Applying Lyon Consensus criteria in the work-up of patients with proton pump inhibitory-refractory heartburn.

Abstract

BACKGROUND:

A hierarchical approach for gastro-oesophageal reflux disease (GERD) diagnosis by impedance-pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics.

AIMS:

To establish the clinical value of Lyon Consensus criteria in the work-up of patients with proton pump inhibitory (PPI)-refractory heartburn.

METHODS:

Expert review of off-therapy impedance-pH tracings from unproven GERD patients with PPI-refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow-induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on-therapy preoperative impedance-pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases.

RESULTS:

Off-therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p < 0.0002). At the on-therapy presurgical evaluation, abnormal/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (p < 0.00001); a relationship between on-therapy ongoing reflux and PPI-refractory heartburn was confirmed by the favorable surgical outcome at 3-year follow-up, 88% of cases being in persistent off-PPI heartburn remission.

CONCLUSIONS:

Impedance-pH monitoring, off- and on-therapy, is of high clinical value in the work-up of patients with PPI-refractory heartburn.

• Authors: Marzio Frazzoni, Leonardo Frazzoni, Mentore Ribolsi, Nicola De Bortoli, Salvatore Tolone, Salvatore Russo, Rita Conigliaro, Roberto Penagini, Lorenzo Fuccio, Rocco Maurizio Zagari, Edoardo Savarino
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 55 Issue 11 Pg. 1423-1430 (06 2022) ISSN: 1365-2036 [Electronic] England
• PMID: 35229321 (Publication Type: Journal Article)
• Copyright: © 2022 John Wiley & Sons Ltd.

Chemical References

• Proton Pump Inhibitors
• Proton Pumps

Topics

• Humans
• Consensus
• Electric Impedance
• Esophageal pH Monitoring
• Gastroesophageal Reflux (diagnosis, drug therapy)
• Heartburn (diagnosis, drug therapy)
• Proton Pump Inhibitors (therapeutic use)
• Proton Pumps (therapeutic use)