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

作者：Jodorkovsky Daniela^*; Price Jennifer C; Kim Brian; Dhalla Sameer; Stein Ellen M; Clarke John O

来源：Digestive Diseases and Sciences, 2014, 59(8): 1817-1822.

DOI：10.1007/s10620-014-3080-z

• Gastroesophageal reflux
• Ambulatory reflux monitoring
• Proton pump inhibitor
• Impedance testing

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. %26lt;br%26gt;The aim of our study was to evaluate the influence of MII-pH testing on patient care. %26lt;br%26gt;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. %26lt;br%26gt;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 %26lt; 0.001; OR 19.77, p %26lt; 0.001). %26lt;br%26gt;MII-pH testing impacted medical or surgical management in over half the patients tested.

• 出版日期2014-8