Clinical use of mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index for the diagnosis of gastro-esophageal reflux disease

Pierfrancesco Visaggi, Lucia Mariani, Federica Baiano Svizzero, Luca Tarducci, Andrea Sostilio, Marzio Frazzoni, Salvatore Tolone, Roberto Penagini, Leonardo Frazzoni, Linda Ceccarelli, Vincenzo Savarino, Massimo Bellini, Prakash C. Gyawali, Edoardo V. Savarino, Nicola de Bortoli

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

The clinical diagnosis of gastro-esophageal reflux disease (GERD) is based on the presence of typical esophageal troublesome symptoms. In clinical practice, heartburn relief following a proton pump inhibitor (PPI) trial or endoscopy can confirm a diagnosis of GERD. In cases of diagnostic uncertainty or before anti-reflux interventions, combined impedance-pH monitoring (MII-pH) provides a comprehensive assessment of both physical and chemical properties of the refluxate, allowing to achieve a conclusive diagnosis of GERD. Recently, the Lyon Consensus proposed the use of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I) as novel MII-pH metrics to support the diagnosis of GERD. The calculation of MNBI and PSPW-I currently needs to be performed manually, but artificial intelligence systems for the automated analysis of MII-pH tracings are being developed. Several studies demonstrated the increased diagnostic yield MNBI and PSPW-I for the categorization of patients with GERD at both on- and off-PPI MII-pH monitoring. Accordingly, we performed a narrative review on the clinical use and diagnostic yield of MNBI and PSPW-I when the diagnosis of GERD is uncertain. Based on currently available evidence, we strongly support the evaluation of PSPW-I and MNBI as part of the standard assessment of MII-pH tracings for the evaluation of GERD, especially in patients with endoscopy-negative heartburn.

Original languageEnglish
Pages (from-to)525-534
Number of pages10
JournalEsophagus
Volume19
Issue number4
DOIs
StatePublished - Oct 2022

Keywords

  • Diagnosis
  • GERD
  • MNBI
  • PSPW index
  • Reflux disease

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