pH-metry Data Research Articles

Increased visceral sensitivity, elevated anxiety, and depression levels in patients with functional esophageal disorders and non-erosive reflux disease.

Little is known about possible underlying psychological abnormalities and physiology of reflux hypersensitivity (RH) as defined in the recent Rome IV classification. We aimed to assess markers of psychological comorbidity as well as gastro-esophageal reflux measurements in RH patients compared to controls and also in patients with functional heartburn (FH) and non-erosive reflux disease (NERD) versus controls. Data of 304 patients visiting our Functional Diagnostics Centre from 2016 to 2018 were analyzed. We focused on a psychological assessment using validated questionnaires (visceral sensitivity index; VSI, hospital anxiety and depression score; HADS) as well as multichannel intraluminal impedance (MII) and pH-metry data from the diagnostic work-up. We found a decreased VSI of 57.8±15.4 points (pts) among RH patients (n=45) indicating higher visceral sensitivity compared to 85.7±2.0 pts in the control group (n=31, P<0.001). Furthermore, a significant difference in VSI was found between the FH (60.8±23.3 pts, n=59, P<0.001) and between the NERD (61.9±20.8 pts, n=67, P<0.001) both compared to the control group. The HADS also displayed a significant difference between the RH (11.9±6.0 pts, P<0.001), FH (11.0±7.4 pts, P<0.001), respectively, NERD (11.3±8.9 pts, P<0.001) as compared to the control group (2.0±1.4 pts). Increased sensation to visceral stimuli as well as anxiety and depression appears to play an important role not only in reflux hypersensitivity and functional heartburn as defined by Rome IV but also in NERD. These findings are in line with the disease concept of disorders of gut-brain interaction in which psychological comorbidities and visceral hypersensitivity play a major role.

Body Weight Reduction Improves Both Reflux Symptoms and Esophageal Physiologic Examination

A 51-year-old woman with gastroesophageal reflux disease (GERD) had high body weight and body mass index (BMI) initially, and proton-pump inhibitor (PPI) was needed for symptom relief. Three years later, her body weight and BMI were reduced. Improvement of GERD questionnaire scores and 24-hour esophageal pH-metry data were disclosed. No additional PPIs were needed. J Med Cases. 2015;6(11):505-507 doi: http://dx.doi.org/10.14740/jmc2331w

Prognosis and Diagnostics of Water-absorbing Capacity of Polydisperse Materials by pH-metry Data

The work focuses on the solution of the problem concerning the diagnostics and prognosis of water-absorbing capacity of polydisperse materials. The relation of water absorption and acid-base properties of the surface is considered. The advantages of the research of acid-base properties of the surface by the pH-metry method are illustrated. The algorithm of the processing and interpretation of pH metric results to diagnose water absorption of powdery substances is suggested. The diagnostics is based on the research of velocity variation of mass transfer in the reaction zone in time. The change of pH suspension per unit of time is considered for the first time as an analytic signal of «WрН» mass transfer velocity. It is demonstrated that the velocity variation of mass transfer in the system “solid body-water” reflects the stopping mechanism of ion exchange and can be used for prognosis of hydrophobic behavior of the solid body surface. The introduced material in the given article will be useful for implementation in research, industrial and school laboratories.

Body Weight Reduction Improves Both Reflux Symptoms and Esophageal Physiologic Examination

A 51-year-old woman with gastroesophageal reflux disease (GERD) had high body weight and body mass index (BMI) initially, and proton-pump inhibitor (PPI) was needed for symptom relief. Three years later, her body weight and BMI were reduced. Improvement of GERD questionnaire scores and 24-hour esophageal pH-metry data were disclosed. No additional PPIs were needed. J Med Cases. 2015;6(11):505-507 doi: http://dx.doi.org/10.14740/jmc2331w

How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?

