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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It should be considered that the causes of refractory gastroesophageal reflux disease (GERD) are multifactorial. Esophageal manometry study is useful when we make distinguish patients with esophageal motility disorders from those with refractory GERD. Endoscopic ultrasonography is also performed to observe the thickness of esophageal wall which represents the disturbance of esophageal motor function. Esophageal pH monitoring is useful to detect the acid clearance disturbance and phenomenon of nocturnal acid breakthrough. Both are occurred at night, and are recently considered to be responsible for refractory GERD. Catheter-free pH monitoring system, Bravo, makes it possible to measure esophageal pH under quite physiological conditions. Genotype of CYP2C19 is sometimes checked in patients with PPI resistance GERD. Intra-gastric pH with omeprazole and lansoprazole depends on patient's genotype of CYP2C19. Monitoring of 24-hour bilirubin, Bilitec, is also useful to detect duodeno-gastro-esophageal reflux.
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PMID:[Test of refractory gastroesophageal reflux disease]. 1534 37

Using a simple 'test' to diagnose gastro-oesophageal reflux disease is difficult because accurately measuring gastric refluxate and correlating reflux events with symptom episodes is complex. This paper reviews the safety, tolerability and diagnostic accuracy of Bravo (Medtronic, Shoreview, MN, USA), ambulatory oesophageal pH monitoring technology. Catheter-based pH electrodes inhibit patients' normal activity, and can yield erroneous results because of placement or subsequent migration of the probe or errors in the thermal compensation algorithm that is requisite for antimony pH electrodes. Bravo pH studies reliably discriminated oesophagitis patients from controls, but are less discriminatory in endoscopy-negative gastro-oesophageal reflux disease patients. The Bravo system can be accurately placed using endoscopic landmarks and pH studies demonstrated more accurate in vivo pH recording than with a catheter-based system. The Bravo system detected fewer reflux events of short duration compared with a catheter-based system. Studies examining the correlation between reflux events and symptoms have not yet been conducted using the Bravo system. In conclusion, the Bravo system offers a more user-friendly ambulatory pH monitoring technique that more accurately records pH compared with a catheter-based system. More research is needed to determine whether the detection of reflux events with Bravo will provide a good correlation with symptom episodes.
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PMID:Review article: oesophageal pH monitoring--technologies, interpretation and correlation with clinical outcomes. 1630 31

Ambulatory pH monitoring detects abnormal levels of acid reflux in the oesophagus and can be used to correlate patients' symptoms with oesophageal acid exposure. Catheter-based pH testing has several limitations, including issues of sensitivity, specificity, tolerability and the inability to record non-acid reflux events. In an effort to improve upon these drawbacks, several devices have been introduced, including the Bilitec system for measuring duodenogastro-oesophageal reflux; intraluminal impedance monitoring, which detects the distribution, composition and clearing of both acid and non-acid oesophageal reflux; and a wireless pH monitoring device, the Bravo capsule. Initial investigations using the Bilitec system demonstrated that duodenogastro-oesophageal reflux tracked very closely with acid reflux and decreased with proton-pump inhibitor (PPI) therapy, casting doubt on the clinical utility of Bilitec monitoring. Recent evidence revealed a possible role for duodenogastro-oesophageal reflux in a subset of patients who continue to report reflux symptoms in the setting of normalized oesophageal acid exposure on high-dose PPI therapy. When combined with pH monitoring, impedance monitoring enhances the detection and characterization of gastro-oesophageal reflux and may have a role in the evaluation of certain specific gastro-oesophageal reflux disease (GERD) symptoms that persist despite acid suppression therapy. The utility of the Bravo wireless technology for GERD diagnosis has been validated in several studies, with improvements over catheter-based pH monitoring in tolerability, accuracy and sensitivity, as well as the ability to record periods both off and on PPI therapy in a single study. All three diagnostic modalities have advanced the understanding of GERD pathogenesis, but their impact on the clinical management of GERD is still the focus of active investigation.
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PMID:Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease--Bilitec, intraluminal impedance and Bravo capsule pH monitoring. 1648 66

