tecnológica impresionante, en comparación con la monitorización del pH solo. Las principales ventajas de la impedancia-pHmetría son: la capacidad de detectar todo tipo de reflujo: ácido, no ácido, líquido, gaseoso. Además, se pueden realizar otras mediciones importantes como la capacidad del esófago para transportar el bolo, la medición de la impedancia de la mucosa basal y la evaluación de la peristalsis primaria posterior al reflujo. La impedancia-pHmetría es un método prometedor, con grandes ventajas sobre la pHmetría convencional. La elección entre estos dos tipos de seguimiento debería ser muy juiciosa. Se sugiere la importancia de una evaluación cuidadosa de cada episodio de reflujo por parte del médico responsable del examen, necesaria para la correcta interpretación de los trazados.

Patients with gastroesophageal reflux disease (GERD) present with heterogeneous symptoms, response to treatment, and physiologic profiles, requiring distinct and personalized management. This article provides a stepwise framework to phenotype GERD beginning with (1) characterization of symptom profile and response to acid suppression; (2) endoscopic evaluation of mucosal and anatomic integrity; (3) ambulatory reflux monitoring to characterize reflux burden and sensitivity; and (4) esophageal physiologic testing to assess gastroesophageal reflux mechanism and effectors of reflux clearance, and evaluate for alternate causes.

Background & aimsWireless pH monitoring measures esophageal acid exposure time (AET) for up to 96 hours. We evaluated competing methods of analysis of wireless pH data.MethodsAdult patients with persisting reflux symptoms despite acid suppression (n = 322, 48.5 ± 0.9 years, 61.7% women) from 2 tertiary centers were evaluated using symptom questionnaires and wireless pH monitoring off therapy, from November 2013 through September 2017; 30 healthy adults (control subjects; 26.9 ± 1.5 years; 60.0% women) were similarly evaluated. Concordance of daily AET (physiologic <4%, borderline 4%-6%, pathologic>6%) for 2 or more days constituted the predominant AET pattern. Each predominant pattern (physiologic, borderline, or pathologic) in relation to data from the first day, and total averaged AET, were compared with other interpretation paradigms (first 2 days, best day, or worst day) and with symptoms.ResultsAt least 2 days of AET data were available from 96.9% of patients, 3 days from 90.7%, and 4 days from 72.7%. A higher proportion of patients had a predominant pathologic pattern (31.4%) than control subjects (11.1%; P = .03). When 3 or more days of data were available, 90.4% of patients had a predominant AET pattern; when 2 days of data were available, 64.1% had a predominant AET pattern (P < .001). Day 1 AET was discordant with the predominant pattern in 22.4% of patients and was less strongly associated with the predominant pattern compared with 48 hour AET (P = .059) or total averaged AET (P = .02). Baseline symptom burden was higher in patients with a predominant pathologic pattern compared with a predominant physiologic pattern (P = .02).ConclusionsThe predominant AET pattern on prolonged wireless pH monitoring can identify patients at risk for reflux symptoms and provides gains over 24 hours and 48 hours recording, especially when results from the first 2 days are discordant or borderline.

Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a catheter-mounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG clinical guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.

Background: The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial. Aims: To test such an association in preterm and term infants. Study design: Prospective observational study. Subjects: Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion. Outcome measures: The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics. Results: Median gestational age at birth was 294/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight. Conclusions: GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association.

PURPOSE OF REVIEW:Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this review, we will focus on how to investigate and treat potential complications, as well as the pros and cons of different investigative and treatment modalities, and what areas continue to need further research. RECENT FINDINGS:EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

PURPOSE OF REVIEW:Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this review, we will focus on how to investigate and treat potential complications, as well as the pros and cons of different investigative and treatment modalities, and what areas continue to need further research. RECENT FINDINGS:EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

The efficacy of proton-pump inhibitor (PPI) therapy often is assessed to determine whether patients' symptoms are acid-related and if patients have gastroesophageal reflux disease (GERD), although the accuracy of this approach is questionable. We evaluated the diagnostic performance of the PPI test, in conjunction with other tests, for the diagnosis of GERD.

