RUOLO DELLA pHIMPEDENZIOMETRIA ESOFAGEA NELLA DIAGNOSI DELLA MRGE ATIPICA

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RUOLO DELLA pH-IMPEDENZIOMETRIA ESOFAGEA NELLA
DIAGNOSI DELLA MRGE ATIPICA

• PATRIZIA ZENTILIN
• UNIVERSITA DI GENOVA

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GERD - New Definition
GERD is a condition which develops when the
reflux of stomach content causes troublesome
symptoms and / or complications


Esophageal Syndromes
Extra-esophageal Syndromes
Proposed Association
Established Association
Symptomatic Syndromes
Syndromes with Esophageal Injury
Sinusitis Pulmonary fibrosis Pharyngitis Recurrent
otitis media
Reflux cough Reflux laryngitis Reflux
asthma Reflux dental erosions
Reflux esophagitis Reflux stricture Barrett's
esophagus Adenocarcinoma
Typical reflux syndrome Reflux chest pain syndrome
Vakil et al. Can J Gastroenterol 2005
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Vaezi MF APT 2006.
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Vaezi MF APT 2006.
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Vaezi MF APT 2006.
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Vaezi MF APT 2006.
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GERD and Extraesophageal Problems
GERD findings NERD ERD
Chronic cough 11.5 14.5 Asthma 4.3 5.2 Non-car
diac chest pain 13.5 15.4 Laryngeal
disorder 9.5 11.2
Jaspersen et al. Aliment Pharmacol Ther 2003
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Reflux-associated symptom episodes in 42
patients with esophagitis
None 41
Acid 33
DGER 10
Mixed 16
Keok et al, 2001
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MII pH Monitoring Vs pH Monitoring

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Cosè limpedenza?

• Lopposizione ad un flusso di corrente

La misura inversa della conduttività del
contenuto di un organo
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Perchè limpedenza cambia?

• Nessun bolo Alta impedenza

Presenza del bolo Bassa impedenza
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Variazioni dellimpedenza durante una deglutizione
Air (b)
Contraction wave (d)
Resting state (a)
Liquid bolus (c)
Impedance
Time
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Scala di impedenza
Bassa conduttività alta impedenza
Impedenza
ARIA
ESOFAGO A RIPOSO
Saliva
CIBO
REFLUSSO
Alta conduttività bassa impedenza
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Rappresentazione schematica di una sonda
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Movimento antegrado del bolo
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Movimento retrogrado del bolo
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EPISODIO DI REFLUSSO ACIDO
BOLUS CLEARANCE TIME 10 sec.
SOGLIA pH 4.0
ACID CLEARANCE TIME 38 sec.
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EPISODIO DI REFLUSSO DEBOLMENTE ACIDO
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Combined pH-impedance recordings showing examples
of the three types of reflux. Vertical bars on
impedance channels indicate the beginning and the
end of bolus reflux. Horizontal bars on the pH
channel show pH values. (a) weakly acidic reflux
(b) weakly alkaline reflux and (c) acid reflux
Zentilin et al, 2006
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Acid reflux migrates to hypopharynx
Example 1
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Weakly acidic reflux migrates to hypopharynx
Example 4
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Weakly acidic reflux migrates to proximal
esophagus(Does not penetrate UES)
Example 2
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Kawamura O. et al., AJG 2004
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Kawamura O. et al., AJG 2004
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LIMITATIONS OF INTRALUMINAL ELECTRICAL IMPEDANCE

• Invasive technique
• Low patients compliance
• Technical failure of the measuring system
• Existence of severe esophageal motor
  abnormalities
• Inability to detect the volume of air or liquid
• Inability to distinguish between bile reflux or
  reflux of other nonacidic gastric contents as
  food material
• Validation of automated software-aided analysis
  is not yet completely established

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Potential clinical advantages of multichannel
intraluminal electrical impedance

• Identification of number and percent times of
  gas, acid and non-acid liquid reflux events
• Correlation of acid and non-acid reflux to GORD
  symptoms
• Evaluation of the proximal extent of reflux
  episodes, especially in patients with
  laryngeal-respiratory symptoms of GORD
• Identification of both acid and non-acid reflux
  events during postprandial periods
• Assessment of GORD patients with persistent
  symptoms on PPIs
• Evaluation of effective control of medical,
  surgical and endoscopic therapies on both acid
  and non-acid reflux
• Evaluation of infant patients on frequent
  feedings, where majority of reflux is nonacid due
  to meal buffering