The aim of this study was to assess the quantitative differences of acid exposure at 1 cm and 6 cm above the squamocolumnar junction (SCJ) using two radiotelemetry pH capsules affixed to the esophageal mucosa. Ten normal subjects and 10 endoscopy-negative gastroesophageal reflux disease (GERD) patients without hiatus hernia (ages 20-54, 12 male) were studied for a 24-h period using the Bravo pH monitoring system. pH capsules were placed 1 cm and 6 cm above the SCJ. Interpretable data for at least 14 h was obtained in 18 of the 20 subjects (9 normal, 9 GERD). Two failures occurred secondary to early capsule dislodgement. Median esophageal acid exposure was significantly increased at 1 cm above the SCJ compared to 6 cm above the SCJ during the total, upright and postprandial time periods in both normal and GERD subjects. During a 2 h postprandial period the esophageal acid exposure was 8-fold greater in GERD subjects and 5-fold greater in normal subjects 1 cm above the SCJ compared to 6 cm above the SCJ. Confident measurement of esophageal acid exposure at a fixed position 1 cm above the SCJ is feasible with the Bravo system. Acid exposure was significantly higher 1 cm above the SCJ compared to 6 cm above the SCJ in both GERD patients and controls. These findings suggest that measurement of acid exposure 1 cm above the SCJ may improve accuracy of pH monitoring by detecting acid reflux events confined to the distal esophagus.
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PMID:Comparison of esophageal acid exposure at 1 cm and 6 cm above the squamocolumnar junction using the Bravo pH monitoring system. 1672 95

Ambulatory wireless 48-h esophageal pH monitoring (Bravo Medtronic, Shoreview, MN, USA) has been shown to be more sensitive in detecting abnormal esophageal acid exposure compared with transnasal 24-h pH probes. However, accurate interpretation of the wireless monitoring data is paramount when contemplating surgical intervention for those with gastroesophageal reflux disease. The aim of this study is to evaluate the incidence of false-positive interpretations of this wireless monitoring data secondary to premature transit of the Bravo capsule into the stomach and subsequently into the duodenum prior to the completion of the 48-h study period. We reviewed 100 consecutive Bravo pH studies at our University Esophageal Motility Center. There were 58 women and 42 men included in our evaluation. Premature transit of the Bravo capsule into the stomach and subsequently into the small bowel was defined by a prolonged gastric pH phase with either evidence of alkalinization and no further reflux episodes or loss of communication with the Bravo capsule prior to the end of the 48-h data collection period. Of the 100 patients reviewed, 11% manifested evidence of early passage of the Bravo capsule resulting in a misinterpretation of the data as abnormal acid exposure. The mean time of inaccurate data after transit of the Bravo capsule was 18 h and 42 min. The mean length of time that the capsule was retained in the stomach prior to duodenal passage was 4 h. If the aforementioned data were included in the final interpretation of the study, it yielded a mean DeMeester score of 44.25 with a mean total time of pH <4 of 14.7% per case. Exclusion of the prolonged gastric phase from the final interpretation of each case resulted in a statistically significant reduction in the mean total time the pH <4 (4.33 vs. 14.7%, p < 0.05) and the mean DeMeester score (12.81 vs. 44.25 p < 0.05). The mean time from the initiation of esophageal pH data to the passage of the Bravo capsule into the stomach was 15 h and 22 min. The observation mandates meticulous inspection of the pH tracing by the interpreting physician throughout the entirety of a 48-h study to identify premature transit of the capsule. Tracings that show prolonged acid exposure or loss of communication with the Bravo capsule should be screened for the capsule's possible early dislodgement and premature advancement into the stomach.
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PMID:48-Hour pH monitoring increases the risk of false positive studies when the capsule is prematurely passed. 1746 23

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world. This article gives an overview about diagnostic procedures for GERD. Standard procedures such as pH-metry, Bilitec and manometry and also new diagnostic tools such as combined multichannel intraluminal impedance (MII) and pH-metry and Bravo Capsule are described in detail. Established endoscopy criteria as well as innovative techniques such as magnification, narrow band imaging and computed virtual chromoendoscopy are also presented. Not all of these procedures need to be used in every patient. Therefore, it is important to know the technical aspects, indications, advantages and disadvantages of each method in order to appropriately use any of these tests. The final goal is to characterise GERD and provide the patient with an appropriate therapy.
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PMID:[Standards and innovations in the diagnosis of gastroesophageal reflux disease]. 1802 15

