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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
patients, while pH impedance was performed only in patients with
normal values.
Results:
In 120 patients we have been identified pathological acid
refluxes already in the first day, so pH monitoring was suspended
and the patients were excluded from the study; in the remaining
180 patients the pH monitoring was prolonged for further 2-3 days
(total of 72/96 h) identifying 144 patients with pathological acid
refluxes (96 patients positive only in a day, 48 patients in all days of
registration) and 36 patients with normal values. PH-impedance was
performed only in the latter patients with evidence of 22 patients
with alkaline reflux, 13 patients with weakly acidic or alkaline
refluxs and 1 negative for any kind of reflux.
Conclusions:
Patients with NERD are markedly heterogeneous so
becomes important clearly distinguish these patients, taking into
account the physiological pH fluctuations during the same day and
“day by day”. This is possible by the pH monitoring Bravo system
(highly tolerable and able to monitor pH for prolonged time, in
respect of normal physiology) which is also able to evaluate the
response to antisecretory therapy.
pH-impedance is able to detect any type of chemical reflux and
allow to distinguish different types of patients suffering from NERD
but not respect normal physiology and not allow a prolonged pH
monitoring (not considering “day by day” pH fluctuations). Our
data show that most of examined patients (88%), do not need to
run a pH-impedance. To correctly classify patients with NERD and
to optimizing the available resources we find useful to use first pH
monitoring BRAVO system, subjecting only negative patients to pH-
impedance.
OC.05.4
YIELD OF PROLONGED WIRELESS PH MONITORING IN 24
TREATED ACHALASIA PATIENTS: RETROSPECTIVE ANALYSIS
Mauro A.*, Franchina M., Elvevi A., Tenca A., Conte D., Penagini R.
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano,
Università degli Studi di Milano, Milano, Italy
Background and aim:
Gastro-oesophageal reflux disease (GORD) is a
long-termcomplication of achalasia treatments. 24 hr pHmonitoring
is often used to detect GORD in these patients. Sensitivity of the test
could be influenced by day to day variability of oesophageal acid
exposure time (AET) and by low incidence/absence of symptoms.
Aim of our study was to evaluate the yield of prolonged wireless pH
monitoring in patients with achalasia successfully treated.
Material and methods:
24 patients with achalasia (10 M; 50 years;
34-75) who underwent prolonged wireless pH monitoring after a
successful treatment with single or multiple pneumatic dilation or
with Heller myothomy (22 and 2 respectively) were reviewed from
our cohort of patient and included in the study. pH variables were
analysed in the first 24 hrs of monitoring to determine if tracings
were indicative of GORD (AET>4.7% and/or positive SI/SAP for
symptoms, i.e. heartburn, chest pain and regurgitation); the same
variables were analysed in the following 24 hrs periods in order
to obtain a worst-day diagnosis of GORD. Furthermore SI and SAP
were measured on the whole period. Endoscopic findings during pH
wireless capsule positioning were acquired; basal tone of the lower
oesophageal sphincter was obtained during oesophageal manometry
performed before the endoscopy. PPI therapy was evaluated before
and after the test, and at the follow up time.
Results:
All patients had at least 48 hrs of monitoring; in nine
patients pH monitoring lasted 96 hrs. Descriptive data are shown in
the table. Three out of 24 patients had GORD diagnosis during the
first day of monitoring; all of them had oesophagitis at endoscopy.
During the following days of monitoring four more patients had a
worst-day diagnosis of GORD (two with oesophagitis). Patients
reporting symptoms during the test (8/24) had negative SI and
SAP both during each 24 hrs and the whole period. In 3/17 patients
without oesophigitis (normal AET and negative SI and SAP for
heartburn) prescription of PPIs was stopped without detrimental
effect on symptoms, whereas in three asymptomatic patients with
both oesophagitis and pathological wireless pH monitoring PPIs
were started after the test and continued until the last follow up.
Table
Data from 24 treated achalasia patients divided according to worst day GORD
diagnosis at prolonged wireless pH monitoring. Median; IQR
GORD positive (7) GORD negative (17) p value
Age
41; 35-46
58; 40-67
0.10
Patients with oesophagitis
5
1
0.0007
n° of pneumatic dilation
2; 1-2
2; 1-2
0.88
before pH monitoring
Interval between treatment
15; 12-16
15; 13-27
0.56
and pH monitoring (mos)
Basal LOS pressure (mmHg)
6; 3-11
4; 3-6
0.32
Follow up time after pH
22; 6-36
43; 29-55
0.08
monitoring (mos)
LOS, lower oesophageal sphincter.
Conclusions:
In achalasia patients after successful treatment GORD
like symptoms may not be due to reflux. Prolonged wireless pH
monitoring is a useful test together with endoscopy for evaluation
of GORD and effective management of these patients.
OC.05.5
ROLE OF HIGH RESOLUTION MANOMETRY FINDINGS AND OF
GASTRO-ESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH NON
OBSTRUCTIVE DYSPHAGIA
Ribolsi M.*, Biasutto D., Balestrieri P., Cicala M.
Campus Bio Medico, Roma, Italy
Background and aim:
Background: Non-obstructive dysphagia
(NOD) is a real challenge in the clinical management. Esophageal
high resolution manometry (HRM) is a novel method, used to
analyze patients with NOD. The role of gastro-esophageal reflux
disease (GERD) in eliciting NOD is not yet fully elucidated. Moreover,
it is still not clear how findings on HRM relate to bolus transport
through the esophagus.
Aim:
To assess the role of HRM findings and of the presence of GERD
in NOD pathogenesis and perception.
Material and methods:
47 consecutive patients with dysphagia
underwent HRM followed by 24h impedance-pH monitoring (MII-
pH). All patients performed upper endoscopy within 3 months
before the study. Patients were analyzed in the semi-recumbent
position, with a catheter incorporating 36 solid state pressure
sensors, located at 1 cm intervals, and 9 impedance measuring
segments (MMS, Enschede, The Netherlands). A total of 10 saline
(5 ml) swallows, at 30-sec intervals were analyzed in each subject.
High resolution manometry tracings were analyzed according to the
Chicago classification v3.0. Acid exposure time (AET) and/or SAP at
MII-pH were considered for GERD diagnosis. Data were compared
with those obtained from 44 typical symptoms GERD patients,
without dysphagia (Group 2).
Results:
Seven patients presenting evidence of esophageal spasm
and 3 of achalasia, and were therefore excluded from the study. The
remaining 37 NOD patients were considered for the data analysis
(Group 1). Mean (±SD) values of IRP, CFV and DCI did not differ
between Group 1 and 2 patients (Table). Seventeen out of the 37
patients (46%) belonging to Group 1 presented positive AET and
19/44 (43%) Group 2 patients presented positive AET/SAP (p< 0.05).
Conclusions:
In NOD patients, in the absence of esophageal motor
abnormalities, high resolution manometry findings are comparable