The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease.

Abstract

INTRODUCTION:

Functional heartburn is defined by Rome III criteria as an endoscopy-negative condition with normal oesophageal acid exposure time, negative symptom association to acid reflux and unsatisfactory response to proton pump inhibitors. These criteria underestimated the role of non-acid reflux.

AIM:

To assess the contribution of impedance-pH with symptom association probability (SAP) analysis in identifying endoscopy-negative patients with reflux disease and separating them from functional heartburn.

METHODS:

Consecutive endoscopy-negative patients treated with proton pump inhibitors (n=219) undergoing impedance-pH monitoring off-therapy were analysed. Distal acid exposure time, reflux episodes, SAP and symptomatic response to proton pump inhibitors were measured.

RESULTS:

Based on impedance-pH/SAP, 67 (31%) patients were pH+/SAP+, 6 (2%) pH+/SAP-, 83 (38%) hypersensitive oesophagus and 63 (29%) functional heartburn. According to pH-metry alone/response to proton pump inhibitors, 62 (28%) were pH+/SAP+, 11 (5%) pH+/SAP-, 61 (28%) hypersensitive oesophagus and 85 (39%) functional heartburn. In the normal-acid exposure population the contribution of impedance-pH/SAP compared to pH-metry alone/response to proton pump inhibitors in identifying patients with reflux disease and functional heartburn resulted to be 10%. In patients with abnormal-acid exposure, the contribution of impedance-pH/SAP increased by 3%.

CONCLUSION:

Comparing impedance-pH testing with pH-metry alone plus the response to proton pump inhibitor therapy demonstrated that the latter ones cause underestimation of reflux disease patients and overestimation of functional heartburn patients.

• Authors: Edoardo Savarino, Elisa Marabotto, Patrizia Zentilin, Marzio Frazzoni, Giorgio Sammito, Daria Bonfanti, Luca Sconfienza, Lorenzo Assandri, Lorenzo Gemignani, Alberto Malesci, Vincenzo Savarino
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 43 Issue 7 Pg. 542-7 (Jul 2011) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 21376679 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Body Mass Index
• Diagnosis, Differential
• Electric Impedance
• Endoscopy, Gastrointestinal
• Esophageal pH Monitoring (standards)
• Female
• Gastroesophageal Reflux (diagnosis, metabolism)
• Heartburn (diagnosis, metabolism)
• Humans
• Male
• Middle Aged
• Reproducibility of Results
• Young Adult