Abstract
Background
The Lyon Consensus proposed a hierarchical approach to GERD diagnosis based on conventional
and new impedance-pH metrics, namely acid exposure time (AET), number of reflux episodes,
post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline
impedance (MNBI).
Aims
To define the value of conventional and new impedance-pH parameters as predictors
of response to label-dose PPI in typical GERD.
Methods
Consecutive adult patients with typical esophageal symptoms were prospectively studied
with impedance-pH monitoring and treated with 8-week label-dose PPI. At the end of
the PPI course, symptoms response was assessed.
Results
Among 255 patients who entered the study, 168 (65.9%) reported symptom remission.
At ROC analysis, both MNBI and PSPW index were significantly associated to PPI responsiveness
with AUC of 0.783 and 0.801, respectively. Cut-off values of 1747Ω for MNBI and 50%
for PSPW index were identified as discriminators between response and non-response
to label-dose PPI. At multivariate analysis, MNBI, PSPW index, and AET >6% were efficient
predictors of PPI responses (OR 3, 5.4 and 2.3, respectively). Number of reflux episodes
did not predict PPI response.
Conclusions
The novel MII-pH variables together with pathological are highly predictive of response
of the typical GERD syndrome to label-dose PPI.
Keywords
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Article info
Publication history
Published online: December 24, 2022
Accepted:
December 8,
2022
Received:
September 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