The efficacy of proton-pump inhibitor (PPI) therapy often is assessed to determine whether patients' symptoms are acid-related and if patients have gastroesophageal reflux disease (GERD), although the accuracy of this approach is questionable. We evaluated the diagnostic performance of the PPI test, in conjunction with other tests, for the diagnosis of GERD.

ObjectivesDental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions.MethodsIn this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH<4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth.ResultsThe mean+/-s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2+/-0.16 black trianglem with esomeprazole and 15.25+/-0.17black trianglem with placebo (P=0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 black trianglem after treatment was-1.122 +/-0.769 dB with esomeprazole and +2.059+/-0.534 dB with placebo (P 0.012), with increased reflectivity signifying demineralization.ConclusionsOCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests

ObjectivesDental erosion, the chemical dissolution of enamel without bacterial involvement, is a rarely reported manifestation of gastroesophageal reflux disease (GERD), as well as of recurrent vomiting and dietary habits. It leads to loss of tooth substance, hypersensitivity, functional impairment, and even tooth fracture. To date, dental erosions have been assessed using only very basic visual methods, and no evidence-based guidelines or studies exist regarding the prevention or treatment of GERD-related dental erosions.MethodsIn this randomized, double-blind study, we used optical coherence tomography (OCT) to quantify dental tissue demineralization and enamel loss before and after 3 weeks of acid-suppressive treatment with esomeprazole 20 mg b.i.d. or placebo in 30 patients presenting to the Berne University Dental Clinic with advanced dental erosions and abnormal acid exposure by 24-h esophageal pH manometry (defined as >4% of the 24-h period with pH<4). Enamel thickness, reflectivity, and absorbance as measures of demineralization were quantified by OCT before and after therapy at identical localizations on teeth with most severe visible erosions as well as several other predefined changes in teeth.ResultsThe mean+/-s.e.m. decrease of enamel thickness of all teeth before and after treatment at the site of maximum exposure was 7.2+/-0.16 black trianglem with esomeprazole and 15.25+/-0.17black trianglem with placebo (P=0.013), representing a loss of 0.3% and 0.8% of the total enamel thickness, respectively. The change in optical reflectivity to a depth of 25 black trianglem after treatment was-1.122 +/-0.769 dB with esomeprazole and +2.059+/-0.534 dB with placebo (P 0.012), with increased reflectivity signifying demineralization.ConclusionsOCT non-invasively detected and quantified significantly diminished progression of dental tissue demineralization and enamel loss after only 3 weeks of treatment with esomeprazole 20 mg b.i.d. vs. placebo. This suggests

In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H-2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage 1 (erosions must be present). With 40 mg omeprazole, healing was observed in 71 %, 83 % and 90 % of the patients after 1, 2 and 3 months of treatment, respectively. After one month of treatment, a complete healing was less frequently observed in patients with stage IV oesophagitis pre-trial (55 %) than in the patients with stages I, II and III pre-trial (90 %) (p < 0.05). Ninety per cent of the patients healed at one month were asymptomatic whereas 50 % of the patients with incomplete healing still had symptoms, most often dysphagia, rarely heartburn. Maintenance treatment with 20 mg was sufficient in most patients, with a probability of remaining healed of 69 % from 9 to 24 months after starting this dosage. In 9 patients with Barrett's oesophagus, the lengths of the circumferential metaplasia were found to be reduced after one year of treatment compared to pre-trial lengths (p < 0.005). There was no further significant reduction of length after 2 years of treatment. Fasting gastrin was increased in most of the patients, although great interpatient variability was observed; 50 % of the patients had levels not exceeding 5 times the upper limit of normal. There was no consistent increase of enterochromaffinlike cell density in 29 patients investigated up to nearly 2 years of omeprazole administration. The treatment was well tolerated. By inducing a profound and

The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastrooesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.