The role of impedance monitoring in patients with extraesophageal symptoms. (15th July 2013)

• Record Type: Journal Article
• Authors: Kavitt, Robert T.; Yuksel, Elif Saritas; Slaughter, James C.; Garrett, C. Gaelyn; Hagaman, David; Higginbotham, Tina; Vaezi, Michael F.
• Is Part Of: Laryngoscope. Volume 123:Number 10(2013:Oct.)
• Page Start: 2463
• Page End: 2468
• Publication Date: 2013-07-15
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.23734
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary23734-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>Ambulatory esophageal impedance monitoring is commonly employed to assess for nonacid reflux in patients with extraesophageal reflux. We aimed to determine if <italic>on</italic> therapy impedance data can be predicted from <italic>off</italic> therapy upper endoscopy, manometry, or pH parameters.</p> </sec> <sec id="lary23734-sec-0002" sec-type="section"> <title>Study Design</title> <p>Prospective Cohort Study.</p> </sec> <sec id="lary23734-sec-0003" sec-type="section"> <title>Methods</title> <p>Patients with extraesophageal reflux symptoms and either partial‐ or nonresponders to twice‐daily PPI underwent impedance monitoring <italic>on</italic> twice‐daily PPI, as well as manometry, upper endoscopy, and 48‐hour wireless pH monitoring <italic>off</italic> acid‐suppressive medications for 1 week. Percent time pH < 4 and number of reflux episodes were obtained. Multivariable linear regression was used to determine association between the impedance data <italic>on</italic> therapy and upper endoscopy, manometry, and pH parameters measured <italic>off</italic> therapy.</p> </sec> <sec id="lary23734-sec-0004" sec-type="section"> <title>Results</title> <p>Seventy‐five patients (77% female, median BMI 29, 38% with hiatal hernia, and 19% with esophagitis) were studied both <italic>on</italic> and <italic>off</italic> therapy. Thirty‐five percent had abnormal impedance monitoring <italic>on</italic> therapy and 84% had abnormal pH testing <italic>off</italic> therapy. There was no significant (<italic>P</italic> = 0.184) overall correlation between total number of impedance events and the baseline physiologic parameters of hiatal hernia, degree of acid reflux, or manometric findings, with only weak correlation (r = 0.54, <italic>P</italic> = 0.045) with % time pH < 4 among patients with esophagitis.</p> </sec> <sec id="lary23734-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In patients with suspected extraesophageal reflux refractory to PPI therapy, impedance measures <italic>on</italic> therapy cannot be predicted from traditional baseline esophageal physiologic parameters. We recommend caution regarding over‐interpretation of impedance data.</p> </sec> <sec id="lary23734-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>2b. <italic>Laryngoscope</italic>, 123:2463–2468, 2013</p> </sec> </abstract>