Original article—alimentary tractThe Utility of Intraluminal Impedance in Patients With Gastroesophageal Reflux Disease–Like Symptoms But Normal Endoscopy and 24-Hour pH Testing
Section snippets
Subjects
Patients were eligible for this study if they had symptoms of heartburn (defined as a substernal burning sensation) or regurgitation (defined as a sensation of liquid moving into the chest and/or mouth from the stomach not associated with nausea) at least twice a week for at least 1 year that failed to respond to antisecretory therapy, had a negative upper endoscopy, and a normal 24-hour pH test defined as total time pH was less than 4, less than 4.5%, upright time less than 6.3%, and recumbent
Results
The study patients included 29 women and 8 men, with an average age of 53 years (range, 33–72 y), who had symptoms for an average of 3.3 years (range, 1.5–8.0 y). Seventeen patients (46%) used twice-daily proton pump inhibitor (PPI) therapy, 10 patients (27%) used once-daily PPI therapy, and the others used H2-receptor antagonist (H2RA), all without improvement of their GERD-like symptoms.
Six (16%) of the 37 study patients had a positive 24-hour pH study (Figure 1). Five patients were taking
Discussion
MII-pH testing combined with an SI revealed evidence consistent with reflux as a cause of GERD-like symptoms in 81% of 37 patients with a negative upper endoscopy and with no evidence of abnormal intraesophageal acid exposure on standard 24-hour pH testing. The remaining 19% of patients had no evidence of symptoms owing to any sort of reflux events and therefore were diagnosed with no reflux disease—or functional heartburn. Six patients (16%) initially had a negative standard pH test and
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