The Role of Impedance-pH Monitoring in the Diagnosis of Non-Erosive Reflux Disease: Clinical Findings and Reflux Characterization

Yıl 2025, Cilt: 8 Sayı: 1, 35 - 38, 28.02.2025

Yasemin Bakkal Temi , Altay Çelebi , Ömer Şenntürk , Deniz Ogutmen Koc , Göktuğ Şirin , Ugur Korkmaz , Ali Erkan Duman , Gökhan Dindar , Neslihan Bozkurt , Sadettin Hülagü

https://doi.org/10.53446/actamednicomedia.1562162

Öz

Objective: Gastroesophageal reflux disease (GERD) is characterized by symptoms and complications resulting from the backflow of gastric contents into the esophagus. Although pH monitoring often appears normal, symptoms persist in patients with nonerosive reflux disease (NERD). The objective of this research was to examine the effectiveness of impedance pH monitoring in identifying NERD and explore its relationship with reflux characteristics and clinical observations.
Method: The data of 40 patients who presented with classic reflux symptoms and were found to have no esophagitis upon endoscopic examination at the Kocaeli University Gastroenterology Clinic between September 2009 and February 2011 were retrospectively analyzed. The 24-hour ambulatory esophageal impedance-pH monitoring data were manually analyzed. The relationship between the clinical symptoms and impedance pH data was also assessed.
Results: The patients' average age 42 (range, 22-65) years, with 23 (58%) females and 17 (42%) males. Acid reflux was detected in 95.8% of the patients who experienced heartburn more than once per week (p=0.029). The severity of heartburn was significantly higher in the acid reflux group (p=0.04), whereas the number of patients with mild acid reflux was significantly higher among those with gas reflux (p=0.005).
Conclusion: The findings of our research indicate that both severe and mild forms of acid reflux may contribute significantly to symptom manifestation in individuals diagnosed with non-erosive reflux disease. It has been found that gas and mixed reflux types are associated with symptoms, even in the absence of esophagitis. Compared to pH monitoring alone, impedance-pH monitoring offers a more comprehensive assessment for identifying non-acid reflux. As such, it should be considered the preferred diagnostic approach when managing patients with NERD.

Anahtar Kelimeler

Impedance-pH monitoring, Non-erosive reflux disease, non-acid reflux

Non-Erozif Reflü Hastalığının Tanısında İmpedans-pH Metrenin Rolü: Klinik Bulgular ve Reflü Karakterizasyonu

Öz

Öz
Amaç: Gastroözofageal reflü hastalığı (GÖRH), mide içeriğinin özofagusa geri dönmesiyle gelişen semptomlar ve komplikasyonlardan oluşur. Non-erozif reflü hastalığı (NERH) olan hastalarda, pH metre sıklıkla normal bulunsa da semptomların devam ettiği saptanmıştır. Bu çalışma, NERH hastalarında impedans-pH metrenin tanıdaki rolünü ve reflü karakterizasyonunun klinik bulgularla ilişkisini incelemeyi amaçlamaktadır.
Yöntem: Eylül 2009 ile Şubat 2011 tarihleri arasında, Kocaeli Üniversitesi Gastroenteroloji Polikliniği’ne tipik reflü semptomlarıyla başvuran ve endoskopik incelemede özofajit tespit edilmeyen 40 hastanın verileri retrospektif olarak incelendi. Hastaların 24 saatlik ambulatuar özofageal impedans-pH monitörizasyonu verileri manuel olarak analiz edildi. Klinik semptomlar ile impedans-pH verileri arasındaki ilişki analiz edildi.
Bulgular: Hastaların yaş ortalaması 42 (22–65) yıl olup, 23’ü (%58) kadın, 17’si (%42) erkektir. Pirozis sıklığı haftada birden fazla olan hastaların %95,8’inde hafif asit reflü tespit edilmiştir (p = 0,029). Asit reflü grubunda pirozis şiddeti anlamlı şekilde daha yüksek bulunurken (p = 0,04), gaz reflüsü olan hastalarda hafif asit reflü sayısı daha yüksek tespit edilmiştir (p = 0,005).
Sonuç: Çalışmamız, non-erozif reflü hastalarında yalnızca asit reflüsünün değil, hafif asit reflüsünün de semptom gelişiminde önemli bir rol oynayabileceğini göstermektedir. Özofajit gelişmese bile gaz ve karma reflü tiplerinin semptomlarla ilişkili olduğu tespit edilmiştir. İmpedans-pH monitörizasyonu, asit dışı reflülerin tanısında pH metreden daha kapsamlı bilgi sağlamaktadır ve NERH hastalarının yönetiminde öncelikli bir tanı yöntemi olmalıdır.

