S Roman1, C P Gyawali2, E Savarino3, R Yadlapati4, F Zerbib5, J Wu6, M Vela7, R Tutuian8, R Tatum9, D Sifrim10, J Keller11, M Fox12, J E Pandolfino4, A J Bredenoord13. 1. Digestive Physiology, Hospices Civils de Lyon and Lyon I University, Inserm U1032, LabTAU, Lyon, France. 2. Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA. 3. Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, Padua, Italy. 4. Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, IL, USA. 5. Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux, Bordeaux, France. 6. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA. 8. Division of Gastroenterology, University Clinics for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland. 9. Department of Surgery, University of Washington, Seattle, WA, USA. 10. Center for Digestive Diseases, Bart's and the London School and Dentistry, London, UK. 11. Department of Internal Medicine, Israelitic Hospital, University of Hamburg, Hamburg, Germany. 12. Department of Gastroenterology, Abdominal Center, St. Claraspital, Basel, Switzerland. 13. Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
BACKGROUND: An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). METHODS: Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. KEY RESULTS: Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. CONCLUSIONS AND INFERENCES: The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled.
BACKGROUND: An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). METHODS: Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. KEY RESULTS: Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. CONCLUSIONS AND INFERENCES: The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled.
Authors: George Triadafilopoulos; Thomas Zikos; Kirsten Regalia; Irene Sonu; Nielsen Q Fernandez-Becker; Linda Nguyen; Monica Christine R Nandwani; John O Clarke Journal: Dig Dis Sci Date: 2018-06-29 Impact factor: 3.199
Authors: Ishita Dhawan; Brendon O'Connell; Amit Patel; Ron Schey; Henry P Parkman; Frank Friedenberg Journal: Dig Dis Sci Date: 2018-12 Impact factor: 3.199
Authors: Andrew J Gawron; Reginald Bell; Barham K Abu Dayyeh; F P Buckley; Kenneth Chang; Christy M Dunst; Steven A Edmundowicz; Blair Jobe; John C Lipham; Dan Lister; Marcia Irene Canto; Michael S Smith; Anthony A Starpoli; George Triadafilopoulos; Thomas J Watson; Erik Wilson; John E Pandolfino; Alexander Kaizer; Zoe Van De Voorde; Rena Yadlapati Journal: Gastrointest Endosc Date: 2020-01-31 Impact factor: 9.427
Authors: Benjamin D Rogers; Amit Patel; Dan Wang; Gregory S Sayuk; C Prakash Gyawali Journal: Clin Gastroenterol Hepatol Date: 2019-08-20 Impact factor: 11.382