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Impedance technology for the management of esophageal disorders

Imedanzmessungen im Ösophagus – Klinische Anwendungen

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Zusammenfassung

GRUNDLAGEN: Impedanzmessungen im Ösophagus werden zunehmend häufiger zur Erkennung und Quantifizierung der Präsenz von Flüssigkeiten in der Speiseröhren eingesetzt. METHODIK: Übersicht der klinischen Anwendungen von Impedanzmessungen, insbesondere kombinierte Impedanz-Manometrie und Impedanz-pH-Metrie. ERGEBNISSE: Kombinierte Impedanz-Manometrie ermöglicht die Quantifizierung des Bolustransites und klärt, inwiefern ösophageale Motilitätsabnormalitäten von einer Bolustransitstörung begleitet sind. Dies ist von besonderem Interesse für Patienten mit nicht-obstruktiver (i.e. funktioneller) Dysphagie und Patienten mit post-operativer Dysphagie. Kombinierte Impedanz-pH-Metrie identifiziert Refluxepisoden unabhängig vom Säuregehalt (i.e. pH). Dieses ist wichtig für Patienten mit persistierenden Beschwerden trotz säurehemmender Therapie. Die Möglichkeit Refluxepisoden mit pH > 4 zu identifizieren, bringt neue Fragen betreffend der optimalen Therapie für Patienten mit symptomatischem nicht-saurem Reflux. SCHLUSSFOLGERUNGEN: Impedanzmessungen ermöglichen uns Flüssigkeitsbewegungen in der Speiseröhre zu identifizieren. Die klinische Wertigkeit dieser zusätzlichen Information dürfte durch zukünftige Studien geklärt werden.

Summary

BACKGROUND: Esophageal impedance measurements are increasingly used to identify and quantify the presence of fluids in the esophagus. METHOD: A review of the available literature on clinical applications of impedance including combined impedance-manometry testing and combined impedance-pH monitoring is done. RESULTS: Combined impedance-manometry testing offers the opportunity to quantify esophageal bolus transit and clarifies the implications of esophageal motility abnormalities on esophageal function. This is of particular interest in patients with non-obstructive dysphagia and in patients with post-fundoplication dysphagia. Combined impedance-pH monitoring allows the detection of gastroesophageal reflux episodes independent of pH. This is of particular importance when evaluating patients with persistent symptoms on acid suppressive therapy. The ability to detect gastroesophageal reflux episodes with pH > 4 unfolds new questions on the optimal approach to patients with symptomatic non-acid reflux. CONCLUSIONS: Impedance technology allows the detection of fluid movements in the esophagus; further studies will determine the clinical utility of this new information.

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References

  • Silny J (1991) Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. J Gastrointest Motil 3: 151–162

    Google Scholar 

  • Silny J, Knigge KP, Fass J, Rau G, Matern S, Schumpelick V (1993) Verification of the intraluminal multiple electrical impedance measurement for recording of gastrointestinal motiliy. J Gastrointest Motil 5: 107–122

    Google Scholar 

  • Simren M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D (2003) Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut 52: 784–790

    Article  PubMed  CAS  Google Scholar 

  • Imam H, Shay S, Ali A, Baker M (2005) Bolus transit patterns in healthy subjects: a study using simultaneous impedance monitoring, videoesophagram, and esophageal manometry. Am J Physiol 288: G1000–G1006

    CAS  Google Scholar 

  • Bredenoord A (2007) High-resolution manometry – bliss upon bliss for esophagology? Eur Surg 39: 167–173

    Article  Google Scholar 

  • Lenglinger J, Ringhofer C, Eisler M, Devyatko E, Cosentini E, Wrba F, Zacherl J, Riegler M (2006) Diagnosis of Gastroesophageal Reflux Disease (GERD). Eur Surg 38: 227–243

    Article  Google Scholar 

  • Srinivasan R, Vela MF, Katz PO, Tutuian R, Castell JA, Castell DO (2001) Esophageal function testing using multichannel intraluminal impedance. Am J Physiol 280: G457–G462

    CAS  Google Scholar 

  • Tutuian R, Vela MF, Balaji N, Wise JL, Murray JA, Peters JH, Shay SS, Castell DO (2003) Esophageal function testing using combined multichannel intraluminal impedance and manometry. Multicenter study of healthy volunteers. Clin Gastroenterol Hepatol 1: 174–182

    Article  PubMed  Google Scholar 

  • Nguyen NQ, Rigda R, Tippett M, Conchillo J, Smout AJ, Holloway RH (2005) Assessment of oesophageal motor function using combined perfusion manometry and multi-channel intra-luminal impedance measurement in normal subjects. Neurogastroenterol Motil 17: 458–465