Anahtar Kelimeler

impedans-pH monitorizasyonu, non-erozif reflü hastalığı, asit dışı reflü

Etik Beyan

Bu çalışma, Kocaeli Üniversitesi Etik Komitesi'nden alınan onay doğrultusunda retrospektif olarak yürütülmüştür (KOÜ. İAEK 2010/49).

Destekleyen Kurum

Bu çalışma hiçbir kuruluş tarafından desteklenmemiştir.

Kaynakça

• 1. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112(5):1448-1456. doi:10.1016/s0016-5085(97)70025-8
• 2. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871-880. doi:10.1136/gutjnl-2012-304269
• 3. Fass R, Ofman JJ. Gastroesophageal reflux disease--should we adopt a new conceptual framework? Am J Gastroenterol. 2002;97(8):1901-1909. doi:10.1111/j.1572-0241.2002.05912.x
• 4. Fass R. Erosive Esophagitis and Nonerosive Reflux Disease (NERD): Comparison of Epidemiologic, Physiologic, and Therapeutic Characteristics. Journal of Clinical Gastroenterology. 2007;41(2):131. doi:10.1097/01.mcg.0000225631.07039.6d
• 5. Hom C, Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2013;42(1):71-91. doi:10.1016/j.gtc.2012.11.004
• 6. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-1920; quiz 1943. doi:10.1111/j.1572-0241.2006.00630.x
• 7. Frazzoni M, de Bortoli N, Frazzoni L, Tolone S, Savarino V, Savarino E. Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives. Dig Dis Sci. 2017;62(8):1881-1889. doi:10.1007/s10620-017-4625-8
• 8. Zerbib F, des Varannes SB, Roman S, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22(10):1011-1021. doi:10.1111/j.1365-2036.2005.02677.x
• 9. Kitapcioglu G, Mandiracioglu A, Bor S. Psychometric and methodological characteristics of a culturally adjusted gastroesophageal reflux disease questionnaire. Dis Esophagus. 2004;17(3):228-234. doi:10.1111/j.1442-2050.2004.00413.x
• 10. Kahrilas PJ. Diagnosis of symptomatic gastroesophageal reflux disease. Am J Gastroenterol. 2003;98(3 Suppl):S15-23. doi:10.1016/s0002-9270(03)00011-x
• 11. Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335(8683):205-208. doi:10.1016/0140-6736(90)90287-f
• 12. Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol. 2008;103(2):267-275. doi:10.1111/j.1572-0241.2007.01659.x
• 13. Savarino E, Tutuian R, Zentilin P, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. Am J Gastroenterol. 2010;105(5):1053-1061. doi:10.1038/ajg.2009.670
• 14. Soto Pérez JC, Icaza ME, Vargas F, Valdovinos Díaz MA. [Non-erosive gastroesophageal reflux disease. Incidence of clinical forms, characteristics of esophageal exposure to acid and symptomatic correlations]. Rev Gastroenterol Mex. 2003;68(2):113-119.
• 15. Emerenziani S, Sifrim D, Habib FI, et al. Presence of gas in the refluxate enhances reflux perception in non-erosive patients with physiological acid exposure of the oesophagus. Gut. 2008;57(4):443-447. doi:10.1136/gut.2007.130104
• 16. Bredenoord AJ, Weusten BLAM, Timmer R, Smout AJPM. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure. Am J Gastroenterol. 2006;101(11):2470-2475. doi:10.1111/j.1572-0241.2006.00945.x