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Current diagnostic tests for gastroesophageal reflux disease (GERD) are suboptimal and do not accurately and reliably measure chronicity of reflux. A minimally invasive device has been developed to assess esophageal mucosal impedance (MI) as a marker of chronic reflux. We performed a prospective longitudinal study to investigate MI patterns in patients with GERD and common nonreflux conditions, to assess MI patterns before and after treatment with proton pump inhibitors and to compare the performance of MI and wireless pH tests.We evaluated MI in 61 patients with erosive esophagitis, 81 with nonerosive but pH-abnormal GERD, 93 without GERD, 18 with achalasia, and 15 with eosinophilic esophagitis. MI was measured at the site of esophagitis and at 2, 5, and 10 cm above the squamocolumnar junction in all participants. MI was measured before and after acid suppressive therapy, and findings were compared with those from wireless pH monitoring.MI values were significantly lower in patients with GERD (erosive esophagitis or nonerosive but pH-abnormal GERD) or eosinophilic esophagitis than in patients without GERD or patients with achalasia (P.001). The pattern of MI in patients with GERD differed from that in patients without GERD or patients with eosinophilic esophagitis; patients with GERD had low MI closer to the squamocolumnar junction, and values increased axially along the esophagus. These patterns normalized with acid suppressive therapy. MI patterns identified patients with esophagitis with higher levels of specificity (95%) and positive predictive values (96%) than wireless pH monitoring (64% and 40%, respectively).Based on a prospective study using a prototype device, measurements of MI detect GERD with higher levels of specificity and positive predictive values than wireless pH monitoring. Clinical Trials.gov, Number: NCT01556919.

Introduction: Gastroesophageal reflux (GER) causes esophageal and extra-esophageal symptoms. Frequent extra-esophageal symptoms are cough, laryngospasm, laryngitis and asthma. Microand macro-aspiration are hypothesized pathophysiologic mechanisms. Aim: to compare the results obtained with two techniques that can measure reflux in the hypo-pharynx. Methods: The "Restech technique" evaluate the pH at the level of the hypo-pharynx through a probe with a pH-antimony sensor which is placed behind the soft palate. Mutichannel intraluminal impedance/pH-monitoring (MII/pH) records the passage gas and liquid reflux, and the pH of the latter, through a probe with 6 impedance sensors and 2 pH antimony sensors (the lower at 3 cm above the LES and the high at the level of hypo-pharynx). Ten adults patients (age 46.33 ± 9.86yrs; range 33.9-66.11) presenting with chronic coughing underwent simultaneous a Restech and MII/pH recording. A time-interval of 2 minutes was allowed between Restech and MII/pH to be considered simultaneous episodes. The results were statistically tested with the Chi-square test; a p value

INTRODUCTION: Gastroesophageal reflux disease (GERD) afflicts more than 100 million US adults, significantly impacts quality of life and imposes >$9 billion/yr in total cost upon our healthcare system. Current GERD diagnostics are suboptimal due to limited sensitivity and specificity, and they are constrained by measurement of esophageal reflux during a single time point at a specified location. They measure presence of reflux but do not measure the long-term mucosal consequences of GERD, a significant limitation of existing platforms. Thus, the aim of our study was to develop and test a novel, minimally invasive technology to assess esophageal mucosal conductivity changes as a result of chronic mucosal exposure to gastroduodenal reflux. METHODS: A single channel mucosal impedance(MI) measuring rings separated by 0.4mm with a 360 degree circumferential design were mounted on a catheter, which could be easily traversed through the working channel of an upper endoscope. 53 patients along the spectrum of GERD were enrolled: Barrett's esophagus (BE) (n=12); Erosive Esophagitis (E+) (n=16); pH+/Non-erosive GERD (pH+) (n=11) and pH-/non-erosive subjects (pH-) (n=14). All pts underwent endoscopy and wireless 48-hour pH monitoring 10-days off PPI tx. During index endoscopy, MI were measured from the site of injury (Barrett's epithelium or esophagitis) as well as 2-, 5and 10-cm above squamocolumnar junction (SCJ). In those without mucosal injury, measurements were taken from 2-, 5and 10-cm above the SCJ. MI measurements (ohms) were obtained continuously for 5 seconds at each location by direct application of the impedance rings to the mucosal surface and the mean of the 5-second measurements for each location was used for analysis. RESULTS: Median (IQ) mucosal measurements were significantly (p=0.001) lower at the site of Barrett's [765 (512-953)] and erosive esophageal mucosa [1147 (530-1307)] than non-erosive regions at the same level [3654 (2315-6146)]. There was a significant (p=0.004) and graded increase in median (IQ) MI axially along the esophagus from distal (2 cm above the SCJ) to proximal (10 cm above the SCJ) (Figure 1). Importantly, there was a graded increase in MI axially along the esophagus in pts with BE, E+ and pH+, which was not present in subjects with visually normal esophageal mucosa and normal acid exposure (E-) (non-GERD) (Figure2). CONCLUSIONS: 1) Esophageal mucosal erosion due to GERD, on average has 81% lower MI than normal tissue. 2) Non-erosive GERD patients show similar pattern of MI along the axial distribution of esophagus as those with erosive disease. 3) This pattern does not exist in those without GERD. 4) These encouraging data show feasibility of the MI concept in providing an alternative and innovative method for detecting chronic consequence of GERD on esophageal mucosal.

LES resting pressure compared to non-IPF patients (14.1 [4-32.5] vs. 16.7 [4-37.2]; p= 0.0999). Mean contraction amplitude in the distal and proximal esophagus were slightly higher in IPF compared to non-IPF patients (92.4 [40-190] vs. 84 [35-170] and 90.6 [10210] vs. 79.9 [10-210], respectively; p=ns), but the difference was not significant. In contrast, IPF patients had significantly higher (p