    Article  PubMed  CAS  Google Scholar 

  • Nguyen HN, Domingues GR, Winograd R, Koppitz P, Lammert F, Silny J, Matern S (2003) Impedance characteristics of normal oesophageal motor function. Eur J Gastroenterol Hepatol 15: 773–780

    Article  PubMed  Google Scholar 

  • Tutuian R, Castell DO (2004) Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities. Study in 350 patients. Am J Gastroenterol 99: 1011–1019

    Article  PubMed  Google Scholar 

  • Tutuian R, Castell DO (2004) Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry. Clin Gastroenterol Hepatol 2: 230–236

    Article  PubMed  Google Scholar 

  • Conchillo JM, Nguyen NQ, Samsom M, Holloway RH, Smout AJ (2005) Multichannel intraluminal impedance monitoring in the evaluation of patients with non-obstructive dysphagia. Am J Gastroenterol 100: 2624–2632

    Article  PubMed  Google Scholar 

  • Tatum RP, Wong JA, Figueredo EJ, Martin V, Oelschlager BK (2007) Return of esophageal function after treatment for achalasia as determined by impedance-manometry. J Gastrointest Surg 11: 1403–1409

    Article  PubMed  Google Scholar 

  • Yigit T, Quiroga E, Oelschlager B (2006) Multichannel intraluminal impedance for the assessment of post-fundoplication dysphagia. Dis Esophagus 19: 382–388

    Article  PubMed  CAS  Google Scholar 

  • Sifrim D, Castell DO, Dent J, Kahrilas PJ (2004) Gastroesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid and gas reflux. Gut 53: 1024–1031

    Article  PubMed  CAS  Google Scholar 

  • Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99: 1037–1043

    Article  PubMed  Google Scholar 

  • Helm JF, Dodds WJ, Pelc LR, Palmer DW, Hogan WJ, Teeter BC (1984) Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med 310: 284–288

    PubMed  CAS  Google Scholar 

  • Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, Mion F, Caillol F, Verin E, Bommelaer G, Ducrotté P, Galmiche JP, Sifrim D (2005) 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 22: 1011–1021

    Article  PubMed  CAS  Google Scholar 

  • Zentilin P, Iiritano E, Dulbecco P, Bilardi C, Savarino E, De Conca S, Parodi A, Reglioni S, Vigneri S, Savarino V (2006) Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis 38: 226–232

    Article  PubMed  CAS  Google Scholar 

  • Mainie I, Tutuian R, Shay S, Vela M, Zhang X, Sifrim D, Castell DO (2006) Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring. Gut 55: 1398–1402

    Article  PubMed  CAS  Google Scholar 

  • Zerbib F, Roman S, Ropert A, des Varannes SB, Pouderoux P, Chaput U, Mion F, Vérin E, Galmiche JP, Sifrim D (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101: 1956–1963

    Article  PubMed  Google Scholar 

  • Becker V, Bajbouj M, Waller K, Schmid RM, Meining A (2007) Clinical trial: persistent gastro-oesophageal reflux symptoms despite standard therapy with proton pump inhibitors – a follow-up study of intraluminal-impedance guided therapy. Aliment Pharmacol Ther 26: 1355–1360

    Article  PubMed  CAS  Google Scholar 

  • Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J (2005) Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 54: 449–454

    Article  PubMed  CAS  Google Scholar 

  • Tutuian R, Mainie I, Agrawal A, Adams D, Castell DO (2006) Nonacid reflux in patients with chronic cough on acid-suppressive therapy. Chest 130: 386–391

    Article  PubMed  Google Scholar 

  • Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO (2006) Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 93: 1483–1487

    Article  PubMed  CAS  Google Scholar 

  • Wykypiel H, Bonatti H, Hinder RA, Glaser K, Wetscher GJ (2006) The laparoscopic fundoplications: Nissen and partial posterior (Toupet) fundoplication. Eur Surg 38: 244–249

    Article  Google Scholar 

  • Clouse RE, Richter JE, Heading RC, Janssens J, Wilson JA (1999) Functional esophageal disorders. Gut 45 (Suppl 2): II31–II36

    Article  PubMed  Google Scholar 

  • Tutuian R, Castell DO (2004) Rumination documented by using combined multichannel intraluminal impedance and manometry. Clin Gastroenterol Hepatol 2: 340–343

    Article  PubMed  Google Scholar 

  • Bredenoord AJ, Weusten BL, Sifrim D, Timmer R, Smout AJ (2004) Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut 53: 1561–1565

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland

    R. Tutuian

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  1. R. Tutuian
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Correspondence to R. Tutuian.

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Tutuian, R. Impedance technology for the management of esophageal disorders. Eur Surg 40, 50–57 (2008). https://doi.org/10.1007/s10353-008-0393-1

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  • DOI: https://doi.org/10.1007/s10353-008-0393-1

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