Chandra, A.; Anggiansah, R.; Anggiansah, A.; Owen, W.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA44
Academic Journal
Introduction: Manometry can detect peristalsis while pH sensors can show acid clearance. Flow and volume clearance can be detected by changes in impedance pairs of electrodes. This ambulatory study uses pressure and impedance to determine on a temporal basis the motility patterns during a reflux event, in order to investigate the role of peristalsis in acid and volume clearance. Subjects and Methods: Recordings from 3 control and 13 patients (symptoms of gastro-oesophageal reflux) were analysed. All underwent 24-hour ambulatory oesophageal study. The combined catheter consisted of 4 pressure transducers at 5, 10, 15, and 28 cm proximal to the manometrically defined lower oesophageal sphincter (LOS). Two impedance electrode pairs were placed at 5 and 10 cm. A pH sensor on a separately bound catheter was sited at 5cm. A RE occurred when distal oesophageal pH was <4, (>4s), Acid clearance was defined by a return of pH >4. Pharyngeal activity determined primary or secondary activity. This was divided into peristalsis and others (e.g. simultaneous, non-transmitted, reverse, isolated). An impedance RE was defined by a 33% decrease in baseline values (>2s), when pH <4. Subsequent volume clearance was defined as a return to impedance baseline. Results: There were a total of 775 REs. Of these 527 (68%) had an associated impedance event. Of these, primary peristalsis has a significantly larger role (p=0.0001) in volume clearance 276/527 (52%) than in acid clearance 322/775 (42%). There were no statistical differences beh, veen controls or patients. Conclusions: Ambulatory impedance has a high concordance with reflux events (68%). This study shows that primary peristalsis has a significantly larger role in volume clearance than in acid clearance.


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