Esophageal impedance baseline according to different time intervals

European Journal of Medical Research

Yvan Vandenplas¹  Annamaria Staiano³  Bruno Hauser¹  Silvia Salvatore²  Dario Ummarino³ 

[1] Department of Pediatrics, Universitair KinderZiekenhuis Brussel, Vrije Unversiteit Brussel, Laarbeeklaan, 101, Brussels, 1090, Belgium;Clinica Pediatrica, Università dell’Insubria, Varese, Italy;University of Naples Federico II, Naples, Italy

关键词: 24 h tracing;    Time intervals;    pH monitoring;    Multichannel intraluminal impedance;    Esophageal impedance baseline;   

Others  :  820265
DOI  :  10.1186/2047-783X-17-18

 received in 2012-02-06, accepted in 2012-06-04,  发布年份 2012

【 摘 要 】

Background

The impedance baseline has been shown to reflect esophageal integrity, and to be decreased in patients with esophagitis. However, different methods for the determination of the impedance baseline have not been compared.

Methods

The median impedance baseline was calculated in 10 consecutive multichannel intraluminal impedance recordings in children with non-erosive reflux disease. All children underwent an endoscopy with a biopsy as part of the clinical work-up to exclude esophagitis. The impedance baseline was obtained both by including and excluding all impedance episodes (IE; reflux, swallows and gas episodes) during the full recording, and during the first 1-minute period without an IE every hour (method 1), every 2 hours (method 2) or every 4 hours (method 3). The impedance baseline obtained during the full recording was set at 100%, and the variation (difference in impedance baseline for the different methods) and variability (difference in impedance baseline during one analysis period) were assessed.

Results

None of the participants had esophagitis. The mean difference over the six channels between the impedance baseline over the total recording with and without IE was approximately 2.5%, and comparable for each channel (range 0.47% to 5.55%). A mean of 1,028 IEs were excluded in each tracing, and it took between 4 and 24 hours to delete all events in one tracing. The difference in the impedance baseline obtained with and without IEs was mainly caused by the gas episodes in the upper channels and swallows in the lower channels. The median impedance baseline according to the three one-minute analysis methods was comparable to the median impedance baseline according to the 24 hour analysis.

Conclusions

The automatic determination of the median impedance baseline over the total tracing including IEs is an adequate method. In isolated tracings with numerous IEs, the calculation of the median impedance baseline over one minute every 4 hours is an alternative option. Companies should develop software to calculate the median impedance baseline during the whole registration deleting all IEs for the analysis.

【 授权许可】

   
2012 Ummarino et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Van Wijk MP, Benninga MA, Omari TI: Role of the multichannel intraluminal impedance technique in infants and children. J Pediatr Gastroenterol Nutr 2009, 48:2-12.
• [2]Omari TI, Rommel N, Szczesniak MN, Fuentealba S, Dinning PG, Davidson GP, Cook IJ: Assessment of intraluminal impedance for the detection of pharyngeal bolus flow during swallowing in healthy adults. Am J Physiol Gastrointest Liver Physiol 2006, 290:G183-G188.
• [3]Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG: North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition: Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009, 49:498-547.
• [4]Castell DO, Mainie I, Tutuian R: Non-acid gastroesophageal reflux: documenting its relationship to symptoms using multichannel intraluminal impedance (MII). Trans Am Clin Climatol Assoc 2005, 116:321-333.
• [5]Farre´ R, Blondeau K, Clement D, Vicario M, Cardozo L, Vieth M, Mertens V, Pauwels A, Silny J, Jimenez M, Tack J, Sifrim D: Evaluation of esophageal mucosa integrity by the intraluminal impedance technique. Gut 2011, 60:885-892.
• [6]Silny J: Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. Neurogastroenterol Motil 1991, 3:151-162.
• [7]Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJM, Loots CM, Smout AJPM: Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 2011, 106:2093-2097.
• [8]Wasko-Czopnik D, Blonski W, Paradowski L: Diagnostic difficulties during combined multichannel intraluminal impedance and pH monitoring in patients with esophagitis or Barrett’s esophagus. Adv Med Sci 2007, 52:196-198.
• [9]López-Alonso M, Moya MJ, Cabo JA, Ribas J, del Carmen Macías M, Silny J, Sifrim D: Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics 2006, 118:e299-e308.
• [10]Nguyen HN, Domingues GR, Winograd R, Lammert F, Silny J, Matern S: Impedance characteristics of esophageal motor function in achalasia. Dis Esophagus 2004, 17:44-50.
• [11]Loots MC, van Wijk MP, Smits JM, Wenzl TG, Benninga MA, Omari TI: Measurement of mucosal conductivity using multichannel intraluminal impedance; a potential marker of mucosal integrity that is restored in infants receiving acid suppression therapy. J Pediatr Gastroenterol Nutr 2011, 53:120-123.