| 1. |
- Falkenback, Dan, et al.
(författare)
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Is the course of gastroesophageal reflux disease progressive? A 21-year follow-up.
- 2009
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44:11, s. 1277-1287
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE. We re-evaluated a cohort of patients referred for reflux symptoms and objectively diagnosed with pathological reflux, with the purpose of clarifying the course of conservatively treated gastroesophageal reflux disease (GERD). MATERIAL AND METHODS. All consecutive patients with GERD diagnosed between 1984 and 1988 showing pathologic 24-h pH-metry in the interval 3.8-10% and without any previous surgery in the gastroesophageal tract were assessed for further follow-up. A total of 40 evaluable patients were followed in the years 2007-08 with endoscopy, manometry, 24-h pH-metry, Helicobacter pylori assessment and the self-administered questionnaires the GERD Impact Scale, the Reflux Disease Questionnaire, the Quality of Life in Reflux and Dyspepsia and the Medical Outcome Study Short Form-36 Health Survey. Baseline data from the 1980s were retrieved and compared with the evaluations conducted at follow-up. RESULTS. At follow-up 20.7 years (range 18.8-23.5 years) after referral, the study population showed more use of acid suppressants (p = 0.007) and increasing prevalences of esophagitis (p = 0.001) and Barrett's esophagus (p = 0.002). Esophagitis was seen in 16/40 patients (40%) at baseline and in 29/40 (72.5%) at follow-up. No significant deterioration was seen at follow-up in manometry data and in most pH data. Patients with esophagitis (ERD) were less likely to have a positive H. pylori test (hazard ratio 0.054; p = 0.002) than non-erosive (NERD) patients. Symptom evaluations showed significantly lower quality of life in the ERD group. CONCLUSIONS. After 20 years a considerable part of the cohort still experienced symptoms of reflux and showed endoscopic progression, although no significant deteriorations were seen in manometry data and in most pH-metry data. H. pylori infection was inversely associated with erosive esophagitis and this supports the hypothesis that H. pylori colonization is a protective factor against GERD.
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| 2. |
- Wenner, Jörgen, et al.
(författare)
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Acid Reflux Immediately Above the Squamocolumnar Junction and in the Distal Esophagus: Simultaneous pH Monitoring Using the Wireless Capsule pH System.
- 2006
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 101:8, s. 1734-1741
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The pattern of reflux in the most distal esophagus of asymptomatic individuals is largely unknown. Using a wireless technique we compared the degree and the pattern of acid reflux just above the squamocolumnar junction (SCJ) with that measured at the conventional level for pH monitoring. METHODS: Fifty-three asymptomatic volunteers underwent endoscopy with transoral placement of two pH recording capsules, one immediately above and one 6 cm above the SCJ. Ambulatory pH monitoring was performed during 48 h. RESULTS: Three subjects were excluded as the distal capsule was inadvertently placed with the pH electrode below the SCJ. The median percent time with pH < 4 and the median number of reflux episodes were significantly higher immediately above the SCJ compared with that found more proximally (16% vs 0.9% and 67 vs 26, p < 0.0001). Of all acid reflux events, 69% were isolated episodes immediately above the SCJ. Only 26% of reflux episodes detected at the SCJ extended to the more proximal pH electrode. Reflux events occurring just above the SCJ were more acidic. The number of reflux events with a minimum pH below 2 or 3 was significantly higher at the SCJ compared with that recorded by the upper capsule (1.6% and 44% vs 6% and 34%, p < 0.0001). CONCLUSIONS: Conventional pH monitoring substantially underestimates the degree of acid exposure in the most distal esophagus. In healthy subjects, acid exposure immediately above the SCJ was considerably higher and was characterized by shorter reflux episodes that had a lower minimum pH compared with that measured at the traditional level for pH monitoring.
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| 3. |
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| 4. |
- Wenner, Jörgen, et al.
(författare)
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Optimal Thresholds and Discriminatory Power of 48-h Wireless Esophageal pH Monitoring in the Diagnosisof GERD.
