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Mauro A, Franchina M, Consonni D, Penagini R. Lower oesophageal sphincter identification for gastro-oesophageal reflux monitoring: The step-up method revisited with use of basal impedance. United European Gastroenterol J 2019; 7:1373-1379. [PMID: 31839963 DOI: 10.1177/2050640619860034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/24/2019] [Indexed: 12/23/2022] Open
Abstract
Background Oesophageal manometry is the gold standard for accurate positioning of multichannel intraluminal impedance pH (MII-pH) monitoring. The pH step-up method is not as accurate as oesophageal manometry and needs patients to be off proton pump inhibitor (PPI) therapy. Objective This study aimed to evaluate the feasibility of the impedance step-up method for lower oesophageal sphincter (LOS) localisation. Methods A total of 100 patients who underwent 24-hour MII-pH monitoring were enrolled. High-resolution manometry (HRM) was performed before MII-pH monitoring in order to locate the LOS by a different operator. The impedance step-up was defined as an increase of ≥50% with respect to gastric baseline. Lin's concordance correlation coefficient (ρc ) with 95% Bland-Altman limits of agreement (LOA) and Spearman's rho correlation coefficient were used when appropriate. Results The median impedance step-up was on average 0.8 cm caudal to the manometric upper border of the LOS. Agreement between two step-up impedance performances and inter-observer agreement were excellent (ρc = 0.98 and 0.95), although the LOA ranges were wide (-2.4 to 4.0 cm). Impedance step-up performances were similar between patients off and on PPI. Conclusions We have described an alternative new method for pH impedance probe positioning using impedance step-up. Although less accurate than HRM in locating the LOS, it has excellent intra- and inter-observer agreement.
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Affiliation(s)
- Aurelio Mauro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Endoscopy Unit, First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marianna Franchina
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Ambulatory 24-hour multichannel intraluminal impedance-pH monitoring and high resolution endoscopy distinguish patients with non-erosive reflux disease from those with functional heartburn. PLoS One 2017; 12:e0175263. [PMID: 28384225 PMCID: PMC5383280 DOI: 10.1371/journal.pone.0175263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/23/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS To assess the contribution of 24-h esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring and high resolution endoscopy (HRE) with i-scan imaging in differentiating non erosive reflux disease (NERD) from functional heartburn (FH). METHODS This is a retrospective cohort study of patients with heartburn from the Endoscopy Unit. NERD patients and FH patients were defined by 24-h MII-pH monitoring and white light endoscopy. Minimal mucosal changes were assessed by HRE with i-scan imaging. RESULTS Total of 156 consecutive patients with heartburn but without esophageal mucosal erosions were studied. Forty-eight of these subjects had NERD, with increased acid exposure time (AET) and positive SAP and/or SI. Eighteen had FH with normal AET and negative SAP and SI. When compared to FH patients and healthy controls, NERD patients had significantly increased number of total acid reflux episodes, as well as increased number of weakly acidic reflux episodes (p<0.01). The rate of proximal reflux episodes in NERD patients was higher than that of FH patients and healthy controls (p<0.01). Irregular or blurring of the Z-line (58.3%) and white mucosal turbidity (47.9%) were the most common endoscopic findings of minimal mucosal changes observed in this study. NERD patients had more prevalent minimal changes than FH patients and the controls (87.5%vs. 66.6%vs. 61.9%; p = 0.004) with sensitivity of 87.5%. Histopathological evaluation showed that NERD patients had significantly higher average scores of intercellular spaces dilation (2.82±0.9 vs. 1.2±0.6, p = 0.005) and papillae elongation (2.65±1.0 vs. 1.5±0.8, p = 0.014), but not for basal cell proliferation (1.6±1.3 vs. 1.0±0.9, p = 0.070). The histological scores of the NERD patients were 7.1±1.2, which were higher than those of FH patients (3.4±1.0, p = 0.004). CONCLUSIONS Minimal mucosal changes could be useful markers to support clinical diagnosis of NERD. Combination of 24-h MII-pH monitoring and i-scan high resolution endoscopy can distinguish patients with NERD from those with FH.
