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Background and aims: Multichannel intra-luminal impedance (MII) and pH monitoring has been shown to be efficacious in the evaluation of patients with incomplete symptom control on proton pump inhibitor (PPI) therapy. The aim of our study is to evaluate the relationship of typical and atypical gastroesophageal reflux (GER) symptoms to frequency of acid and non-acid reflux (NAR) episodes in patients on PPI therapy.
Methods: Patients with persistent GER symptoms who underwent 24 hour combined MII-pH monitoring while on PPI therapy form the cohort of the study. Reflux episodes were detected by impedance channels located 3, 5, 7, 9, 15, and 17 cm above the lower esophageal sphincter (LES) and classified into acid or non-acid based on pH data from 5 cm above the LES. Symptom Index (SI) was considered positive if >50% of specific symptom events were preceded by acid or non-acid reflux episodes within five minutes.
Results: Of 63 patients who underwent combined MII-pH monitoring on PPI therapy, there were 46 (75%) women and the mean age was 51.6 years (range 18-83). Fifty five patients reported one or more symptoms during the study, of these 25 (39.7%) patients had a positive SI for at least one symptom (12 with acid reflux and 16 with NAR). For typical GERD symptoms, 14 (19%) had a positive SI for acid reflux, 18 (24%) for NAR, and 43 (58%) had a negative SI. For atypical symptoms, 6 (14%) had a positive SI for acid reflux, six (14%) had a positive SI for NAR, and 32 (72%) had a negative SI.
Conclusion: Combined MII-pH shows that about 2/3rd of patients complaining of symptoms on PPI therapy do not have positive symptom index to either acidic and/or non-acidic reflux while remaining patients can have their symptoms attributable to reflux.