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Correlation between hypersensitivity induced by esophageal acid infusion and the baseline impedance level in patients with suspected gastroesophageal reflux

  • Original Article—Alimentary Tract
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Abstract

Objectives

To evaluate the relevance between the pH parameters and baseline impedance level or esophageal hypomotility in patients with suspected gastroesophageal reflux.

Method

The recordings of 51 patients with heartburn, acid regurgitation, globus or noncardiac chest pain were analyzed. Evaluation included a 24-h multichannel intraluminal impedance-pH test while on off-proton pump inhibitor therapy over 1 week, high-resolution manometry and Bernstein test. Mean baseline impedance level at the most distal portion of the impedance channel was assessed manually. Esophageal hypomotility was evaluated using transitional zone defect (TZD) and distal break (DB) length measurement.

Result

In the study subjects (n = 51), 6 had a DeMeester score of more than 14.7 and 14 had a positive symptom index. The Bernstein test was positive in ten patients. The baseline impedance level was inversely correlated with the acid exposure time % (r = −0.660, P < 0.001). Also, all reflux and weakly acid reflux time % measured by impedance monitoring showed a weak correlation with TZD + DB length (r = 0.327 and 0.324, P = 0.019 and 0.020, respectively). Although a positive Bernstein test has no relevance for the acid exposure time or acid-related symptoms as represented by the DeMeester score or symptom index, the baseline impedance level was significantly lower in patients with a positive Bernstein test than in those with a negative one (2,628.4 ± 862.7 vs. 1,752.2 ± 611.1 Ω, P = 0.004).

Conclusion

A lower baseline impedance level is closely related to increased esophageal acid exposure. Hypersensitivity induced by esophageal acid infusion might be attributed to acid-induced mucosal changes of the esophagus.

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Acknowledgments

The authors are indebted to J. Patrick Barron, Professor Emeritus, Tokyo Medical University, and Adjunct Professor, Seoul National University Bundang Hospital, for his pro bono editing of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Bundang Hospital, 173-82, Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea

    A. Young Seo, Cheol Min Shin, Nayoung Kim, Hyuk Yoon, Young Soo Park & Dong Ho Lee

  2. Health Promotion Center, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea

    A. Young Seo

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  1. A. Young Seo
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  2. Cheol Min Shin
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Correspondence to Cheol Min Shin.

Electronic supplementary material

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535_2014_1013_MOESM1_ESM.tif

Figure S1. Measurement of the transition zone defect (TZD) and distal break (DB)length. TZD was measured as the length (y axis) in centimeters of the break between the skeletal and smooth muscle contraction segments in the 20-mmHg isobaric contour. DB was measured as the length in centimeters of a visible break at the distal pressure troughs in the 20-mmHg isobaric contour. (TIFF 11157 kb)

535_2014_1013_MOESM2_ESM.tif

Figure S2. Diagnosis of hiatal hernia using endoscopy or high-resolution manometry.Endoscopically, the gastroesophageal junction (EGJ) at 2 cm or more above the diaphragmatic pinchcock is considered as the presence of hiatal hernia (C). In high-resolution manometry, the two main EGJ components are a lower esophageal sphincter (LES) and crural diaphragm (CD). Type I: CD and LES are completely superimposed (D). Type II: minimal separation between CD and LES during inspiration (E). The nadir between two peaks remains above the gastric baseline pressure. Type III: wide separation between CD and LES (>2 cm, F) (TIFF 7403 kb)

535_2014_1013_MOESM3_ESM.tif

Figure S3. Time period selection for measurement of esophageal impedance baseline levels. Mean impedance value of the 12 selected periods was considered baseline impedance. (TIFF 108 kb)

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Seo, A.Y., Shin, C.M., Kim, N. et al. Correlation between hypersensitivity induced by esophageal acid infusion and the baseline impedance level in patients with suspected gastroesophageal reflux. J Gastroenterol 50, 735–743 (2015). https://doi.org/10.1007/s00535-014-1013-4

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  • DOI: https://doi.org/10.1007/s00535-014-1013-4

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