[Impedance Measurement for Non-Erosive Reflux Disease
| Status: | Withdrawn |
|---|---|
| Conditions: | Gastroesophageal Reflux Disease , Healthy Studies |
| Therapuetic Areas: | Gastroenterology, Other |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 11/14/2018 |
| Start Date: | December 2016 |
| End Date: | October 22, 2018 |
Measurement of the Distal 5 cm of the Esophagus in Patients With Non-Erosive Reflux Disease and Controls
This study is being done to determine if people with and without GERD or trouble swallowing
have increased esophageal mucosa impedance (food getting into the esophageal tissue).
have increased esophageal mucosa impedance (food getting into the esophageal tissue).
In patients with gastroesophageal reflux disease (GERD) but without gross evidence of
esophageal injury, confirmation of acid reflux is typically performed through testing that
measures reflux at or proximal to 5 cm above the gastroesophageal junction. These tests such
as pH/impedance monitoring and Bravo probe placement in the esophagus have been the gold
standard for diagnosing and quantitating the degree of gastroesophageal reflux. This stands
in contrast to the concept that the esophagus distal to 5 cm is first and foremost exposed to
gastroesophageal reflux and that most injury in the form of erosive esophagitis is seen in
the 4cm segment below where this instruments measure reflux. As a result, this type of
testing may not allow for full understanding of the pathophysiology of GERD. Furthermore,
with refluxed acid exposure limited to the distal esophagus in some patients, use of
conventional pH testing could lead to inaccurate diagnosing of GERD.
Esophageal impedance testing measures epithelial integrity as reflected through the ability
of the mucosa to conduct electric current. As dilation of intercellular spaces in biopsies
from patients with GERD is considered the earliest indication of esophageal injury in
response to reflux in the absence of gross endoscopic injury, the measure of increased
current conduction through these dilated spaces has been shown to be an accurate means of
diagnosing patients with non-erosive reflux disease. To this point, most esophageal impedance
has been measured using impedance ports placed at locations similar to the pH probes in a
combined intra-esophageal ambulatory catheter. As a result, the most distal point of
impedance measurement is also 5 cm above the gastroesophageal junction. Recently, a site
specific endoscopically placed impedance probe has been developed that can measure esophageal
mucosal impedance at any point of the esophagus.
In this study the Principal Investigator would like to look at patients with and without
reflux symptoms measuring impedance at 1,2,3,4 and 5 cm at the 6 o'clock position above the
Gastroesophageal Junction.
esophageal injury, confirmation of acid reflux is typically performed through testing that
measures reflux at or proximal to 5 cm above the gastroesophageal junction. These tests such
as pH/impedance monitoring and Bravo probe placement in the esophagus have been the gold
standard for diagnosing and quantitating the degree of gastroesophageal reflux. This stands
in contrast to the concept that the esophagus distal to 5 cm is first and foremost exposed to
gastroesophageal reflux and that most injury in the form of erosive esophagitis is seen in
the 4cm segment below where this instruments measure reflux. As a result, this type of
testing may not allow for full understanding of the pathophysiology of GERD. Furthermore,
with refluxed acid exposure limited to the distal esophagus in some patients, use of
conventional pH testing could lead to inaccurate diagnosing of GERD.
Esophageal impedance testing measures epithelial integrity as reflected through the ability
of the mucosa to conduct electric current. As dilation of intercellular spaces in biopsies
from patients with GERD is considered the earliest indication of esophageal injury in
response to reflux in the absence of gross endoscopic injury, the measure of increased
current conduction through these dilated spaces has been shown to be an accurate means of
diagnosing patients with non-erosive reflux disease. To this point, most esophageal impedance
has been measured using impedance ports placed at locations similar to the pH probes in a
combined intra-esophageal ambulatory catheter. As a result, the most distal point of
impedance measurement is also 5 cm above the gastroesophageal junction. Recently, a site
specific endoscopically placed impedance probe has been developed that can measure esophageal
mucosal impedance at any point of the esophagus.
In this study the Principal Investigator would like to look at patients with and without
reflux symptoms measuring impedance at 1,2,3,4 and 5 cm at the 6 o'clock position above the
Gastroesophageal Junction.
Inclusion Criteria:
- Adults ages 18-90
- Patients with heartburn and no hiatal hernia undergoing clinically indicated endoscopy
- Patients with heartburn and a hiatal hernia > 3cm undergoing clinically indicated
endoscopy
- Patients undergoing clinically indicated upper endoscopy for indications other than
dysphagia or GERD
- Patients with reflux symptoms, a normal appearing esophagus on clinically indicated
endoscopy undergoing clinically indicated ambulatory pH/impedance testing.
Exclusion Criteria:
- Previous gastric or esophageal surgery.
- Use of proton pump inhibitors 1 month prior to the study
- Patients on anticoagulation other than aspirin or clopidogrel
- Presence of erosive esophagitis or Barrett's esophagus
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