Combined multichannel intraluminal impedance-pH monitoring detects gastro-esophageal reflux and identifies acid and non-acid reflux events.
It can be used in patients with persistent symptoms on proton-pump inhibitor (PPI) therapy.
Dr Castell and colleagues assessed laparoscopic Nissen fundoplication for symptoms associated with reflux despite acid suppression documented by multichannel intraluminal impedance-pH monitoring.
The investigative team identified these patients from a prospectively maintained database.
The investigators cross-referenced these with patients who had undergone fundoplication.
|16 of 17 patients with a positive symptom index were asymptomatic|
|British Journal of Surgery|
Follow-up after fundoplication was by periodic telephone interview and review of clinical records.
Of 200 evaluated patients, the team reported that 19 underwent laparoscopic Nissen fundoplication.
Before surgery, the investigators noted that 18 of 19 patients had a positive symptom index, and 1, a negative symptom index.
After a mean follow-up of 14 months, 16 of 17 patients with a positive symptom index were asymptomatic or markedly improved.
The investigators observed that persistent symptoms occurred in the patient with a negative symptom index.
In addition, the team observed that 1 patient had recurrent symptoms after 9 months.
Dr Castell's team concludes, “Patients with a positive symptom index resistant to PPIs with non-acid or acid reflux demonstrated by multichannel intraluminal impedance-pH monitoring can be treated successfully by laparoscopic Nissen fundoplication.”