Prospective assessment of patient selection for antireflux surgery by combined multichannel intraluminal impedance pH monitoring.
BACKGROUND
Selecting gastroesophageal reflux disease (GERD) patients for surgery on the basis of standard 24-h pH monitoring may be challenging, particularly if this investigation does not correlate with clinical symptoms. Combined multichannel intraluminal impedance pH monitoring (MII-pH) is able to physically detect each episode of intraesophageal bolus movements, enabling identification of either acid or non-acid reflux episodes and thus establish the association of the reflux with symptoms.


METHODS
We prospectively assessed and reviewed data from 314 consecutive patients who underwent MII-pH for GERD not responsive or not compliant to proton pump inhibitor therapy. One hundred fifty-three patients with a minimum follow-up of 1 year constituted the study population. Clinical outcomes and satisfaction rate were collected in all patients who underwent laparoscopic Nissen-Rossetti fundoplication. Outcomes were reported for patients with normal and ineffective peristalsis and for patients with positive pH monitoring, negative pH monitoring and positive total number of reflux episodes at MII, and negative pH monitoring and normal number of reflux episodes at MII and a positive symptom index correlation with MII.


RESULTS
The overall patient satisfaction rate was 98.3%. No differences were recorded in the clinical outcomes of the patients with preoperative normal and ineffective peristalsis. No differences in patients' satisfaction and clinical postoperative DeMeester symptom scoring system were noted between the groups as determined by MII-pH.


CONCLUSIONS
MII-pH provides useful information for objective selection of patients to antireflux surgery. Nissen fundoplication provides excellent outcomes in patients with positive and negative pH and positive MII monitoring or Symptom Index association. More extensive studies are needed to definitively standardize the useful MII-pH parameters to select the patient to antireflux surgery.
del Genio
Gianmattia
G
Foregut and Obesity Pathophysiology Study Center, First Division of General and Gastrointestinal Surgery, Department of Surgery, University of Naples II, Via Strettola a Chiaia, 7, 80122, Naples, Italy. gdg@doctor.com
Tolone
Salvatore
S
del Genio
Federica
F
Aggarwal
Rajesh
R
d'Alessandro
Antonio
A
Allaria
Alfredo
A
Rossetti
Gianluca
G
Brusciano
Luigi
L
del Genio
Alberto
A
D000328:Adult; D000704:Analysis of Variance; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome