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. 2021 Oct 30;27(4):525-532.
doi: 10.5056/jnm20073.

Esophageal Nocturnal Baseline Impedance and Post-reflux Swallow-induced Peristaltic Wave Index in Identifying Proton Pump Inhibitor-refractory Non-erosive Reflux Disease

Yan Wang  1 , Bixing Ye  1 , Meifeng Wang  1 , Lin Lin  1 , Liuqin Jiang  1
Affiliations

Esophageal Nocturnal Baseline Impedance and Post-reflux Swallow-induced Peristaltic Wave Index in Identifying Proton Pump Inhibitor-refractory Non-erosive Reflux Disease

Yan Wang et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: Esophageal mean nocturnal baseline impedance (MNBI) levels and post-reflux swallow-induced peristaltic wave (PSPW) index could increase the diagnostic value of 24-hour multichannel intraluminal impedance and pH monitoring in patients with gastroesophageal reflux disease. This study aims to compare the MNBI and PSPW index in patients with no evidence of erosive reflux disease.

Methods: Impedance-pH monitoring tracings from 70 patients, 50 with non-erosive reflux disease (NERD) and 20 with functional heartburn (FH), were reviewed. According to proton pump inhibitors (PPI) treatment response, NERD patients were divided into NERD/PPI responders and NERD/PPI nonresponders. MNBI, PSPW index, and intercellular spaces were measured and compared among each group.

Results: MNBI values and PSPW index were lower in NERD patients than in FH (P < 0.01 and P < 0.05, respectively). MNBI positively correlated with PSPW index (r = 0.525, P < 0.001). NERD/PPI responders had lower MNBI values and PSPW index compared to NERD/PPI nonresponders (both P < 0.01). MNBI and PSPW index distinguished NERD from FH patients with an area under the curve of 0.914 and 0.677, respectively. Wider intercellular space could be identified in patients with NERD (P < 0.01).

Conclusion: MNBI and PSPW index may differentiate NERD from FH patients and relate to PPI treatment efficacy in patients with NERD.

Keywords: Electric impedance; Gastroesophageal reflux; Intercellular spaces; Proton pump inhibitors.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Mean nocturnal baseline impedance (MNBI) levels from each impedance channel in: (A) non-erosive reflux disease (NERD) and functional heartburn (FH) patients and (B) NERD/proton pump inhibitor (PPI) responders and NERD/PPI nonresponders. **P < 0.01.
Figure 2
Figure 2
Comparison of post-reflux swallow-induced peristaltic wave (PSPW) index between: (A) non-erosive reflux disease (NERD) and functional heartburn (FH) patients and (B) NERD/ proton pump inhibitor (PPI) responders and NERD/PPI nonresponders. *P < 0.05, **P < 0.01.
Figure 3
Figure 3
Correlation between mean nocturnal baseline impedance (MNBI) levels (z5) and: (A) acid exposure time (AET), (B) post-reflux swallow-induced peristaltic wave (PSPW) index. AET, acid exposure time.
Figure 4
Figure 4
Receiver operating characteristic (ROC) curves for distinguishing functional heartburn (FH) from non-erosive reflux disease (NERD) patients. AET, acid exposure time; PSPW, post-reflux swallow-induced peristaltic wave; MNBI, mean nocturnal baseline impedance.
Figure 5
Figure 5
Comparison of the width of intercellular space among (A) functional heartburn (FH), (B) non-erosive reflux disease (NERD)/proton pump inhibitor (PPI) responders, (C) NERD/PPI non responders, and width of intercellular spaces in all groups (D). **P < 0.01.
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