Background and objectiveRespiratory function deteriorates over time after lung transplant. Reflux disease with pulmonary complications is a possible cause of this decline. This case series we aim to assess whether respiratory function improves after Nissen fundoplication in lung transplant patients and if surgery reduces gastroesophageal reflux disease (GERD) symptoms and use of proton pump inhibitors (PPIs). Materials and methodsA retrospective case series of lung transplant patients with reflux disease and Nissen fundoplication. Clinical symptoms, pH-metry data, use of PPIs were recorded before the procedure and up to 18 months postoperatively. The FEV1 values before and after Nissen fundoplication were recorded at 3 monthly intervals. Patients’ satisfaction scores were recorded before operation and postoperatively. ResultsA total of 64 lung transplant patients were selected. After Nissen fundoplication, the pH studies were done on 26 patients. The mean overall acid exposure fraction was 1.03% (P<0.05). FEV1 declined for 6 months postoperatively and then gradually improved. The comparison of FEV1 at 3 months preoperatively to 3 months postoperatively showed no significant difference (P=0.067) as well as at 6 months. A significant improvement in clinical GERD symptoms was achieved after antireflux surgery; however, the patients remained receiving PPIs. ConclusionsNF has been established as a safe operation for lung transplant patients. Late Nissen fundoplication did not improve lung function significantly amongst lung transplanted patients; however, patients with symptomatic GERD may have benefited from Nissen fundoplication in terms of symptom relief. A multicenter randomized control trial is needed to assess the effect of early unselected reflux control on respiratory function and graft survival.

Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance

Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in multichannel intraluminal impedance (MII) represent reflux episodes or artifacts. Hiatal hernia (HH) may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. The aim was to search for a mechanism that can explain pH-only reflux, 20 patients (12 females and 8 males, median age 52 years, interquartile range [IQR]: 40.5-60.75 years) were investigated with MII-pH off PPI. Impedance and pH-metry data were analyzed separately. The differences in detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. In an in vitro experiment, MII-pH probes were flushed with citric acid in plastic tubes of different size with capillary diameter and diameters of 2.5 mm and 4.5 mm, while recording pH values and impedance. HH was present in six patients and absent in 14 patients. In patients with HH in comparison with patients with absent HH, the difference of acid reflux detection between pH-metry and MII is significantly higher (70%, IQR: 15-88% and 3.6%, IQR: 0-31%, respectively). In vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5-mm plastic tubes. Acid reflux episodes in patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon.

554 Role of RNA Binding Protein CUGBP2 in Radiation-Mediated Autophagy

with increased GER which may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. Aim: To search for a mechanism that can explain the differences between MII and pH-metry in detecting acid reflux episodes in patients with HH. Methods: 19 patients with GERD symptoms (12 female, 7 male, median age 51yrs (19-65yrs)) were investigated with combined MII-pH. All of the patients were not taking acid suppressive medication for at least 10 days before investigation. Impedance and pH-metry data were analysed separately. The differences in the detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. Presence of HH was defined endoscopically and classified as present if larger than 1 cm. Additionally we used an In Vitro reflux model. Thereby the impedance probe was flushed with citric acid in plastic tubes (PT) of different size with capillary diameter and diameters of 2,5 mm and 4,5 mm. Citric acid was flushed through the PT repetitively while recording pH and Impedance. Results: HH was present in 6 patients and absent in 13 patients. The mean number of acid reflux episodes in all patients was 24 ± 20 using pH-metry and 18 ± 19 times using MII accounting for a difference of 27% detection rate. In patients with HH in comparison to patients with absent HH the difference of acid reflux detection between pH-metry and MII is significantly higher (26±11; 72% and 5±18; 14% respectively; p<0.01). In Vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5 mm PT. Simulated reflux using capillaries and the 2.5 mm PT led to a decrease in pH without decrease in impedance. Conclusion: Acid reflux episodes in GERD patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon.

