Journal of Gastrointestinal Surgery

, Volume 12, Issue 9, pp 1491–1496

Prospective Assessment of Patient Selection for Antireflux Surgery by Combined Multichannel Intraluminal Impedance pH Monitoring

  • Gianmattia del Genio
  • Salvatore Tolone
  • Federica del Genio
  • Rajesh Aggarwal
  • Antonio d’Alessandro
  • Alfredo Allaria
  • Gianluca Rossetti
  • Luigi Brusciano
  • Alberto del Genio
original article

Abstract

Introduction

Selecting gastroesophageal reflux disease (GERD) patients for surgery on the basis of standard 24-h pH monitoring may be challenging, particularly if this investigation does not correlate with clinical symptoms. Combined multichannel intraluminal impedance pH monitoring (MII-pH) is able to physically detect each episode of intraesophageal bolus movements, enabling identification of either acid or non-acid reflux episodes and thus establish the association of the reflux with symptoms.

Materials and Methods

We prospectively assessed and reviewed data from 314 consecutive patients who underwent MII-pH for GERD not responsive or not compliant to proton pump inhibitor therapy. One hundred fifty-three patients with a minimum follow-up of 1 year constituted the study population. Clinical outcomes and satisfaction rate were collected in all patients who underwent laparoscopic Nissen–Rossetti fundoplication. Outcomes were reported for patients with normal and ineffective peristalsis and for patients with positive pH monitoring, negative pH monitoring and positive total number of reflux episodes at MII, and negative pH monitoring and normal number of reflux episodes at MII and a positive symptom index correlation with MII.

Results

The overall patient satisfaction rate was 98.3%. No differences were recorded in the clinical outcomes of the patients with preoperative normal and ineffective peristalsis. No differences in patients’ satisfaction and clinical postoperative DeMeester symptom scoring system were noted between the groups as determined by MII-pH.

Conclusion

MII-pH provides useful information for objective selection of patients to antireflux surgery. Nissen fundoplication provides excellent outcomes in patients with positive and negative pH and positive MII monitoring or Symptom Index association. More extensive studies are needed to definitively standardize the useful MII-pH parameters to select the patient to antireflux surgery.

Keywords

Multichannel intraluminal impedance GERD Antireflux surgery Nissen MII-pH 

Abbreviations

GERD

gastroesophageal reflux disease

MII-pH

combined multichannel intraluminal pH monitoring

LES

lower esophageal sphincter

LNRF

laparoscopic Nissen–Rossetti fundoplication

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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Gianmattia del Genio
    • 1
  • Salvatore Tolone
    • 1
  • Federica del Genio
    • 1
  • Rajesh Aggarwal
    • 1
  • Antonio d’Alessandro
    • 1
  • Alfredo Allaria
    • 1
  • Gianluca Rossetti
    • 1
  • Luigi Brusciano
    • 1
  • Alberto del Genio
    • 1
  1. 1.Foregut and Obesity Pathophysiology Study Center, First Division of General and Gastrointestinal Surgery, Department of SurgeryUniversity of Naples IINaplesItaly

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