Improving diagnostic efficacy of multichannel intraluminal impedance-ph-monitoring of the esophagus by means of evaluating post-reflux swallow-induced peristaltic waves and basal impedance.

OBJECTIVE

Introduction

The postreflux swallow-induced peristaltic wave (PSPW) index and methods of baseline impedance estimation are novel parameters proposed to improve diagnostic yield of intraluminal impedance-pH monitoring (MII-pH-M). Measuring intraluminal baseline impedance level (BIL) reflects mucosal integrity of distal esophagus. We offer original approach with automatic generating a histogram of impedance and visual identification of peak (mode) corresponding to BIL. The aim: To check the possibilities of introduction of methods for determining the index of PSPW and the average night basal level of impedance (MNBI), BIL-moda on the domestic MII-pH-M technique.

PATIENTS AND

METHODS

Materials and methods:Patients were divided on 2 groups: 1st [nonerosive GERD] - 11 women and 11 men, mean age (±S.E.M.) of 48.0±3.1 y.o.; 2nd [Reference] - 11 women and 10 men, mean age 47.9±3.5 y.o. Reference group included patients with non-ulcer dyspepsia. All patients MII-pH-monitoring with measuring current 6 μA at a frequency of 1 kHz and sampling frequency of 50 Hz. BIL was assessed at 3 cm proximal to the lower esophageal sphincter.

RESULTS

Results

In our study we obtained the best cut-off point for PSPW index - 58.2% with sensitivity 86.4% and specificity 81.0% (AUC=0,85). Our BIL-moda parameter demonstrated the best cut-off point <2,65 kΩ with sensitivity 90.9% and specificity 85.7% (AUC=0,89). The MNBI indicator showed accuracy in the best cut-off point - 3,967 kΩ with sensitivity 95.5% and specificity 76.2% (AUC=0,87).

CONCLUSION

Conclusions

Applying the PSPW index, MNBI and our BIL-moda showed an obvious gain in diagnostic sensitivity - in 10% cases of NERD.