Abstract
Gastroesophageal reflux disease (GERD) is a common condition in gastroenterology practice. Classical techniques like endoscopy and 24-h pH-metry are often used to diagnose patients with symptoms related to GERD. Although these techniques have been useful over the years both for diagnosis and therapeutic guidance, there are still many patients with typical or atypical GERD symptoms with normal endoscopy and pH-metry who do not respond adequately to anti-secretory therapy. 24-h impedance combined with pH is a new technique and currently considered as the gold standard for diagnosis of GERD. It offers greater sensitivity for the detection of all reflux episodes, and allows us to establish their nature (liquid, gas, mixed), composition (acidic, non-acidic), and clearance. This chapter describes basic principles, technique, interpretation, and clinical application of 24-h pH impedance monitoring.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Nguyen HN, Domingues GR, Lammert F. Technological insights: combined impedance manometry for esophageal motility testing-current results and further implications. World J Gastroenterol. 2006;12:6266–73.
Fass J, Silny J, Braun J, Heindrichs U, Dreuw B, Schumpelick V, et al. Measuring esophageal motility with a new intraluminal impedance device. First clinical results in reflux patients. Scand J Gastroenterol. 1994;29:693–702.
Dolder M, Tutuian R. Laboratory based investigations for diagnosing gastroesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2010;24:787–98.
Cho YK. How to interpret esophageal impedance pH monitoring. J Neurogastroenterol Motil. 2010;16:327–30.
Tutuian R, Castell DO. Review article: complete gastro-oesophageal reflux monitoring – combined pH and impedance. Aliment Pharmacol Ther. 2006;24 Suppl 2:27–37.
Sifrim D, Fornari F. Esophageal impedance-pH monitoring. Dig Liver Dis. 2008;40:161–6.
Bredenoord AJ. Impedance-pH monitoring: new standard for measuring gastro-oesophageal reflux. Neurogastroenterol Motil. 2008;20:434–9.
Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:647–55.
Villa N, Vela MF. Impedance-pH testing. Gastroenterol Clin North Am. 2013;42:17–26.
Sifrim D, Holloway R, Silny J, Xin Z, Tack J, Lerut A, et al. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology. 2001;120:1588–98.
Ghoshal UC, Singh R, Misra A. Esophageal function tests in clinical practice: a review. Trop Gastroenterol. 2010;31:145–54.
Wang A, Pleskow DK, Banerjee S, Barth BA, Bhat YM, Desilets DJ, et al. Esophageal function testing. Gastrointest Endosc. 2012;76:231–43.
Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–43.
Zentilin P, Iiritano E, Dulbecco P, Bilardi C, Savarino E, De Conca S, et al. Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis. 2006;38:226–32.
Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–21.
Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.
Tutuian R, Castell DO. Reflux monitoring: role of combined multichannel intraluminal impedance and pH. Gastrointest Endosc Clin N Am. 2005;15:361–71.
Galmiche JP. Impedance-pH monitoring in proton pump inhibitor resistant patients: ready for clinical application? Gut. 2006;55:1379–81.
Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.
Vela MF. Non-acid reflux: detection by multichannel intraluminal impedance and pH, clinical significance and management. Am J Gastroenterol. 2009;104:277–80.
Bredenoord AJ, Weusten BL, Timmer R, Conchillo JM, Smout AJ. Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy. Am J Gastroenterol. 2006;101:453–9.
Savarino E, Zentilin P, Tutuian R, Pohl D, Casa DD, Frazzoni MC, et al. The role of nonacid reflux in NERD: lessons learned from impedance-pH monitoring in 150 patients off therapy. Am J Gastroenterol. 2008;103:2685–93.
Bredenoord AJ, Weusten BL, Curvers WL, Timmer R, Smout AJ. Determinants of perception of heartburn and regurgitation. Gut. 2006;55:313–8.
Tutuian R, Vela MF, Hill EG, Mainie I, Agrawal A, Castell DO. Characteristics of symptomatic reflux episodes on Acid suppressive therapy. Am J Gastroenterol. 2008;103:1090–6.
Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut. 2006;55:1398–402.
Tutuian R, Mainie I, Agrawal A, Adams D, Castell DO. Nonacid reflux in patients with chronic cough on acid-suppressive therapy. Chest. 2006;130:386–91.
Bajbouj M, Becker V, Neuber M, Schmid RM, Meining A. Combined pH-metry/impedance monitoring increases the diagnostic yield in patients with atypical gastroesophageal reflux symptoms. Digestion. 2007;76:223–8.
Blondeau K, Tack J. Pro: impedance testing is useful in the management of GERD. Am J Gastroenterol. 2009;104:2664–6.
Zerbib F, Roman S, Ropert A, des Varannes SB, Pouderoux P, Chaput U, et al. Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol. 2006;101:1956–63.
Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54:449–54.
Blondeau K, Dupont LJ, Mertens V, Tack J, Sifrim D. Improved diagnosis of gastro-oesophageal reflux in patients with unexplained chronic cough. Aliment Pharmacol Ther. 2007;25:723–32.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer India
About this chapter
Cite this chapter
Ghoshal, U.C., Singh, R. (2016). Catheter-Based 24-h pH-Metry and Impedance: Technique, Interpretation, and Clinical Application. In: Ghoshal, U. (eds) Evaluation of Gastrointestinal Motility and its Disorders. Springer, New Delhi. https://doi.org/10.1007/978-81-322-0822-8_9
Download citation
DOI: https://doi.org/10.1007/978-81-322-0822-8_9
Published:
Publisher Name: Springer, New Delhi
Print ISBN: 978-81-322-0821-1
Online ISBN: 978-81-322-0822-8
eBook Packages: MedicineMedicine (R0)