Esophageal testing aims to quantify gastroesophageal reflux or characterize esophageal motility. Reflux monitoring traditionally has been based on the detection of acidic reflux by a transnasal catheter that measures esophageal pH. Recently there have been two major developments in this field: the wireless Bravo pH capsule (Medtronic, Inc., Minneapolis, MN), which allows catheter-free monitoring, and impedance-pH measurement, a catheter-based technique that enables detection of acidic and nonacidic reflux. The assessment of esophageal motility has relied on conventional manometry for many years. Two new procedures also recently became available to assess esophageal motility: high-resolution manometry, which uses many closely spaced pressure sensors and provides spatiotemporal plots of esophageal pressure changes, and impedance manometry, a test that directly measures bolus transit and provides conventional manometric data. The advantages, disadvantages, and clinical importance of these new esophageal tests are discussed in this review.
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PMID:New esophageal function testing (impedance, Bravo pH monitoring, and high-resolution manometry): clinical relevance. 1862 30

Gastro-oesophageal reflux disease (GERD) is a highly prevalent condition in Western countries leading to millions of outpatient visits per year. GERD symptoms including heartburn, regurgitation and chest pain are caused by reflux of gastric content in the oesophagus even in the absence of endoscopically visible mucosal lesions. Several procedures are used to identify gastro-oesophageal reflux, the clinically widely used are: conventional (catheter-based) pH monitoring, wireless oesophageal pH monitoring (Bravo), bilirubin monitoring (Bilitec), and combined multichannel intraluminal impedance-pH monitoring (MII-pH). Each technique has strengths and limitations of which clinicians and investigators should be aware when deciding which to choose in a particular patient. Important is the ability to quantify gastro-oesophageal reflux and evaluate the relationship between symptoms and reflux episodes. The present review summarises the technical aspects in performing and interpreting esophageal reflux monitoring procedures.
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PMID:Reflux monitoring: pH-metry, Bilitec and oesophageal impedance measurements. 1950 60

Gastroesophageal reflux disease (GERD) still remains the most common out- GI-related condition in the out-patient setting. While primary care physicians often use empiric trials with proton pump inhibitors (PPI trial) to diagnose GERD, often specialised tests are required to confirm or exclude gastroesophageal reflux causing esophageal or extraesophageal symptoms. The most commonly used procedures to diagnose GERD include: conventional (catheter based) pH monitoring, wireless esophageal pH monitoring (Bravo), bilirubin monitoring (Bilitec), and combined multichannel intraluminal impedance-pH monitoring (MII-pH). Each technique has strengths and limitations of which clinicians and investigators should be aware when deciding which one to choose.
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PMID:Laboratory based investigations for diagnosing gastroesophageal reflux disease. 2112 94

Background/Aim. The aim of this study was to determine the effect of propofol on acid reflux as measured with the Bravo pH monitoring system. Methods. 48-hour pH tracings of 88 children were retrospectively evaluated after placement of the Bravo capsule under propofol. Comparisons between day 1 and day 2, as well as 6-hour corresponding segments from day 1 and day 2, were made. Results. The number of reflux episodes was significantly increased during the first six-hour period on day one as compared to day 2 (P = 0.006). The fraction of time the pH was <4 was also increased during this period, though it did not reach statistical significance. When comparing full 24-hour periods, there was no difference noted in either the number of reflux episodes or the fraction of time pH < 4 between day one and day two. Conclusion. Our data suggest an increase in gastroesophageal reflux during the postanesthesia period. This could be a direct effect of propofol, or related to other factors. Regardless of the cause, monitoring of pH for the first 6 hours following propofol administration may not be reliable when assessing these patients. Monitoring pH over a prolonged 48-hour time period can overcome this obstacle.
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PMID:Effect of Propofol on Acid Reflux Measured with the Bravo pH Monitoring System. 2369 37


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