Utilising multichannel intraluminal impedance for diagnosing GERD: a review

Area of Science:

• Gastroenterology
• Digestive Physiology
• Medical Diagnostics

Background:

• Diagnosing gastroesophageal reflux (GER) can be challenging, particularly for symptoms unresponsive to high-dose acid suppression.
• Advancements in technology enable the detection and quantification of nonacid or weakly acidic reflux.
• Multichannel intraluminal impedance (MII) is an emerging tool for reflux detection.

Purpose of the Study:

• To review the role of MII in diagnosing GERD and related disorders.
• To compare MII with traditional pH monitoring for reflux detection.
• To explore MII's utility in evaluating atypical GERD symptoms.

Main Methods:

• Review of published studies comparing MII and pH monitoring in normal subjects and GERD patients.
• Analysis of MII's ability to detect nonacidic reflux, aerophagia, and differentiate reflux from swallows.
• Examination of studies evaluating MII for atypical GERD symptoms.

Main Results:

• MII detects nonacid or weakly acidic reflux, which occurs frequently in both normal and GERD subjects.
• pH monitoring fails to detect the majority of nonacid or weakly acidic reflux events.
• GERD subjects exhibit more liquid-type reflux, while normal subjects show more gas-type reflux.
• Proton pump inhibitors render reflux nonacidic or weakly acidic without reducing its amount.

Conclusions:

• MII provides a more powerful diagnostic tool for GERD than pH monitoring alone.
• MII enhances the understanding of reflux characteristics, including nonacidic and gas-type reflux.
• MII shows promise in evaluating atypical GERD symptoms and guiding treatment strategies.