Parameters on Esophageal pH Impedance Monitoring that Predict Outcomes of Patients with Gastroesophageal Reflux Disease
Abstract
Background & Aims: pH impedance monitoring detects acid and non-acid reflux events, but little is known about which parameters predict outcomes of different management strategies. We evaluated a cohort of medically and surgically managed patients following pH-impedance monitoring to identify factors that predict symptom improvement after therapy. Methods: In a prospective study, we followed 187 subjects undergoing pH impedance testing from January 2005 through August 2010 at Washington University in St. Louis (mean age, 53.8±0.9 years; 70.6% female). Symptom questionnaires assessed dominant symptom intensity (DSI) and global symptom severity (GSS) at baseline and on follow up. Data collected from pH impedance studies included acid exposure time (AET), reflux exposure time (RET, duration of impedance drop 5 cm above lower esophageal sphincter, reported as percentage of time similar to AET), symptom reflux correlation (symptom index and symptom association probability, SAP), and total numbers of reflux events. Univariate and multivariate analyses were performed to determine factors associated with changes in DSI and GSS after therapy. Results: Of study subjects, 49.7% were tested on proton pump inhibitor (PPI) therapy and 68.4% were managed medically. After 39.9±1.3 months follow up, DSI and GSS scores decreased significantly (P<.05). On univariate analysis, abnormal AET predicted decreased DSI and GSS scores (P≤.049 for each comparison); RET and SAP from impedance-detected…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 187 participants or records.
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