TY - JOUR
T1 - Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group
AU - Roman, S.
AU - Gyawali, C. P.
AU - Savarino, E.
AU - Yadlapati, R.
AU - Zerbib, F.
AU - Wu, J.
AU - Vela, M.
AU - Tutuian, R.
AU - Tatum, R.
AU - Sifrim, D.
AU - Keller, J.
AU - Fox, M.
AU - Pandolfino, J. E.
AU - Bredenoord, A. J.
AU - AUTHOR GROUP
AU - Azpiroz, Fernando
AU - Babaei, Arash
AU - Bhatia, Shobna
AU - Boeckxstaens, Guy
AU - Bor, Serhat
AU - Carlson, Dustin
AU - Castell, Donald
AU - Cicala, Michele
AU - Clarke, John
AU - de Bortoli, Nicola
AU - Drug, Vasile
AU - Frazzoni, Marzio
AU - Holloway, Richard
AU - Kahrilas, Peter
AU - Kandulski, Arne
AU - Katz, Phil
AU - Katzka, David
AU - Mittal, Ravinder
AU - Mion, Francois
AU - Novais, Luis
AU - Patel, Amit
AU - Penagini, Roberto
AU - Ribolsi, Mentore
AU - Richter, Joel
AU - Salvador, Renato
AU - Savarino, Vincenzo
AU - Serra, Jordi
AU - Schnoll-Sussman, Felice
AU - Smout, Andre
AU - Soffer, Edy
AU - Sweis, Rami
AU - Tack, Jan
AU - Tolone, Salvatore
AU - Vaezi, Michael
AU - Woodland, Philip
AU - Xiao, Yinglian
PY - 2017
Y1 - 2017
N2 - Background: An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). Methods: Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. Key Results: Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa > 1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) > 50% or symptom association probability (SAP) > 95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. Conclusions and Inferences: The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa > 1 cm, and esophageal acid exposure greater > 6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled
AB - Background: An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). Methods: Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. Key Results: Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa > 1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) > 50% or symptom association probability (SAP) > 95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. Conclusions and Inferences: The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa > 1 cm, and esophageal acid exposure greater > 6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled
U2 - https://doi.org/10.1111/nmo.13067
DO - https://doi.org/10.1111/nmo.13067
M3 - Review article
C2 - 28370768
SN - 1350-1925
VL - 29
SP - e13067
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 10
ER -