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Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease.

Publication ,  Journal Article
Patel, A; Sayuk, GS; Gyawali, CP
Published in: Clin Gastroenterol Hepatol
May 2015

BACKGROUND & AIMS: pH-impedance monitoring detects acid and nonacid reflux events, but little is known about which parameters predict outcomes of different management strategies. We evaluated a cohort of medically and surgically managed patients after pH-impedance monitoring to identify factors that predict symptom improvement after therapy. METHODS: In a prospective study, we followed up 187 subjects undergoing pH-impedance testing from January 2005 through August 2010 at Washington University in St. Louis, Missouri (mean age, 53.8 ± 0.9 y; 70.6% female). Symptom questionnaires assessed dominant symptom intensity (DSI) and global symptom severity (GSS) at baseline and at follow-up evaluation. Data collected from pH impedance studies included acid exposure time (AET), reflux exposure time (RET) (duration of impedance decrease 5 cm above lower esophageal sphincter, reported as the percentage of time similar to AET), symptom reflux correlation (symptom index and symptom association probability [SAP]), and the total number of reflux events. Univariate and multivariate analyses were performed to determine factors associated with changes in DSI and GSS after therapy. RESULTS: Of the study subjects, 49.7% were tested on proton pump inhibitor (PPI) therapy and 68.4% were managed medically. After 39.9 ± 1.3 months of follow-up, DSI and GSS scores decreased significantly (P < .05). On univariate analysis, an abnormal AET predicted decreased DSI and GSS scores (P ≤ .049 for each comparison); RET and SAP from impedance-detected reflux events (P ≤ .03) also were predictive. On multivariate analysis, abnormal AET consistently predicted symptomatic outcome; other predictors included impedance-detected SAP, older age, and testing performed off PPI therapy. Abnormal RET, acid symptom index, or SAP, and numbers of reflux events did not independently predict a decrease in DSI or GSS scores. CONCLUSIONS: Performing pH-impedance monitoring off PPI therapy best predicts response to antireflux therapy. Key parameters with predictive value include increased AET, and correlation between symptoms and reflux events detected by impedance.

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Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

May 2015

Volume

13

Issue

5

Start / End Page

884 / 891

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Prospective Studies
  • Prognosis
  • Missouri
  • Middle Aged
  • Male
  • Humans
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology
 

Citation

APA
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ICMJE
MLA
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Patel, A., Sayuk, G. S., & Gyawali, C. P. (2015). Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol, 13(5), 884–891. https://doi.org/10.1016/j.cgh.2014.08.029
Patel, Amit, Gregory S. Sayuk, and C Prakash Gyawali. “Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease.Clin Gastroenterol Hepatol 13, no. 5 (May 2015): 884–91. https://doi.org/10.1016/j.cgh.2014.08.029.
Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015 May;13(5):884–91.
Patel, Amit, et al. “Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease.Clin Gastroenterol Hepatol, vol. 13, no. 5, May 2015, pp. 884–91. Pubmed, doi:10.1016/j.cgh.2014.08.029.
Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015 May;13(5):884–891.
Journal cover image

Published In

Clin Gastroenterol Hepatol

DOI

EISSN

1542-7714

Publication Date

May 2015

Volume

13

Issue

5

Start / End Page

884 / 891

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Prospective Studies
  • Prognosis
  • Missouri
  • Middle Aged
  • Male
  • Humans
  • Gastroesophageal Reflux
  • Gastroenterology & Hepatology