Delia Pugliese1, Aurelio Mauro2, Dario Consonni3, Ivana Bravi2, Andrea Tenca2, Alessandra Elvevi2, Dario Conte2, Roberto Penagini2. 1. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via della Commenda 19, 20122, Milan, Italy. delia.pugliese@unimi.it. 2. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via della Commenda 19, 20122, Milan, Italy. 3. Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122, Milan, Italy.
Abstract
BACKGROUND: The addition of impedance to 24-h pH monitoring has allowed detection of weakly acidic reflux, but the extent to which pH-impedance (pH-MII) monitoring improves outcomes is unknown. METHODS: This was a prospective observational study. Patients referred for pH or pH-MII monitoring completed a standardized questionnaire on improvement in the dominant symptom, their satisfaction, and treatment at 3 and 12 months after the test during a telephone interview. RESULTS: A total of 184 patients (mean age, 52 years, range, 19-82 years; 35 % with typical symptoms; and 89 % tested off therapy) completed pH (n = 92) or pH-MII monitoring (n = 92) over a period of 15 months. The two arms were similar in terms of demographic, clinical, and endoscopic variables. Ten patients in the pH-MII arm showed evidence of weakly acidic reflux disease. There was no difference in the percentage of patients in the pH and pH-MII monitoring arms who experienced improvement in their dominant symptom after 3 (58 vs. 63 %; p = 0.621) or 12 months (66 vs. 70 %; p = 0.234), and the same was true for patient satisfaction. There were also no between-group difference in the use of proton pump inhibitors (PPIs) after 3 (63 vs. 68.5 %; p = 0.437) or 12 months (47 vs. 60.5 %; p = 0.051). PPIs were prescribed more frequently after a positive test (p < 0.001) although they were used by 45.6 % of the negative patients. Only one patient underwent fundoplication. CONCLUSIONS: Two-thirds of patients undergoing pH-MII monitoring experience a positive outcome, similarly to what occurs after traditional pH monitoring. Physicians often pay little attention to the test results, especially if they are negative.
BACKGROUND: The addition of impedance to 24-h pH monitoring has allowed detection of weakly acidic reflux, but the extent to which pH-impedance (pH-MII) monitoring improves outcomes is unknown. METHODS: This was a prospective observational study. Patients referred for pH or pH-MII monitoring completed a standardized questionnaire on improvement in the dominant symptom, their satisfaction, and treatment at 3 and 12 months after the test during a telephone interview. RESULTS: A total of 184 patients (mean age, 52 years, range, 19-82 years; 35 % with typical symptoms; and 89 % tested off therapy) completed pH (n = 92) or pH-MII monitoring (n = 92) over a period of 15 months. The two arms were similar in terms of demographic, clinical, and endoscopic variables. Ten patients in the pH-MII arm showed evidence of weakly acidic reflux disease. There was no difference in the percentage of patients in the pH and pH-MII monitoring arms who experienced improvement in their dominant symptom after 3 (58 vs. 63 %; p = 0.621) or 12 months (66 vs. 70 %; p = 0.234), and the same was true for patient satisfaction. There were also no between-group difference in the use of proton pump inhibitors (PPIs) after 3 (63 vs. 68.5 %; p = 0.437) or 12 months (47 vs. 60.5 %; p = 0.051). PPIs were prescribed more frequently after a positive test (p < 0.001) although they were used by 45.6 % of the negative patients. Only one patient underwent fundoplication. CONCLUSIONS: Two-thirds of patients undergoing pH-MII monitoring experience a positive outcome, similarly to what occurs after traditional pH monitoring. Physicians often pay little attention to the test results, especially if they are negative.
Authors: N de Bortoli; I Martinucci; E Savarino; M Bellini; A J Bredenoord; R Franchi; L Bertani; M Furnari; V Savarino; C Blandizzi; S Marchi Journal: Neurogastroenterol Motil Date: 2013-08-29 Impact factor: 3.598
Authors: D Jaspersen; J Labenz; S N Willich; M Kulig; M Nocon; A Leodolter; T Lind; W Meyer-Sabellek; M Vieth; M Stolte; P Malfertheiner Journal: Dig Liver Dis Date: 2006-01-18 Impact factor: 4.088
Authors: Frank Zerbib; Sabine Roman; Alain Ropert; Stanislas Bruley des Varannes; Philippe Pouderoux; Ulriikka Chaput; François Mion; Eric Vérin; Jean-Paul Galmiche; Daniel Sifrim Journal: Am J Gastroenterol Date: 2006-07-18 Impact factor: 10.864