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. 2023 Jul 30;29(3):335-342.
doi: 10.5056/jnm22130.

Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study

Sebastian S Zeki  1   2 , Ismail Miah  1 , Pierfrancesco Visaggi  1   3 , Anna Wolak  1 , Minerva deSilva  1 , Jason M Dunn  1   2 , Andrew Davies  2   4 , James Gossage  2   4 , Abrie Botha  4 , Guiping Sui  1 , Jafar Jafari  1 , Terry Wong  1
Affiliations

Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study

Sebastian S Zeki et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.

Methods: Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher's exact test, Wilcoxon rank sum test, or Student's t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.

Results: One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041).

Conclusions: WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.

Keywords: Diagnosis; Esophageal pH Monitoring; Gastroesophageal reflux.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
The characteristics of Gastroesophageal reflux disease (GERD) positive wireless pH monitoring (WPM) recordings for patients with negative impedance studies. (A) The number of days with GERD for GERD positive WPM studies. (B) The percentage acid exposure time (AET) for WPM-GERD positive and WPM-GERD negative studies. (C) Histogram of the worst day for WPM-GERD positive patients. (D) The symptoms registered by patients during WPM. (E) AET for patients grouped by the day on which the AET was worst. (F) Summarized regression lines across all worst day groups.
Figure 2
Figure 2
Acid exposure time (AET) at pH impedance for wireless pH monitoring (WPM)-gastroesophageal reflux disease (GERD) positive versus WPM-GERD negative studies. (A) Basal respiratory minimum (resp. min.) (B) Number of acid episodes. (C) Acid exposure time. (D) Proportion of patients with esophagitis.
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