Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease

Nunzio Ranaldo, Giuseppe Losurdo, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Massimo De Carne, Enzo Ierardi, Alfredo Di Leo

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Abstract

A relevant percentage of non-erosive reflux disease (NERD) is refractory to proton pump inhibitors (PPIs) treatment. Multichannel intraluminal impedance pH (MII-pH) monitoring should give useful pathophysiological information about refractoriness. Therefore, our aim was to assess whether this technique could be useful to guide a 'tailored' therapy in refractory NERD. We retrospectively recruited NERD patients undergoing MII-pH monitoring for unsuccessful treatment. All patients had undergone upper endoscopy, and those with erosive esophagitis were excluded. No patient received PPI during MII-pH monitoring. Subjects were subgrouped into three categories: acid reflux, non-acid reflux and functional heartburn. MII-pH-guided therapy was performed for 4 weeks as follows: patients with acid reflux received PPI at double dose, patients with non-acid reflux PPI at full dose plus alginate four times a day and patients with functional heartburn levosulpiride 75 mg per day. A visual analog scale (VAS) ranging from 0 to 100 mm was administered before and after such tailored therapy to evaluate overall symptoms. Responders were defined by VAS improvement of at least 40%. Sixty-nine patients with refractory NERD were selected (female-male ratio 43 : 26, mean age 47.6±15.2 years). Overall effectiveness of tailored therapy was 84% without statistical difference among subgroups (88.5% acid reflux, 92% non-acid reflux, 66.6% functional heartburn; P=0.06). Univariate analysis showed that therapy failure directly correlated with functional heartburn diagnosis (OR=4.60) and suggested a trend toward a negative correlation with smoking and a positive one with nausea. However, at multivariate analysis, these parameters were not significant. Functional heartburn experienced a lower median percent VAS reduction than acid reflux (52.5% versus 66.6%, P<0.01) even if equal to non-acid reflux (66.6%). In conclusion, a tailored approach to refractory NERD, guided by MII-pH monitoring, demonstrated to be effective and should be promising to cure symptom persistence after conventional therapy failure. Nevertheless, standardized guidelines are advisable.

Original languageEnglish
Pages (from-to)e3040
Number of pages7
JournalCell Death and Disease
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 7 2017

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Electric Impedance
Heartburn
Proton Pump Inhibitors
Visual Analog Scale
Acids
Therapeutics
Esophagitis
Nausea
Endoscopy
Multivariate Analysis
Smoking
Guidelines

Keywords

  • Journal Article

Cite this

Ranaldo, N., Losurdo, G., Iannone, A., Principi, M., Barone, M., De Carne, M., ... Di Leo, A. (2017). Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease. Cell Death and Disease, 8(9), e3040. https://doi.org/10.1038/cddis.2017.436

Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease. / Ranaldo, Nunzio; Losurdo, Giuseppe; Iannone, Andrea; Principi, Mariabeatrice; Barone, Michele; De Carne, Massimo; Ierardi, Enzo; Di Leo, Alfredo.

In: Cell Death and Disease, Vol. 8, No. 9, 07.09.2017, p. e3040.

Research output: Contribution to journalArticle

Ranaldo, N, Losurdo, G, Iannone, A, Principi, M, Barone, M, De Carne, M, Ierardi, E & Di Leo, A 2017, 'Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease', Cell Death and Disease, vol. 8, no. 9, pp. e3040. https://doi.org/10.1038/cddis.2017.436
Ranaldo, Nunzio ; Losurdo, Giuseppe ; Iannone, Andrea ; Principi, Mariabeatrice ; Barone, Michele ; De Carne, Massimo ; Ierardi, Enzo ; Di Leo, Alfredo. / Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease. In: Cell Death and Disease. 2017 ; Vol. 8, No. 9. pp. e3040.
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