Combined Multichannel Intraluminal Impedance Research Articles

Management of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

Rumination documented by combined multichannel intraluminal impedance and manometry—case report

Rumination documented by combined multichannel intraluminal impedance and manometry—case report

Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring.

Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in resistance to alternating current between two metal electrodes produced by the presence of bolus inside the esophageal lumen. Combined MII and manometry (MII-EM) provides simultaneous information on intraluminal pressure changes and bolus movement, whereas combined MII and pH (MII-pH) allows detection of pH episodes irrespective of their pH values (ie, acid and non-acid reflux). Combined MII-EM studies are performed very similarly to standard manometry. Based on studies in healthy volunteers and patients, combined MII-EM challenges current existing criteria that define the effectiveness of esophageal body function. Combined MII-pH testing brings a shift in gastroesophageal reflux testing paradigm. In MII-pH studies, reflux events are no longer detected by pH. Refluxate presence, distribution, and clearing are primarily detected by MII and simply characterized as acid versus non-acid based on pH change and as liquid, gas, or mixed based on MII. MII determines refluxate clearance time, whereas pH measures acid clearance time. MII-pH shows promise to become an important clinical tool, particularly to assess gastroesophageal reflux in the postprandial period and in patients with persistent symptoms on therapy and with atypical symptoms.

Use of multichannel intraluminal impedance to document proximal esophageal and pharyngeal nonacidic reflux episodes

Recent studies in adults and children suggest that combined multichannel intraluminal impedance and pH measurement (MII-pH) has the potential to become the new “gold standard” for gastroesophageal reflux testing. In combined MII-pH, reflux is detected by changes in resistance to alternating current induced by the presence of intraluminal materials with different conductivities, and is characterized as acid or nonacid reflux based on concomitant pH measurements. Proximal distribution and duration of nonacid reflux events, predominantly in postprandial periods and during acid-suppressive therapy, can now be quantified. The ability to associate symptoms with nonacid reflux events will help guide therapy in select groups of patients, such as patients with ongoing symptoms on acid-suppressive therapy as well as in the pediatric population.

Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers.

Combined multichannel intraluminal impedance and manometry (MII-EM) assesses esophageal function by simultaneous measurement of both pressure and bolus transit. Normative data for this method have not been published. The aim of this study was to establish normative data for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. Forty-three normal volunteers recruited from 4 centers (15 women, 28 men; age range, 21-72 years) underwent combined MII-EM with a catheter containing 4 impedance-measuring segments and 4 solid-state pressure transducers. Each center recruited and analyzed subjects independently, according to pre-established criteria. Each subject received 20 x 5 mL swallows, 10 liquid and 10 viscous material. Tracings were analyzed manually for bolus presence time, bolus head advance time, segmental transit times, total bolus transit time, contraction amplitude, duration, and onset velocity. Ninety-seven and four-tenths percent of manometrically normal liquid and 96.1% of manometrically normal viscous swallows had complete bolus transit by impedance. Almost half (47.2%) of manometrically ineffective liquid and 34.7% of ineffective viscous swallows had complete bolus transit, whereas 91.7% of manometric simultaneous liquid swallows and 54.5% of simultaneous viscous swallows had complete bolus transit. More than 93% of normal individuals had at least 80% complete liquid or at least 70% complete viscous bolus transit. This study establishes normative data for combined MII-EM. Combined MII-EM may be a more sensitive tool in assessing esophageal function compared to standard manometry because impedance can distinguish different bolus transit patterns. Studies in patients with manometrically defined esophageal motility abnormalities should help clarify the functional importance of manometric ineffective and simultaneous swallows.

Esophageal function testing with combined multichannel intraluminal impedance and manometry: Multicenter study in healthy volunteers

Background & Aims: Combined multichannel intraluminal impedance and manometry (MII-EM) assesses esophageal function by simultaneous measurement of both pressure and bolus transit. Normative data for this method have not been published. The aim of this study was to establish normative data for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. Methods: Forty-three normal volunteers recruited from 4 centers (15 women, 28 men; age range, 21-72 years) underwent combined MII-EM with a catheter containing 4 impedance-measuring segments and 4 solid-state pressure transducers. Each center recruited and analyzed subjects independently, according to pre-established criteria. Each subject received 20 × 5 mL swallows, 10 liquid and 10 viscous material. Tracings were analyzed manually for bolus presence time, bolus head advance time, segmental transit times, total bolus transit time, contraction amplitude, duration, and onset velocity. Results: Ninety-seven and four-tenths percent of manometrically normal liquid and 96.1% of manometrically normal viscous swallows had complete bolus transit by impedance. Almost half (47.2%) of manometrically ineffective liquid and 34.7% of ineffective viscous swallows had complete bolus transit, whereas 91.7% of manometric simultaneous liquid swallows and 54.5% of simultaneous viscous swallows had complete bolus transit. More than 93% of normal individuals had at least 80% complete liquid or at least 70% complete viscous bolus transit. Conclusions: This study establishes normative data for combined MII-EM. Combined MII-EM may be a more sensitive tool in assessing esophageal function compared to standard manometry because impedance can distinguish different bolus transit patterns. Studies in patients with manometrically defined esophageal motility abnormalities should help clarify the functional importance of manometric ineffective and simultaneous swallows.

Esophageal function testing using combined multichannel intraluminal impedance and manometry: Experience from 150 consecutive patients

Esophageal function testing using combined multichannel intraluminal impedance and manometry: Experience from 150 consecutive patients

Evaluation of patients with achalasia using combined multichannel intraluminal impedance and esophageal manometry (MII/EM)

Evaluation of patients with achalasia using combined multichannel intraluminal impedance and esophageal manometry (MII/EM)

Persistent non-acid reflux symptoms diagnosed using combined multi-channel intraluminal impedance and pH metry

Persistent non-acid reflux symptoms diagnosed using combined multi-channel intraluminal impedance and pH metry

Baclofen reduces both acid and nonacid gastroesophageal reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Baclofen reduces both acid and nonacid gastroesophageal reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Symptoms are not reliably associated with acid or nonacid gastroesophageal reflux: Assessement by combined multichannel intraluminal impedance and pH (MII/pH)

Symptoms are not reliably associated with acid or nonacid gastroesophageal reflux: Assessement by combined multichannel intraluminal impedance and pH (MII/pH)