Is the course of gastroesophageal reflux disease progressive? A 21-year follow-up

Objective. We re-evaluated a cohort of patients referred for reflux symptoms and objectively diagnosed with pathological reflux, with the purpose of clarifying the course of conservatively treated gastroesophageal reflux disease (GERD). Material and methods. All consecutive patients with GERD diagnosed between 1984 and 1988 showing pathologic 24-h pH-metry in the interval 3.8–10% and without any previous surgery in the gastroesophageal tract were assessed for further follow-up. A total of 40 evaluable patients were followed in the years 2007–08 with endoscopy, manometry, 24-h pH-metry, Helicobacter pylori assessment and the self-administered questionnaires the GERD Impact Scale, the Reflux Disease Questionnaire, the Quality of Life in Reflux and Dyspepsia and the Medical Outcome Study Short Form-36 Health Survey. Baseline data from the 1980s were retrieved and compared with the evaluations conducted at follow-up. Results. At follow-up 20.7 years (range 18.8–23.5 years) after referral, the study population showed more use of acid suppressants (p = 0.007) and increasing prevalences of esophagitis (p = 0.001) and Barrett's esophagus (p = 0.002). Esophagitis was seen in 16/40 patients (40%) at baseline and in 29/40 (72.5%) at follow-up. No significant deterioration was seen at follow-up in manometry data and in most pH data. Patients with esophagitis (ERD) were less likely to have a positive H. pylori test (hazard ratio 0.054; p = 0.002) than non-erosive (NERD) patients. Symptom evaluations showed significantly lower quality of life in the ERD group. Conclusions. After 20 years a considerable part of the cohort still experienced symptoms of reflux and showed endoscopic progression, although no significant deteriorations were seen in manometry data and in most pH-metry data. H. pylori infection was inversely associated with erosive esophagitis and this supports the hypothesis that H. pylori colonization is a protective factor against GERD.

Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Background/Aims: Atypical manifestations of gastroesophageal reflux disease (GERD) are diverse. We aimed to determine whether pepsin detection in the sputum/saliva could be useful for diagnosing GERD in patients with clinically suspected atypical GERD symptoms. Methods: Patients with clinically suspected atypical GERD symptoms provided sputum/saliva collected before bedtime, at the time of those symptoms, and after awakening for pepsin measurement by Western blot analysis. All subjects received 24-hour esophageal pH monitoring, and then 40 mg of esomeprazole was given twice a day for 2 weeks. Results: The pepsin test was positive in 20 out of 40 patients, with pepsin detected mainly in the samples collected at the time of symptoms (45%). Samples collected from healthy volunteers (n = 8) were all negative for pepsin. 24-hour pH-metry was positive in 9 patients (23%). Based on 24-hour pH-metry data, the sensitivity and negative predictive value of the pepsin test were excellent in most of typical and atypical symptom groups, whereas its specificity and positive predictive value were relatively low, particularly in atypical symptom groups. Conclusions: Pepsin measurement in the sputum/saliva collected at the time of symptoms provides a sensitive, non-invasive method for diagnosing GERD in patients with clinically suspected atypical GERD symptoms.

Correlations between Exhaled Nitric Oxide Levels and pH-Metry Data in Asthmatics with Gastro-Oesophageal Reflux

Background: In gastro-oesophageal reflux (GER), micro-aspirations of gastric fluid may damage the epithelial surface of the airways, an important source of endogenous nitric oxide (NO). Objectives: The aim of the study was to evaluate the possible influence of GER on fractional exhaled nitric oxide (FE_NO) release. Methods: FE_NO levels were compared in two age-matched groups of allergic children: (1) 20 with mild asthma, responding to standard anti-asthma pharmacologic therapy (asthmatic children) and (2) 12 with mild ‘asthma-like symptoms’ and GER. Results: No differences in pulmonary functions parameters (FEV₁, FVC and FEF_25–75%) were found between the two groups of children (p > 0.1); FE_NO levels were higher in asthmatic children compared with GER children (p = 0.0001). GER children underwent 24-hour oesophageal pH-metry, and possible correlations between pH-metry data, pulmonary functions and FE_NO levels were evaluated. No correlations were found between pulmonary functions and pH-metry data (p > 0.05, each correlation). In contrast, correlations were observed between FE_NO levels and pH-metry data, including (1) percentage of study time with pH < 4 (r = –0.80, p = 0.008), (2) number of episodes with pH < 4 (r = –0.76, p = 0.012), and (3) number of episodes >5 min with pH < 4 (r = –0.69, p = 0.02). Conclusions: Thus, FE_NO levels are lower in allergic children with ‘asthma-like symptoms’ and GER as compared to asthmatic children. The correlations between FE_NO levels and pH-metry data suggest that inhalation of acid gastric content may interfere with NO production in the airways.