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Belhocine K, Vavasseur F, Volteau C, Flet L, Touchefeu Y, Bruley des Varannes S. Controlling on-demand gastric acidity in obese subjects: a randomized, controlled trial comparing a single dose of 20 mg rabeprazole and 20 mg omeprazole. BMC Gastroenterol 2014; 14:128. [PMID: 25027286 PMCID: PMC4110066 DOI: 10.1186/1471-230x-14-128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 05/06/2014] [Indexed: 01/11/2023] Open
Abstract
Background Obesity is associated with a risk of gastroesophageal reflux disease. The pharmacodynamic efficacy of proton pump inhibitors has not been specifically evaluated in obese subjects. The aim of this study was to compare the antisecretory response to a single oral dose of 20 mg rabeprazole, 20 mg omeprazole and placebo in obese subjects. Methods Gastric pH was monitored for 24 hours on three separate occasions in eighteen H. pylori-negative, asymptomatic obese subjects. Subjects were given omeprazole, rabeprazole or placebo in a randomized order and in a double-blind fashion. The main analysis criterion was 24-h percent of time post dose with intragastric pH above 3; secondary criteria were percentage of time above pH 4, median pH, [H+] concentrations and nocturnal acid breakthrough (NAB). Results were analyzed using linear mixed models and Wilks test comparing variances. Results 24-h median [IQ] percentages of time with gastric pH above 3 and 4 were higher with rabeprazole than omeprazole (46 [37–55] vs. 30 [15–55] %, 9 [5-11] % for placebo) but the differences did not reach statistical significance (p = 0.11 and 0.24, respectively). Median acid concentrations were significantly lower with rabeprazole than with omeprazole and placebo (22 [14–53] vs. 54 [19–130] and 95 [73–170] mmoles/l, p < 0.01) for all periods. The number of NAB was significantly lower with rabeprazole than with omeprazole (median 1 [1,2] vs. 2 [1-3], p = 0.04). Variances of 24-h data (pH above 3 and 4, median pH, [H+] concentrations) were significantly lower with rabeprazole than with omeprazole (p < 0.0001). Conclusions In asymptomatic obese subjects the gastric antisecretory response to a single dose of rabeprazole and omeprazole was strong and not significantly different between drugs despite a significantly more homogeneous response with rabeprazole. Trial registration ClinicalTrial.gov: NCT01136317
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Lee AL, Button BM, Denehy L, Roberts SJ, Bamford TL, Ellis SJ, Mu FT, Heine RG, Stirling RG, Wilson JW. Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis. Respirology 2013; 19:211-217. [DOI: 10.1111/resp.12182] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/05/2013] [Accepted: 08/06/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Annemarie L. Lee
- Physiotherapy, Melbourne School of Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Physiotherapy; The Alfred; Melbourne Victoria Australia
| | - Brenda M. Button
- Department of Physiotherapy; The Alfred; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; The Alfred Hospital; Melbourne Victoria Australia
| | - Linda Denehy
- Physiotherapy, Melbourne School of Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - Stuart J. Roberts
- Department of Gastroenterology; The Alfred; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
| | - Tiffany L. Bamford
- Department of Medicine; Monash University; Melbourne Victoria Australia
- Janssen; Pharmaceutical Companies of Johnson and Johnson; Melbourne Victoria Australia
| | | | - Fi-Tjen Mu
- Department of Immunology; Monash University; Melbourne Victoria Australia
| | - Ralf G. Heine
- Murdoch Children's Research Institute; University of Melbourne; Melbourne Victoria Australia
- Department of Gastroenterology and Clinical Nutrition; Royal Children's Hospital; Melbourne Victoria Australia
| | - Robert G. Stirling
- Department of Medicine; Monash University; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; The Alfred Hospital; Melbourne Victoria Australia
| | - John W. Wilson
- Department of Medicine; Monash University; Melbourne Victoria Australia
- Department of Allergy, Immunology and Respiratory Medicine; The Alfred Hospital; Melbourne Victoria Australia
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Wang K, Duan LP, Ge Y, Xia ZW, Xu ZJ. A comparative study of 22-channel water-perfusion system and solid-state system with 36-sensors in esophageal manometery. BMC Gastroenterol 2012; 12:157. [PMID: 23134719 PMCID: PMC3503791 DOI: 10.1186/1471-230x-12-157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/04/2012] [Indexed: 12/04/2022] Open
Abstract
Background To compare the characteristics between 22-channel water-perfusion manometry (WPM) and solid-state manometry (SSM) with 36 sensors of the pressure measurements, as well as patients’ discomfort indices in nose and pharynx, the preparation and operation time of the manometry. Methods 12 volunteers were included in the study. Each of the volunteers underwent esophageal manometry by both 22-channel water-perfusion catheter (WPC) and solid-state catheter (SSC) with 36 sensors in random order, and separated by 30 min. The subjects gave a VAS score soon after each test. Non-parametric tests were used to analyze the differences and Bland-Altman plots were used to assess the consistency of the two systems. Results During the wet swallows, there were significant differences between the two systems in three measurements of location of lower esophageal sphincter (LES) upper margin (Z = -2.11, P = 0.035), LES relax ratio (Z = -2.20, P = 0.028) and IRP4s (Z = -2.05, P = 0.041). During the jelly pocket swallows, LES relax ratio measurements of the two systems showed significant differences (Z = -2.805, P = 0.005). Further Bland–Altman plots analysis presented good agreement between the two systems measurements of location of LES upper margin, LES relax ratio and IRP4s. The discomfort indices of subjects’ nasal sensation were higher when inserting the solid-state catheter [5(3.75-5)] than water-perfusion one (2.5(2-4)) (Z = -2.471, P = 0.013), as well as the discomfort indices of pharyngeal sensation (7.5(4.75-9) vs. 4.5(3.75-6.5)), (Z = -2.354, P = 0.019). The preparation time for WPC was 40(39-41) minutes, which was much longer than that for SSC 32.5(31.75-33) minutes, (Z = -3.087, P = 0.002). And the nurses reported it’s much easier to insert WPC (Z = -3.126, P = 0.002). Conclusions In conclusion, most pressure measurements were consistent between WPM and SSM. Patients tolerated better with WPC, while for operators, the SSC presented more convenient.
