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Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring.

Publication ,  Journal Article
Patel, A; Sayuk, GS; Gyawali, CP
Published in: Neurogastroenterol Motil
September 2016

BACKGROUND: Positive symptom association probability (SAP) with physiologic esophageal acid exposure time (AET) on pH-impedance monitoring defines reflux hypersensitivity (RH), a correlate of acid sensitivity on pH monitoring. We evaluated prevalence, clinical characteristics, and symptomatic outcomes of RH in a prospective observational cohort with reflux symptoms undergoing pH-impedance monitoring. METHODS: Reflux hypersensitivity was diagnosed when SAP was positive with pH- and/or impedance-detected reflux events with physiologic AET. Symptom burden was assessed using dominant symptom intensity (DSI, product of symptom severity and frequency on 5-point Likert scales) and global symptom severity (GSS, global esophageal symptoms on 100-mm visual analog scales) by questionnaire, both at baseline and on prospective follow-up. Clinical characteristics and predictors of symptomatic improvement were assessed with univariate and multivariate analyses. KEY RESULTS: Seventy-seven patients (29%) met criteria for RH, of which 53 patients (53.7 ± 1.8 years, 66% F) were contacted after 3.3 ± 0.2 years for follow-up. Reflux hypersensitivity was detected on pH-impedance testing both on and off antisecretory therapy; pH alone missed 51% of RH. About 57% reported ≥50% GSS improvement. Sixteen patients undergoing antireflux surgery (ARS) reported better symptom improvement compared to 37 patients treated medically (GSS change: p = 0.005; DSI change: p = 0.04). Hiatus hernia (p = 0.03) and surgical management (p ≤ 0.04) predicted symptom improvement on univariate analysis, while acid sensitivity was a negative predictor for outcome on both univariate (p = 0.02) and multivariate analyses (p ≤ 0.04). CONCLUSIONS & INFERENCES: Reflux hypersensitivity is a mechanism for persistent reflux symptoms in almost one-third of patients undergoing pH-impedance testing. While acid sensitivity predicts suboptimal symptom improvement, antireflux therapy may improve RH in select settings.

Duke Scholars

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

September 2016

Volume

28

Issue

9

Start / End Page

1382 / 1390

Location

England

Related Subject Headings

  • Treatment Outcome
  • Symptom Assessment
  • Proton Pump Inhibitors
  • Prospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Hydrogen-Ion Concentration
  • Humans
  • Gastroesophageal Reflux
 

Citation

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Patel, A., Sayuk, G. S., & Gyawali, C. P. (2016). Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil, 28(9), 1382–1390. https://doi.org/10.1111/nmo.12838
Patel, A., G. S. Sayuk, and C. P. Gyawali. “Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring.Neurogastroenterol Motil 28, no. 9 (September 2016): 1382–90. https://doi.org/10.1111/nmo.12838.
Patel A, Sayuk GS, Gyawali CP. Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil. 2016 Sep;28(9):1382–90.
Patel, A., et al. “Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring.Neurogastroenterol Motil, vol. 28, no. 9, Sept. 2016, pp. 1382–90. Pubmed, doi:10.1111/nmo.12838.
Patel A, Sayuk GS, Gyawali CP. Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH-impedance monitoring. Neurogastroenterol Motil. 2016 Sep;28(9):1382–1390.
Journal cover image

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

September 2016

Volume

28

Issue

9

Start / End Page

1382 / 1390

Location

England

Related Subject Headings

  • Treatment Outcome
  • Symptom Assessment
  • Proton Pump Inhibitors
  • Prospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Hydrogen-Ion Concentration
  • Humans
  • Gastroesophageal Reflux