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Prevalence, characteristics, and treatment outcomes of reflux hypersensitivity detected on pH‐impedance monitoring
Author(s) -
Patel A.,
Sayuk G. S.,
Gyawali C. P.
Publication year - 2016
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12838
Subject(s) - medicine , reflux , prospective cohort study , univariate analysis , esophageal ph monitoring , gastroenterology , multivariate analysis , cohort , gerd , disease
Background Positive symptom association probability ( SAP ) with physiologic esophageal acid exposure time ( AET ) on pH‐impedance monitoring defines reflux hypersensitivity ( RH ), a correlate of acid sensitivity on pH monitoring. We evaluated prevalence, clinical characteristics, and symptomatic outcomes of RH in a prospective observational cohort with reflux symptoms undergoing pH‐impedance monitoring. Methods Reflux hypersensitivity was diagnosed when SAP was positive with pH‐ and/or impedance‐detected reflux events with physiologic AET . Symptom burden was assessed using dominant symptom intensity ( DSI , product of symptom severity and frequency on 5‐point Likert scales) and global symptom severity ( GSS , global esophageal symptoms on 100‐mm visual analog scales) by questionnaire, both at baseline and on prospective follow‐up. Clinical characteristics and predictors of symptomatic improvement were assessed with univariate and multivariate analyses. Key Results Seventy‐seven patients (29%) met criteria for RH , of which 53 patients (53.7 ± 1.8 years, 66% F) were contacted after 3.3 ± 0.2 years for follow‐up. Reflux hypersensitivity was detected on pH‐impedance testing both on and off antisecretory therapy; pH alone missed 51% of RH . About 57% reported ≥50% GSS improvement. Sixteen patients undergoing antireflux surgery ( ARS ) reported better symptom improvement compared to 37 patients treated medically ( GSS change: p = 0.005; DSI change: p = 0.04). Hiatus hernia ( p = 0.03) and surgical management ( p ≤ 0.04) predicted symptom improvement on univariate analysis, while acid sensitivity was a negative predictor for outcome on both univariate ( p = 0.02) and multivariate analyses ( p ≤ 0.04). Conclusions & Inferences Reflux hypersensitivity is a mechanism for persistent reflux symptoms in almost one‐third of patients undergoing pH‐impedance testing. While acid sensitivity predicts suboptimal symptom improvement, antireflux therapy may improve RH in select settings.