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Affiliation(s)
- Kun Wang
- Department of Gastroenterology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
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Stec SM, Grabczak EM, Bielicki P, Zaborska B, Krenke R, Kryński T, Dąbrowska M, Domagała-Kulawik J, Domeracka-Kołodziej A, Sikorska A, Kułakowski P, Chazan R. Diagnosis and management of premature ventricular complexes-associated chronic cough. Chest 2009; 135:1535-1541. [PMID: 19318662 DOI: 10.1378/chest.08-1814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Chronic cough frequently remains unexplained. Although various cardiac arrhythmias have already been reported as a cause of chronic cough, this phenomenon has not been evaluated prospectively. Therefore, we studied the incidence and management of cough associated with premature ventricular complexes (PVCs) in a population of patients with this condition. METHODS Patients without organic heart disease who had been referred for the management of symptomatic PVC were evaluated prospectively. PVC-associated cough was recognized if cough episodes occurred just after spontaneous or induced PVC or observed in an ECG or a multichannel recording system that included ECG. A differential diagnosis of cough was performed according to the guidelines on cough. Afterward, antiarrhythmic therapy was instituted to eliminate PVC and cough. RESULTS Of the 120 patients who were referred for the management of PVC, 10 had a chronic cough. After extensive workup for the cause of chronic cough, the cough was thought to be solely due to PVC in one patient, partially due to PVC plus another cause in five patients, and not due to PVC but to nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and chronic sinusitis in four patients. Patients with PVC-associated cough reported more severe perception of symptoms associated with arrhythmia than patients without cough (mean [+/- SD] visual analog scale score, 8.2 +/- 0.5 vs 5.7 +/- 1.6, respectively; p < 0.01). PVC-associated cough disappeared after antiarrhythmic treatment (radiofrequency ablation [n = 4], oral antiarrhythmic agent [n = 1]), or after spontaneous remission of PVC (n = 1). CONCLUSIONS PVC may be a cause of chronic cough. Interdisciplinary cooperation is warranted for the proper diagnosis and management of PVC-associated cough.
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Affiliation(s)
- Sebastian M Stec
- Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
| | - Elżbieta M Grabczak
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Piotr Bielicki
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Beata Zaborska
- Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Tomasz Kryński
- Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
| | - Marta Dąbrowska
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Joanna Domagała-Kulawik
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | | | - Agnieszka Sikorska
- Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
| | - Piotr Kułakowski
- Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
| | - Ryszarda Chazan
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
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Recurrent symptoms after fundoplication with a negative pH study--recurrent reflux or functional heartburn? J Gastrointest Surg 2009; 13:54-60. [PMID: 18712573 DOI: 10.1007/s11605-008-0653-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 07/28/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds of these patients will have a negative 24-h pH study. The aim of our study is to determine whether these patients have an associated functional disorder or abnormal cytokine activity and to examine the reproducibility of pH testing. METHODS A prospective analysis was carried out on a cohort of patients who had undergone a fundoplication and postoperative pH testing for recurrent heartburn: group A--patients with recurrent heartburn and a negative 24-h pH study and group B (control group)--patients with recurrent heartburn and a positive pH study. Questionnaires, a blood sample, and repeat pH testing were completed. RESULTS Sixty-nine patients were identified. Group A's depression score (8.6 +/- 4.1) was significantly higher than group B's (5.9 +/- 4.2; P = 0.03). Cytokine levels were similar in both groups. Forty-seven of 49 (96%) patients who underwent repeat pH testing had a negative study. Symptom-reflux correlation was highly significant (P < 0.001). CONCLUSION Some patients with recurrent heartburn and a negative pH study have associated functional or psychiatric comorbidities such as depression. Reproducibility of 24-h pH testing in these patients is excellent.