VALIDATION AND MODIFICATION OF THE pH METRY-ANALYSIS PROTOCOL WITH THE pH INDEPENDENT IMPEDANCE TECHNIQUE

131 pH monitoring is considered the goldstandard in diagnosing gastroesophageal reflux (GER). However, it does not in fact measure reflux, but only pH values. Thus the parameters to define GER pH-wise were derived empirically. These parameters were evaluated for their validity of reflux recognition and modified using the intraesophageal impedance technique (IMP), a pH-independent method for the registration of bolus movement. Methods: Simultaneous pH-IMP-measurements were performed in 50 infants. Using the standardized ESPGAN protocol for the analysis of pH metry data, the parameters sampling rate (SR), cutoff value (CV: GER registration, if pH < CV), minimal GER duration (MD) and latency time (LT, i.e. time after end of GER, wherein pH-drops < CV are considered the same episode) were varied. A new parameter, pre-latency time (preLT, i.e. time before beginning of GER, wherein pH-drops < CV are neglected), was introduced. By software aided analysis the optimal set of parameters regarding sensitivity and positive prediction was determined. Results: During a total measuring time of 310 hours 1856 reflux episodes were identified by IMP and considered the reference data. 306 GER with pH < 4 should have been identified by pH metry. With the standard parameters (SR 15/min, CV pH 4, MD 15s, LT 30s) 307 GER were detected by pH metry: 145 true GER (sensitivity 47.4%) and 162 falsely identified episodes(positive prediction 47.2%). Using the best parameter set (SR 60/min, CV pH 4, MD 5s, LT 30s, preLT 3s) 150 true (sensitivity 49.0%) and 154 false (positive prediction 49.3%) GER were detected. Conclusions: The diagnostic potential of pH metry, its sensitivity and positive prediction in identifying acid reflux was validated with IMP as the reference. The empirically derived parameters for the analysis of pH metry data proved to be valuable using standard hard- and software. By increasing sampling rate, decreasing minimal GER duration and with the introduction of a new parameter, the pre-latency time, sensitivity and positive prediction could be slightly increased. However, due to its nonacidity, the major amount of GER is concealed to pH metry and only detected by the impedance technique.

Natural history of gastro-oesophageal reflux disease without oesophagitis.

This retrospective study was undertaken to characterise the clinical course and reflux pattern of patients with gastro-oesophageal reflux without evidence of oesophagitis. We investigated 33 patients (12 women, 21 men; mean age 36 years) with typical symptoms, a negative oesophagoscopy, and a 24 hour oesophageal pH-metry indicative of pathological gastro-oesophageal reflux. All patients received antacids or prokinetic drugs or both for three to six months. Nineteen of 33 patients still had symptoms at the end of treatment, of whom five had developed erosive changes of the oesophageal mucosa. The other 14 discontinued treatment and remained asymptomatic during a six month follow up period. Comparison of the pretreatment pH-metry data of the 19 symptomatic patients and the 14 asymptomatic patients showed no differences in the pattern of gastro-oesophageal reflux in the two groups. We conclude that in a substantial proportion of patients with pathological reflux without oesophagitis symptoms may persist and mucosal lesions may develop during conventional treatment without any apparent change in the reflux. Patients who developed endoscopic oesophagitis did not have a more severe pretreatment pattern of gastro-oesophageal reflux when compared with those who did not develop oesophageal mucosal damage.