Multichannel Intraluminal Impedance–pH Testing Is Clinically Useful in the Management of Patients with Gastroesophageal Reflux Symptoms

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• 作者：Daniela Jodorkovsky (1) (2)
  Jennifer C. Price (1)
  Brian Kim (1)
  Sameer Dhalla (1)
  Ellen M. Stein (1)
  John O. Clarke (1)
  
• 关键词：Gastroesophageal reflux ; Ambulatory reflux monitoring ; Proton pump inhibitor ; Impedance testing
• 刊名：Digestive Diseases and Sciences
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：59
• 期：8
• 页码：1817-1822
• 全文大小：328 KB
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• 作者单位：Daniela Jodorkovsky (1) (2)
  Jennifer C. Price (1)
  Brian Kim (1)
  Sameer Dhalla (1)
  Ellen M. Stein (1)
  John O. Clarke (1)
  
  1. Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. New York Medical College, Munger Pavilion 206, Valhalla, NY, 10595, USA
  
• ISSN：1573-2568

文摘

Background Multichannel intraluminal impedance–pH testing (MII–pH) allows for the detection of acid and non-acid reflux, thus, increasing yield over pH testing. Limited data exist on how physicians use test results in practice. Aim The aim of our study was to evaluate the influence of MII–pH testing on patient care. Methods We reviewed records of patients with symptoms of gastroesophageal reflux disease who underwent MII–pH testing. Management decisions evaluated included changes in prescribed medications and surgical consultation for anti-reflux surgery. Statistical analysis was performed using Pearson Chi square test, and multivariable logistic regression. Results MII–pH testing resulted in a medication change in 41?% of patients, surgical consultation in 19.7?%, and anti-reflux surgery in 11.1?%. In patients who were not on proton pump inhibitor (PPI) therapy, MII–pH results were most useful in the decision to start a PPI. On PPI therapy, results were more often used to decide whether to increase (32.3?%) or switch the PPI (23.5?%) in patients with continued acid reflux. Results were most useful to stop the PPI in normal studies (11.1?%). More patients with non-acid reflux (14.3?%) and normal results (19.7?%) were started on a neuromodulator compared to other diagnoses. The MII–pH result was most useful in the decision to start baclofen or bethanecol when the patient was found to have non-acid reflux (25?%). Patients with an abnormal MII–pH or abnormal MII alone were more likely to be referred to surgery (OR 19.5, p?p? Conclusions MII–pH testing impacted medical or surgical management in over half the patients tested.