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Can MF, Yagci G, Cetiner S, Gulsen M, Yigit T, Ozturk E, Gorgulu S, Tufan T. Accurate positioning of the 24-hour pH monitoring catheter: Agreement between manometry and pH step-up method in two patient positions. World J Gastroenterol 2007; 13:6197-202. [PMID: 18069759 PMCID: PMC4171229 DOI: 10.3748/wjg.v13.i46.6197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions.
METHODS: Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed.
RESULTS: In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (≤ 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position.
CONCLUSION: In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.
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Gupta A, Jadcherla SR. The relationship between somatic growth and in vivo esophageal segmental and sphincteric growth in human neonates. J Pediatr Gastroenterol Nutr 2006; 43:35-41. [PMID: 16819375 PMCID: PMC4028631 DOI: 10.1097/01.mpg.0000226368.24332.50] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Measurement of aerodigestive tract length is an important determinant for accurate placement of esophageal probes and gavage tubes at the desired location. The relationship of esophageal body, upper esophageal sphincter (UES) and lower esophageal sphincter (LES) lengths with somatic growth in neonates is not well understood. OBJECTIVES Our objectives were to (1) evaluate a relationship between segmental esophageal lengths and somatic growth parameters and (2) ascertain the relationship between segmental esophageal lengths and gestational age (GA) and postmenstrual age (PMA) in preterm and full-term born human neonates. DESIGN/METHODS One hundred esophageal manometry studies were performed in 75 infants (30-60 weeks PMA) and the high-pressure zones of LES and UES identified. The distance from nares to LES and from nares to UES, esophageal body length, length of UES and LES derived from the manometry studies were correlated with somatic growth parameters. Growth rate of different esophageal segments was also determined in 26 subjects that underwent longitudinal studies. Analysis of variance and linear regression analysis were performed. RESULTS Seventy-five neonates of 23.0-40.6 weeks gestational age (0.6-4.4 kg) were studied at 29.1-58.6 weeks PMA (1.0-6.4 kg). Significant correlation (P < 0.001) of PMA and physical growth parameters with the growth of nares-LES (R = 0.8), esophageal body length (R = 0.6) and nares-UES (R = 0.4) were noted. Nares-to-LES length increased at a rate of 0.25 cm/wk PMA during 33.0-36.0 weeks of age. CONCLUSIONS In vivo esophageal segmental lengths correlated strongly with somatic growth parameters and PMA in neonates. We speculate that this approach has many practical applications with the use of esophageal probes and catheters.
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Affiliation(s)
- Alankar Gupta
- Section of Neonatology, Columbus Children's Hospital, Columbus, OH
| | - Sudarshan Rao Jadcherla
- Section of Neonatology, Columbus Children's Hospital, Columbus, OH
- Sections of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Columbus Children's Hospital and the Ohio State University College of Medicine and Public Health, Columbus, OH
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des Varannes SB, Sacher-Huvelin S, Vavasseur F, Masliah C, Le Rhun M, Aygalenq P, Bonnot-Marlier S, Lequeux Y, Galmiche JP. Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting. World J Gastroenterol 2006; 12:2569-73. [PMID: 16688803 PMCID: PMC4087990 DOI: 10.3748/wjg.v12.i16.2569] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners.
METHODS: Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and double-blind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a “clear improvement” of symptoms on a 7-point Likert scale.
RESULTS: The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of “clear improvement”.
CONCLUSION: The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting.
