Document Detail


Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease--Bilitec, intraluminal impedance and Bravo capsule pH monitoring.
MedLine Citation:
PMID:  16483266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ambulatory pH monitoring detects abnormal levels of acid reflux in the oesophagus and can be used to correlate patients' symptoms with oesophageal acid exposure. Catheter-based pH testing has several limitations, including issues of sensitivity, specificity, tolerability and the inability to record non-acid reflux events. In an effort to improve upon these drawbacks, several devices have been introduced, including the Bilitec system for measuring duodenogastro-oesophageal reflux; intraluminal impedance monitoring, which detects the distribution, composition and clearing of both acid and non-acid oesophageal reflux; and a wireless pH monitoring device, the Bravo capsule. Initial investigations using the Bilitec system demonstrated that duodenogastro-oesophageal reflux tracked very closely with acid reflux and decreased with proton-pump inhibitor (PPI) therapy, casting doubt on the clinical utility of Bilitec monitoring. Recent evidence revealed a possible role for duodenogastro-oesophageal reflux in a subset of patients who continue to report reflux symptoms in the setting of normalized oesophageal acid exposure on high-dose PPI therapy. When combined with pH monitoring, impedance monitoring enhances the detection and characterization of gastro-oesophageal reflux and may have a role in the evaluation of certain specific gastro-oesophageal reflux disease (GERD) symptoms that persist despite acid suppression therapy. The utility of the Bravo wireless technology for GERD diagnosis has been validated in several studies, with improvements over catheter-based pH monitoring in tolerability, accuracy and sensitivity, as well as the ability to record periods both off and on PPI therapy in a single study. All three diagnostic modalities have advanced the understanding of GERD pathogenesis, but their impact on the clinical management of GERD is still the focus of active investigation.
Authors:
I Hirano
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  23 Suppl 1     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-17     Completed Date:  2006-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  12-24     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2951, USA. i-hirano@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care / methods
Bilirubin / analysis
Duodenogastric Reflux / diagnosis,  physiopathology
Electric Impedance / diagnostic use
Equipment Design
Esophagitis, Peptic / diagnosis,  drug therapy,  physiopathology
Gastroesophageal Reflux / diagnosis*,  drug therapy,  physiopathology
Humans
Hydrogen-Ion Concentration
Monitoring, Physiologic / instrumentation*,  methods
Proton Pumps / antagonists & inhibitors
Sensitivity and Specificity
Time Factors
Chemical
Reg. No./Substance:
0/Proton Pumps; 635-65-4/Bilirubin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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