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Twenty-four-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of gastroesophageal reflux disease, particularly in presence of reduced gastric acid secretion

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Abstract

Background

Current gold standard for the diagnosis of gastroesophageal reflux disease (GERD) is 24-hour pH metry though it fails to detect non-acidic reflux. The sensitivity of 24-hour pH metry alone (both catheter-based and Bravo capsule) is questionable, especially if gastric acid secretion is low due to reduced parietal cell mass, Helicobacter pylori–induced gastric atrophy and antisecretory therapy. Accordingly, we analyzed the diagnostic ability of 24-hour pH metry as compared to impedance monitoring in relation to the gastric pH without antisecretory therapy.

Methods

A retrospective analysis of prospectively collected data from 150 patients with suspected GERD undergoing a 24-hour pH impedance study was done.

Results

Among 150 patients with symptoms suggestive of GERD, 106 (70.6%) had confirmed GERD diagnosed either by 24-hour pH metry alone (10 [9.4%]), impedance monitoring alone (49 [46.2%]) or both (47 [44.3%]). Abnormal reflux of acidic and non-acidic gastric contents was detected by 24-hour pH metry and 24-hour impedance monitoring in 57/106 (53.7%) and 96/106 (90.5%) of patients, respectively (p < .00001). Patients with GERD diagnosed by 24-hour impedance monitoring had a higher mean gastric pH (2.9 [median 1.3, IQR 5.3]) than those diagnosed by 24-hour pH metry (2.1 [median 1.4, IQR 2.6]) or both (1.6 [median 1.2, IQR 2.1]) (p = 0.001).

Conclusion

Twenty-four-hour impedance monitoring detects GERD more often than 24-hour pH metry. Patients with higher mean gastric pH leading to non-acidic reflux were more often diagnosed by 24-hour impedance monitoring than 24-hour pH metry. Thus, 24-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of GERD, particularly in presence of reduced gastric acid secretion.

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Acknowledgements

The authors thank Mr. Raghunath of the GI Pathophysiology and Motility Laboratory in the Department of Gastroenterology for his support for this work.

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Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Uday C. Ghoshal, Sugata Narayan Biswas, Anshuman Elhence, Bushra Fatima, Anand Prakash Agrahari & Asha Misra

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  1. Uday C. Ghoshal
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  2. Sugata Narayan Biswas
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  3. Anshuman Elhence
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Contributions

UCG: study concept, design, data analysis and writing and editing the paper; SNB, AE: collection of the data, contribution to writing; BF, APA and AM: performing the 24-hour pH and impedance studies and help during data collection. All authors read and approved the final version of the paper.

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Correspondence to Uday C. Ghoshal.

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UCG, SNB, AE, BF, APA and AM declare no competing interests.

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The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, printer/publishers or the Indian Society of Gastroenterology are responsible for the results/ findings and content of this article. The opinions expressed in this paper are the independent opinion of the authors and are not influenced in any way by the funding bodies.

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UCG and SNB contributed equally to the work and are joint first authors of the paper.

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Ghoshal, U.C., Biswas, S.N., Elhence, A. et al. Twenty-four-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of gastroesophageal reflux disease, particularly in presence of reduced gastric acid secretion. Indian J Gastroenterol 42, 525–533 (2023). https://doi.org/10.1007/s12664-023-01359-3

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