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Yi CH, Chen CL, Lin HHH, Chen MC. Esophageal acid exposure in healthy adults in Taiwan: experience with pH step-up method by dual-channel pH-metry. Kaohsiung J Med Sci 2005; 21:299-303. [PMID: 16089306 DOI: 10.1016/s1607-551x(09)70124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Esophageal acid exposure is common in normal subjects. The aim of this study was to investigate proximal and distal esophageal acid exposure in asymptomatic volunteers using dual-channel esophageal pH-metry with probe positioning by pH step-up. A total of 21 healthy subjects (9 male; mean age, 51 years) underwent 24-hour ambulatory esophageal pH recording with the pH step-up method using a two-channel pH probe, a portable digital data recorder, and computerized data analysis. All reflux episodes, episodes longer than 5 minutes, longest reflux episode, duration of acidity (pH <4), and percentage of time with acidity were analyzed. The 95th percentile for reflux parameters assessed in the distal/proximal esophagus were: total reflux episodes, 100/34; episodes greater than 5 minutes, 2.9/0; longest reflux episode, 16.6/2.95 minutes; duration of acidity, 87.95/15.5 minutes; and percentage of time with acidity, 7.0%/1.3%. Proximal and distal acid exposure were well correlated. Results showed that neither gender nor age influenced reflux parameters and that asymptomatic volunteers might experience some gastroesophageal reflux.
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Affiliation(s)
- Chih-Hsun Yi
- Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi University School of Medicine and Medical Center, Hualien, Taiwan
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Veugelers R, Calis EAC, Penning C, Verhagen A, Bernsen R, Bouquet J, Benninga MA, Merkus PJFM, Arets HGM, Tibboel D, Evenhuis HM. A population-based nested case control study on recurrent pneumonias in children with severe generalized cerebral palsy: ethical considerations of the design and representativeness of the study sample. BMC Pediatr 2005; 5:25. [PMID: 16029493 PMCID: PMC1201147 DOI: 10.1186/1471-2431-5-25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 07/19/2005] [Indexed: 11/18/2022] Open
Abstract
Background In children with severe generalized cerebral palsy, pneumonias are a major health issue. Malnutrition, dysphagia, gastro-oesophageal reflux, impaired respiratory function and constipation are hypothesized risk factors. Still, no data are available on the relative contribution of these possible risk factors in the described population. This paper describes the initiation of a study in 194 children with severe generalized cerebral palsy, on the prevalence and on the impact of these hypothesized risk factors of recurrent pneumonias. Methods/Design A nested case-control design with 18 months follow-up was chosen. Dysphagia, respiratory function and constipation will be assessed at baseline, malnutrition and gastro-oesophageal reflux at the end of the follow-up. The study population consists of a representative population sample of children with severe generalized cerebral palsy. Inclusion was done through care-centres in a predefined geographical area and not through hospitals. All measurements will be done on-site which sets high demands on all measurements. If these demands were not met in "gold standard" methods, other methods were chosen. Although the inclusion period was prolonged, the desired sample size of 300 children was not met. With a consent rate of 33%, nearly 10% of all eligible children in the Netherlands are included (n = 194). The study population is subtly different from the non-participants with regard to severity of dysphagia and prevalence rates of pneumonias and gastro-oesophageal reflux. Discussion Ethical issues complicated the study design. Assessment of malnutrition and gastro-oesophageal reflux at baseline was considered unethical, since these conditions can be easily treated. Therefore, we postponed these diagnostics until the end of the follow-up. In order to include a representative sample, all eligible children in a predefined geographical area had to be contacted. To increase the consent rate, on-site measurements are of first choice, but timely inclusion is jeopardised. The initiation of this first study among children with severe neurological impairment led to specific, unexpected problems. Despite small differences between participants and non-participating children, our sample is as representative as can be expected from any population-based study and will provide important, new information to bring us further towards effective interventions to prevent pneumonias in this population.
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Affiliation(s)
- Rebekka Veugelers
- Intellectual Disability Medicine, department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Department of Paediatric Surgery Erasmus MC, Sophia Children's Hospital, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Elsbeth AC Calis
- Intellectual Disability Medicine, department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Department of Paediatric Surgery Erasmus MC, Sophia Children's Hospital, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Corine Penning
- Intellectual Disability Medicine, department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
- Department of Paediatric Surgery Erasmus MC, Sophia Children's Hospital, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Arianne Verhagen
- Department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Roos Bernsen
- Department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jan Bouquet
- Department of Paediatric Gastro-enterology Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastro-enterology and Nutrition Academic Medical Centre / Emma's Children's Hospital, G8 217, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Peter JFM Merkus
- Department of Paediatric Pulmonology Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Hubertus GM Arets
- Department of Paediatric Pulmonology UMC, HP KH.01.419.0, PO Box 85590, 3508 AB Utrecht, The Netherlands
| | - Dick Tibboel
- Department of Paediatric Surgery Erasmus MC, Sophia Children's Hospital, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Heleen M Evenhuis
- Intellectual Disability Medicine, department of General Practice Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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