Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"

ZHANG Jing; WANG Zhifeng; KE Meiyun; FANG Xiucai; LI Xiaoqing; ZHANG Jiachang; SHU Ke; SUN Xiaohong

doi:10.16766/j.cnki.issn.1674-4152.003407

Volume 22 Issue 3

Mar. 2024

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Article Navigation > Chinese Journal of General Practice > 2024 > 22(3): 380-383

ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong. Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the 'Lyon Consensus'[J]. Chinese Journal of General Practice, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407

Citation:

ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong. Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"[J]. Chinese Journal of General Practice, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407

Citation:

ZHANG Jing, WANG Zhifeng, KE Meiyun, FANG Xiucai, LI Xiaoqing, ZHANG Jiachang, SHU Ke, SUN Xiaohong. Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"[J]. Chinese Journal of General Practice, 2024, 22(3): 380-383. doi: 10.16766/j.cnki.issn.1674-4152.003407

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Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"

doi: 10.16766/j.cnki.issn.1674-4152.003407

ZHANG Jing^{1, 2}
, WANG Zhifeng¹
, KE Meiyun¹
, FANG Xiucai¹
, LI Xiaoqing¹
, ZHANG Jiachang^{1, 3}
, SHU Ke^{1, 4}
, SUN Xiaohong^{1, 5
,
,}

1.
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

Funds:

2018YFC2000300

2022-PUMCH-B-132

Received Date: 2023-06-06
Available Online: 2024-05-27

Abstract

Abstract

Objective This study retrospectively reanalyzed the reflux parameters of patients with gastroesophageal reflux disease (GERD) detected through esophageal pH and impedance pH monitoring, following the "Lyon Consensus". The DeMeester scores (DMS) were compared to the acid exposure time (AET). Methods This study included a total of 1 023 GERD patients who underwent 24-hour esophageal pH monitoring or impedance pH monitoring at the Gastrointestinal Dynamics Center of Peking Union Medical College Hospital from January 2008 to December 2022. The reflux parameters were reanalyzed and compared using DMS and AET, respectively. Results (1) According to the "Lyon Consensus", AET demonstrates 94.7% sensitivity and 99.0% specificity, while DMS shows 98.1% sensitivity and 97.2% specificity. DMS exhibits higher sensitivity than AET, whereas AET has greater specificity than DMS. The monitoring results of the both methods are highly consistent (P < 0.05). (2) Among the 105 patients with AET ranging from 4% to 6%, they were divided into DMS (+) and DMS (-) groups. Significant differences were observed between the two groups in terms of the total number of reflux episodes, number of reflux episodes lasting≥5 min, %supine time esophageal pH < 4, and longest reflux episode (in minutes). These findings suggest that these parameters should be considered and analyzed in addition to AET. (3) It is worth noting that more than 50% GERD patients with AET ranging from 4% to 6% still cannot determine the presence or absence of pathological reflux. Conclusion Both the diagnostic standards of AET and DMS provide robust supporting evidence for esophageal acid exposure. AET exhibits lower sensitivity but higher specificity compared to DMS. To enhance the sensitivity of AET, considering the hypothesis of AET>4% demonstrates esophageal acid exposure might be beneficial.
- Gastroesophageal reflux disease,
- pH monitoring,
- DeMeester score,
- Acid exposure time

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References(19)

