The role of esophageal pH-impedance testing in clinical practice.

Abstract:

PURPOSE OF REVIEW:Ambulatory reflux monitoring is typically performed when esophageal symptoms do not respond to usual antireflux medications, or prior to invasive antireflux therapy. Although pH-based metrics have been the standard in defining esophageal reflux burden, novel impedance parameters have been introduced in recent years that can either be extracted from pH-impedance monitoring or obtained directly from esophageal mucosa. This review evaluates the clinical role of esophageal pH-impedance monitoring in clinical practice in the present day. RECENT FINDINGS:Elevated acid exposure time in the distal esophagus remains the primary metric that predicts symptom improvement from antireflux therapy. Although conventional impedance-based metrics (numbers of reflux episodes, reflux-symptom association) provide complementary evidence, novel impedance-based metrics show promise in documenting reflux-induced damage to esophageal mucosal integrity, and in potentially predicting treatment outcome. The postreflux swallow-induced peristaltic wave measures integrity of primary peristalsis triggered by a reflux episode. Baseline impedance values reflect histopathological damage to mucosal integrity, and improve following successful antireflux therapy. Mucosal impedance assessed at endoscopy is a new diagnostic tool that is currently being evaluated in multinational research studies. SUMMARY:Esophageal pH-impedance monitoring has potential to augment confidence in a reflux diagnosis beyond that provided by pH-monitoring alone.

authors

Hobbs P,Gyawali CP

doi

10.1097/MOG.0000000000000441

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

249-257

issue

4

eissn

0267-1379

issn

1531-7056

journal_volume

34

pub_type

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