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Detection of gastroesophageal reflux symptoms in clinical practice

Multichannel intraluminal impedance–pH testing is clinically useful in the management of patients with gastroesophageal reflux symptoms, reports this month's Digestive Diseases & Sciences.

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Multichannel intraluminal impedance–pH testing (MII–pH) allows for the detection of acid and non-acid reflux, thus, increasing yield over pH testing.

Limited data exist on how physicians use test results in practice.

Dr Daniela Jodorkovsky and colleagues evaluated the influence of MII–pH testing on patient care.

The researchers reviewed records of patients with symptoms of gastroesophageal reflux disease who underwent MII–pH testing.

Management decisions evaluated included changes in prescribed medications and surgical consultation for anti-reflux surgery.

MII–pH testing resulted in anti-reflux surgery in 11%
Digestive Diseases & Sciences

Statistical analysis was performed using Pearson Chi square test, and multivariable logistic regression.

The research team found that MII–pH testing resulted in a medication change in 41% of patients, surgical consultation in 20%, and anti-reflux surgery in 11%.

In patients who were not on proton pump inhibitor (PPI) therapy, MII–pH results were most useful in the decision to start a PPI.

The team noted that on PPI therapy, results were more often used to decide whether to increase or switch the PPI in patients with continued acid reflux.

The researchers found that results were most useful to stop the PPI in normal studies.

More patients with non-acid reflux, and normal results were started on a neuromodulator compared to other diagnoses.

The team noted that MII–pH result was most useful in the decision to start baclofen or bethanecol when the patient was found to have non-acid reflux.

The research team observed that patients with an abnormal MII–pH or abnormal MII alone were more likely to be referred to surgery.

Dr Jodorkovsky's team concludes, "MII–pH testing impacted medical or surgical management in over half the patients tested."

Dig Dis Sci 2014: 59(8): 1817-1822
28 August 2014

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