References

[1]	KATZKA D A, KAHRILAS P J. Advances in the diagnosis and management of gastroesophageal reflux disease[J]. BMJ, 2020, 371: m3786. DOI: 10.1136/bmj.m3786.
[2]	周金池, 赵曙光, 王新, 等. 中国部分地区基于社区人群胃食管反流病患病率Meta分析[J]. 胃肠病学和肝病学杂志, 2020, 29(9): 1012-1020. doi: 10.3969/j.issn.1006-5709.2020.09.012 ZHOU J C, ZHAO S G, WANG X, et al. Meta-analysis of the prevalence of gastroesophageal reflux disease based on community population in some areas of China[J]. Chinese Journal of Gastroenterology and Hepatology, 2020, 29(9): 1012-1020. doi: 10.3969/j.issn.1006-5709.2020.09.012
[3]	VISAGGI P, DEL CORSO G, GYAWALI C P, et al. Ambulatory pH-impedance findings confirm that grade B Esophagitis provides objective diagnosis of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2023, 118(5): 794-801. doi: 10.14309/ajg.0000000000002173
[4]	RUSU R I, FOX M R, TUCKER E, et al. Validation of the Lyon classification for GORD diagnosis: acid exposure time assessed by prolonged Wireless pH-monitoring in healthy controls and patients with erosive oesophagitis[J]. Gut, 2021, 70(12): 2230-2237. doi: 10.1136/gutjnl-2020-323798
[5]	GYAWALI C P, KAHRILAS P J, SAVARINO E, et al. Modern diagnosis of GERD: the Lyon Consensus[J]. Gut, 2018, 67(7): 1351-1362. doi: 10.1136/gutjnl-2017-314722
[6]	NETO R M L, HERBELLA F A M, SCHLOTTMANN F, et al. Does DeMeester score still define GERD?[J]. Dis Esophagus, 2019, 32(5): doy118. DOI: 10.1093/dote/doy118.
[7]	GYAWALI C P, YADLAPATI R, FASS R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0[J]. Gut, 2024, 73(2): 361-371. doi: 10.1136/gutjnl-2023-330616
[8]	任梦华, 孙淑珍, 王红建, 等. 经口内镜下贲门缩窄术治疗反流性食管炎效果分析[J]. 中华实用诊断与治疗杂志, 2022, 36(8): 841-844. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202208020.htm REN M H, SUN S Z, WANG H J, et al. Efficacy of peroral endoscopic cardial constriction on reflux esophagitis[J]. Journal of Chinese Practical Diagnosis and Therapy, 2022, 36(8): 841-844. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202208020.htm
[9]	陈琰, 隋昕珂, 黄鑫, 等. 反流性食管炎患者食管外症状的危险因素分析[J]. 解放军医学杂志, 2021, 46(8): 808-811. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY202108011.htm CHEN Y, SUI X K, HUANG X, et al. Clinical study of risk factors associated with extraesophageal symptoms in patients with reflux esophagitis[J]. Medical Journal of Chinese People ' s Liberation Army, 2021, 46(8): 808-811. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJY202108011.htm
[10]	于爱萍, 董新华, 李珂, 等. 腹腔镜Nissen与Toupet胃底折叠术治疗难治性胃食管反流病的效果比较[J]. 中国实用医刊, 2021, 48(22): 1-4. YU A P, DONG X H, LI K, et al. Comparison of effects of laparoscopic Nissen versus Toupet fundoplication in the treatment of refractory gastroesophageal reflux disease[J]. Chinese Journal of Practical Medicine, 2021, 48(22): 1-4.
[11]	吴国丽, 邱晶, 李晓慧, 等. 逍遥丸联合兰索拉唑治疗老年胃食道反流病的疗效及对胃肠激素的影响[J]. 药物评价研究, 2020, 43(7): 1335-1338. https://www.cnki.com.cn/Article/CJFDTOTAL-YWPJ202007023.htm WU G L, QIU J, LI X H, et al. Efficacy of Xiaoyao Pills combined with lansoprazole in treatment of senile gastroesophageal reflux disease and its effect on gastrointestinal hormones[J]. Drug Evaluation Research, 2020, 43(7): 1335-1338. https://www.cnki.com.cn/Article/CJFDTOTAL-YWPJ202007023.htm
[12]	ROMAN S, GYAWALI C P, SAVARINO E, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group[J]. Neurogastroenterol Motil, 2017, 29(10): 1-15.
[13]	HOSHINO M, OMURA N, YANO F, et al. Comparison of the multichannel intraluminal impedance pH and conventional pH for measuring esophageal acid exposure: a propensity score-matched analysis[J]. Surg Endosc, 2017, 31(12): 5241-5247. doi: 10.1007/s00464-017-5595-9
[14]	STREETS C G, DEMEESTER T R. Ambulatory 24-hour esophageal pH monitoring: why, when, and what to do[J]. J Clin Gastroenterol, 2003, 37(1): 14-22. doi: 10.1097/00004836-200307000-00007
[15]	ANG D, XU Y, ANG T L, et al. Wireless oesophageal pH monitoring: establishing values in a multiracial cohort of asymptomatic Asian subjects[J]. Dig Liver Dis, 2013, 45(5): 371-376. doi: 10.1016/j.dld.2012.11.014
[16]	HASAK S, YADLAPATI R, ALTAYAR O, et al. Prolonged Wireless pH monitoring in patients with persistent reflux symptoms despite proton pump inhibitor therapy[J]. Clin Gastroenterol Hepatol, 2020, 18(13): 2912-2919. doi: 10.1016/j.cgh.2020.01.031
[17]	SIFRIM D, ROMAN S, SAVARINO E, et al. Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world[J]. Gut, 2021, 70(8): 1441-1449. doi: 10.1136/gutjnl-2020-322627
[18]	GYAWALI C P, TUTUIAN R, ZERBIB F, et al. Value of pH impedance monitoring while on twice-daily proton pump inhibitor therapy to identify need for escalation of reflux management[J]. Gastroenterology, 2021, 161(5): 1412-1422. doi: 10.1053/j.gastro.2021.07.004
[19]	SPECHLER S J, HUNTER J G, JONES K M, et al. Randomized trial of medical versus surgical treatment for refractory heartburn[J]. N Engl J Med, 2019, 381(16): 1513-1523. doi: 10.1056/NEJMoa1811424

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Analysis and comparison of impedance-pH monitoring parameters in diagnosis of GERD based on the "Lyon Consensus"

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