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Review
. 2022 Oct;19(4):525-534.
doi: 10.1007/s10388-022-00933-6. Epub 2022 Jun 29.

Clinical use of mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index for the diagnosis of gastro-esophageal reflux disease

Pierfrancesco Visaggi  1 , Lucia Mariani  1 , Federica Baiano Svizzero  1 , Luca Tarducci  1 , Andrea Sostilio  1 , Marzio Frazzoni  2 , Salvatore Tolone  3 , Roberto Penagini  4   5 , Leonardo Frazzoni  6 , Linda Ceccarelli  1 , Vincenzo Savarino  7 , Massimo Bellini  1 , Prakash C Gyawali  8 , Edoardo V Savarino  9 , Nicola de Bortoli  10
Affiliations
Review

Clinical use of mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index for the diagnosis of gastro-esophageal reflux disease

Pierfrancesco Visaggi et al. Esophagus. 2022 Oct.

Abstract

The clinical diagnosis of gastro-esophageal reflux disease (GERD) is based on the presence of typical esophageal troublesome symptoms. In clinical practice, heartburn relief following a proton pump inhibitor (PPI) trial or endoscopy can confirm a diagnosis of GERD. In cases of diagnostic uncertainty or before anti-reflux interventions, combined impedance-pH monitoring (MII-pH) provides a comprehensive assessment of both physical and chemical properties of the refluxate, allowing to achieve a conclusive diagnosis of GERD. Recently, the Lyon Consensus proposed the use of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I) as novel MII-pH metrics to support the diagnosis of GERD. The calculation of MNBI and PSPW-I currently needs to be performed manually, but artificial intelligence systems for the automated analysis of MII-pH tracings are being developed. Several studies demonstrated the increased diagnostic yield MNBI and PSPW-I for the categorization of patients with GERD at both on- and off-PPI MII-pH monitoring. Accordingly, we performed a narrative review on the clinical use and diagnostic yield of MNBI and PSPW-I when the diagnosis of GERD is uncertain. Based on currently available evidence, we strongly support the evaluation of PSPW-I and MNBI as part of the standard assessment of MII-pH tracings for the evaluation of GERD, especially in patients with endoscopy-negative heartburn.

Keywords: Diagnosis; GERD; MNBI; PSPW index; Reflux disease.

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Conflict of interest statement

Pierfrancesco Visaggi: None; Lucia Mariani: None; Federica Baiano Svizzero: None; Luca Tarducci: None; Andrea Sostilio: None; Marzio Frazzoni: None; Salvatore Tolone: None; Roberto Penagini: received Lecture Fee: Alfasigma, Reckitt Benckiser, Sofar, Leonardo Frazzoni: None, Linda Ceccarelli: None; Vincenzo Savarino: received lecture fees from Reckitt Benkiser, Takeda, Grunenthal, Teofarma, Alfasigma; Massimo Bellini: None, Prakash C Gyawali: None, Edoardo V. Savarino: received lecture fees from Abbvie, Alfasigma, Amgen, Aurora Pharma, Bristol-Myers Squibb, EG Stada Group, Fresenius Kabi, Grifols, Janssen, Johnson&Johnson, Innovamedica, Malesci, Medtronic, Merck & Co, Reckitt Benckiser, Sandoz, Shire, SILA, Sofar, Takeda, Unifarco, Nicola de Bortoli: received lecture fees from Malesci and Reckitt Benckiser.

Figures

Fig. 1
Fig. 1
A 10-min window used to calculate the mean nocturnal baseline impedance at multichannel intraluminal pH-impedance monitoring
Fig. 2
Fig. 2
a Post-reflux swallow-induced peristaltic wave within 30 s after a reflux. This peristaltic wave should be included when calculating the PSPW index. b A peristaltic wave taking place 45 s after a reflux. This peristaltic wave should not be included when calculating the PSPW index
See this image and copyright information in PMC

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