24-h multichannel intraluminal impedance-pH monitoring may be an inadequate test for detecting gastroesophageal reflux in patients with mixed typical and atypical symptoms

• Published in: Surgical endoscopy Vol. 29; no. 7; pp. 1700 - 1708
• Main Authors: Han, Michelle S., Lada, Michal J., Nieman, Dylan R., Tschoner, Andreas, Peyre, Christian G., Jones, Carolyn E., Watson, Thomas J., Peters, Jeffrey H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Acids; Catheters; Data collection; Electric Impedance; Endoscopy; Esophageal pH Monitoring - instrumentation; Esophageal Sphincter, Lower - metabolism; Esophageal Sphincter, Lower - physiopathology; Esophagus; Female; Gastroenterology; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - metabolism; Gastrointestinal surgery; Gynecology; Heartburn - diagnosis; Heartburn - etiology; Hepatology; Hiatal hernias; Humans; Male; Manometry; Medicine; Medicine & Public Health; Middle Aged; Patients; Proctology; Surgery; Wireless pH monitoring; Gastroesophageal reflux; Atypical symptoms; Impedance-pH monitoring
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-014-3867-1

Background The detection of gastroesophageal reflux (GERD) via pH testing is the key component of the evaluation of patients considered for antireflux surgery. Two common pH testing systems exist, a multichannel, intraluminal impedance-pH monitoring (MII-pH) catheter, and wireless (Bravo ® ) capsule; however, discrepancies between the two systems exist. In patients with atypical symptoms, MII-pH catheter is often used preferentially. We aimed to elucidate the magnitude of this discrepancy and to assess the diagnostic value of MII-pH and the Bravo wireless capsule in a population of patients with mixed respiratory and typical symptoms. Methods The study population consisted of 66 patients tested with MII-pH and Bravo pH testing within 90 days between July 2009 and 2013. All patients presented with laryngo-pharyngo-respiratory (LPR) symptoms. Patient demographics, symptomatology, manometric and endoscopic findings, and pH monitoring parameters were analyzed. Patients were divided into four comparison groups: both pH tests positive, MII-pH negative/Bravo positive, MII-pH positive/Bravo negative, and both pH tests negative. Results Nearly half of the patients (44 %) had discordant pH test results. Of these, 90 % (26/29) had a negative MII-pH but positive Bravo study. In this group, the difference in the DeMeester score was large, a median of 29.3. These patients had a higher BMI (28.5 vs. 26.1, p  = 0.0357), were more likely to complain of heartburn (50 vs. 23 %, p  = 0.0110), to have a hiatal hernia, (85 vs. 53 %, p  = 0.0075) and a structurally defective lower esophageal sphincter (LES, 85 vs. 58 %, p  = 0.0208). Conclusions In patients with LPR symptoms, we found a high prevalence of discordant esophageal pH results, most commonly a negative MII-pH catheter and positive Bravo. As these patients exhibited characteristics consistent with GERD (heartburn, defective LES, hiatal hernia), the Bravo results are likely true. A 24-h MII-pH catheter study may be inadequate to diagnose GERD in this patient population.