- 2007
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 102:9, s. 1862-1869
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The discriminative power of 48-h wireless esophageal pH monitoring in the diagnosis of gastroesophageal reflux disease has not been clearly demonstrated, and the cutoff level for esophageal acid exposure generating the optimal sensitivity and specificity is unknown. SUBJECTS AND Patients with typical reflux symptoms and a distinct response to acid suppressive medication METHODS: underwent upper GI endoscopy followed by 48-h wireless esophageal pH studies with the pH electrode placed 6 cm above the squamocolumnar junction. The results were compared to those obtained in 55 healthy controls. Sensitivity, specificity, and thresholds for esophageal acid exposure were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The patient population consisted of 64 patients, 25 women and 39 men, with a median age of 48 yr. Analysis of the area under the ROC curve showed that, for all patients as well as for subgroups of patients with (N = 33) and without (N = 31) esophagitis, the total percent time with pH < 4 for the 48-h study period was the best parameter to discriminate patients from controls. Analysis of acid exposure for day 1, day 2, or using the day with the highest acid exposure did not improve the diagnostic accuracy. A test specificity in the range of 90-95% resulted in a cutoff level of 3.6-4.4% of the total time with pH < 4 for the 48-h period. This threshold generated a test sensitivity of 59-64% in all patients, 76-79% for patients with esophagitis and 42-48% in patients with no esophagitis. CONCLUSIONS: The total percentage of time that esophageal pH was less than 4 for the entire 48-h study period was the parameter that best discriminated patients with typical reflux symptoms from healthy controls, and to achieve a specificity of 90-95% a cutoff level of 4% is recommended. The low sensitivity of wireless pH recording in patients without erosive esophagitis substantially reduces the clinical value of the test.
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| 5. |
- Wenner, Jörgen, et al.
(författare)
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Wireless Esophageal pH Monitoring Is Better Tolerated than the Catheter-Based Technique: Results from a Randomized Cross-Over Trial.
- 2007
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 102:2, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Esophageal pH monitoring using a wireless pH capsule has been suggested to generate less adverse symptoms resulting in improved patient acceptance compared with the catheter-based method although evidence to support this assumption is lacking. The aim of this study was to evaluate and compare the subjective experience of patients undergoing both techniques for esophageal pH monitoring. METHODS: Using a randomized study design, patients referred for esophageal pH testing underwent both wireless and traditional catheter-based 24-h pH recording with a 7-day interval. The wireless pH capsule was placed during endoscopy and followed by 48-h pH recording. All patients answered a questionnaire, including a 10-cm visual analog scale (VAS), which described the perceived severity of symptoms and the degree of interference with normal daily activities during the pH tests. RESULTS: Thirty-one patients, 16 women and 15 men, were included in the analysis. The severity of all adverse symptoms associated with the wireless technique was significantly lower compared with the catheter-based technique (median VAS 2.1 vs 5.1, P < 0.001). Wireless pH recording was associated with less interference with off-work activities and normal daily life, median VAS 0.6 and 0.7 compared with 5.0 and 5.7, respectively, for the catheter-based technique (P < 0.001). Patients actively working during both tests reported less interference with normal work during the capsule-based test than during the catheter-based pH test (median VAS 0.3 vs 6.8, P = 0.005). Twenty-seven patients (87%) stated that, if they had to undergo esophageal pH monitoring again, they preferred the wireless test over the catheter-based pH test (P < 0.0001). CONCLUSIONS: This randomized study showed that a significant majority of patients undergoing esophageal pH monitoring preferred the wireless pH capsule over the traditional catheter-based technique because of less adverse symptoms and less interference with normal daily life.
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| 6. |
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| 7. |
- Wenner, Jörgen, et al.
(författare)
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Wireless pH Recording Immediately Above the Squamocolumnar Junction Improves the Diagnostic Performance of Esophageal pH Studies.
- 2008
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 103, s. 2977-2985
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: The optimal position for pH electrode placement in the diagnosis of gastroesophageal reflux disease (GERD) is unknown. The aim of this study was to evaluate the discriminatory power of targeted pH recording immediately above the squamocolumnar junction (SCJ) and to compare the results with those obtained by simultaneous recording at the conventional level for pH monitoring. SUBJECTS AND METHODS: Sixty-two patients with typical reflux symptoms and 49 asymptomatic volunteers underwent 48-h simultaneous wireless pH monitoring with two endoscopically placed pH recording capsules, one immediately above the SCJ and one at the traditional position, 6 cm above the SCJ. The diagnostic accuracy, sensitivity, and specificity of pH monitoring at the two levels were analyzed using receiver operating characteristics (ROC) curves. RESULTS: Of the 62 patients (39 men and 23 women, median age 48 yrs), 32 patients had erosive esophagitis and 30 had no endoscopic evidence of mucosal injury. Analysis of the area under the ROC curve (AUC) indicated that the total percent time with pH<4 for the entire 48-h period was the parameter that best distinguished GERD patients from controls. pH monitoring performed directly above the SCJ significantly increased the number of patients correctly classified with GERD compared to standard electrode placement. With a predefined test specificity of 90%, pH monitoring immediately above the SCJ increased the sensitivity of the test from 63% to 86% in all patients, from 78% to 97% in patients with esophagitis and from 47% to 73% in patients with no esophagitis. CONCLUSIONS: Compared to standard electrode placement, wireless pH recording immediately above the SCJ improved the diagnostic performance of esophageal pH monitoring in patients with GERD.
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