title: Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring.
abstract: OBJECTIVE
  Respiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance-pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes.
  
  
  METHODS
  We undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations.
  
  
  RESULTS
  Of the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the Stretta procedure (0 vs. 19.4%, p = 0.006).
  
  
  CONCLUSIONS
  MII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms.
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.|Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China.
authors.forename: Jimin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Yan
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
authors.forename: Weitao
authors.initials: W
authors.lastname: Liang
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
authors.forename: Diangang
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.|Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China.
authors.forename: Zhonggao
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017097:Electric Impedance; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery