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Combined Esophageal Multichannel Intraluminal Impedance and pH Monitoring (MII -pH) in the Diagnostics and Treatment of Gastroesophageal Reflux Disease and its Complications

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Masiak W., Wallner G., Wallner J., Pedowski T., Solecki M.

Polish Journal of Surgery

2011

vol. 83

issue 9

488-496

The technique of 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH) is currently considered to be the golden standard in the diagnostics of gastroesophageal reflux disease (GERD). The technique allows for differentiation of gas and liquid reflux as well as detection of non-acid reflux, which cannot be detected with other techniques that are based only on measuring the pH of gastric contents.The aim of the study was to assess the usefulness of MII-pH in the diagnostics and treatment of GERD and its complications.Material and methods. A group of 213 patients referred to II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie [the Second Faculty and Clinic of General and Gastrointestinal Surgery and Gastrointestinal Oncology at Medical University of Lublin] due to persistent symptoms of GERD and 21 volunteers without any clinical evidence of GERD underwent esophageal monitoring via MII-pH. The results were correlated with those of upper gastrointestinal tract endoscopy. The data gathered during MII-pH and endoscopy as well as information from questionnaires were entered into an MS Excel spreadsheet and subsequently analyzed with STATISTICA PL software.Results and conclusions. MII-pH proved to be considerably more useful than conventional pHmetry in recording acid reflux. The sensitivity of pH-metry based on the MII-pH technique was established at 74%. GERD-induced changes in the esophageal mucosa result in decreased impedance baseline. The presence and severity of inflammatory esophageal lesions was proven to be associated with acid reflux episodes and proximal reflux episodes. No direct relationship between the grade of GERD and the occurrence of non-acid reflux episodes was confirmed. Non-acid reflux episodes were shown to predispose to non-erosive reflux disease (NERD). The results of this study confirm that MIIpH is an essential technique in the diagnostics, as well as in assessment of the course of treatment and the severity of GERD.

Multichannel Intraluminal Impedance and pH Testing - A New Diagnostic Technique for Gastroesophageal Reflux Disease. Own Experience

100%

Wallner G., Solecki M., Huk J., Dąbrowski A., Majewski M., Dombroskyy A.

Polish Journal of Surgery

2007

vol. 79

issue 7

490-495

In 2001 FDA (Food and Drug administration, USA) gave its permission for simultaneous oesophageal intraluminal impedance examination and pH testing in the clinical practice. In 2002 in Porto, Portugal, a committee of international experts proposed a new classification of reflux types.Material and methods. From October 2005 to June 2006, we examined 36 patients sent to the clinic with GERD symptoms using a Sleuth® recording device.Results. The group of 36 patients (19 women and 17 men); mean age of 47 years with a range of 16-74 years) was examined. The mean length of time for the examination was 22 h 47 min, the shortest one lasting 18 h 36 min; brakes were caused by battery failure. 1509 episodes of reflux were confirmed by impedance channels. Only 538 (35.65%) of these reflux episodes were acidic or weakly acidic and 971 (64.35%) were non-acidic. There was one patient without acid reflux episodes during examination and only 12 non-acidic episodes. The proximal extend, defined as 15 cm above the LES, achieved 616 reflux episodes (40.82%). None of the patients had abnormal physical clearing times; 5 had extended chemical clearing times (13.8%) in recumbent positions.Summary. This paper is not a statistical evaluation of a MII-pH study and is only a report of our first experiences with this new diagnostic method. Objective evaluation of symptom correlation to reflux in MII and the chemical character of the refluxate gives a much more precise qualification to the best type of treatment. In cases of non-acidic reflux, MII-pH testing hastens decision making about surgery.

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2 Polish Journal of Surgery

1 2011

1 2007

2 Solecki M.

2 Wallner G.

1 Dombroskyy A.

1 Dąbrowski A.

1 Huk J.

1 Majewski M.

1 Masiak W.

1 Pedowski T.

1 Wallner J.

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Combined Esophageal Multichannel Intraluminal Impedance and pH Monitoring (MII -pH) in the Diagnostics and Treatment of Gastroesophageal Reflux Disease and its Complications

Multichannel Intraluminal Impedance and pH Testing - A New Diagnostic Technique for Gastroesophageal Reflux Disease. Own Experience