Results: A total of 75 patients was enrolled 39 (52%) of them were women. Predictors of treatment response were analyzed using logistic regression multivariate analysis. Treatment was considered fail if GerdQ score was >8 after PPI therapy. Then patients were given oral PPI treatment, twice a day, for 2 weeks. All patients underwent MII-pH evaluation consisting of physical characteristics of the refluxate (liquid, gas or mixed) type of refluxate (acid or non-acid) percent acid exposure time, and symptom-associated probability. Upper endoscopy was done to distinguish erosive and non-erosive reflux disease. Diagnosis of GERD was established using GERD questionnaires. Patients were enrolled in Cipto Mangunkusumo Hospital between 20. Method: This was a prospective study using before-and-after treatment design. The use of MII-pH to predict initial treatment response with PPI has not been evaluated in Indonesia. Initial assessment using combined Multichannel Intraluminal Impedance and pH Monitoring (MII-pH) predicts empirical treatment response with Proton-Pump Inhibitor (PPI) in patients with Gastroesophageal Reflux Disease (GERD)ĭepartment of Internal Medicine, Medical Faculty Universitas of Indonesia, Jakarta, Indonesiaīackground: Combined MII-pH has been recently introduced to characterize patients with (GERD).
This has the potential to alter diagnosis in difficult cases and affect management by intensifying acid suppression therapy. Extended Bravo studies managed to procure a diagnosis of GORD in more than half of the cases with an initial normal MII-pH but persistent symptoms. Inclusion of cases with positive symptom reflux association for Bravo cohort also showed additional diagnostic yield ranging from 42.9 to 47.7% ( p ≤ 0.031) across all subgroups. Bravo with AET cut-off >4.2% captured an additional 59.1% of cases with increased AET ( p 4.4% and >5.3%. Our study group (male = 14 and female = 30) successfully completed Bravo studies beyond 48 hours in 97.7%. Statistical analysis was performed using SPSS v20. Subgroups (B) and (C) have normal number of acid reflux events.
Subgroup analyses were subsequently made on cohorts whose MII-pH showed normal AET with (A) normal number of total reflux episodes, (B) normal number of non-acid reflux (NAR) events and (C) increased number of NAR events. Reference values for MII-pH and Bravo equivalent were adopted from internationally established studies. Cases with an abnormal acid exposure time (AET) were used as primary end-point based on ‘worst day analysis’. Bravo studies were performed off PPI over an extended period beyond 48 hrs (up to 96 hrs). A total of 44 patients with GORD symptoms but normal MII-pH studies off proton pump inhibitor (PPI) were referred for Bravo capsule studies. This study aims to assess the additional diagnostic yield of extended Bravo recordings (up to 96 hours) in patients with normal 24 hr MII-pH results. Wireless pH capsule (Bravo) can potentially increase the diagnostic yield of standard 24 hr catheter-based studies with prolonged monitoring. Extended Bravo studies (>48 hrs) offer an additional diagnostic yield of gastro-oesophageal reflux disease (GORD) in patients with normal multichannel intraluminal impedance-pH (MII-pH) studiesĬhristopher Tze Wei Chia 1, Ismail Miah 2, Jafar Jafari 2, Ikram Nasr 2, Ioannis Koumoutsos 2 and Terence Wong 2ġ Gastroenterology, Tan Tock Seng Hospital, Singapore 2 Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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