Manually calculated oesophageal bolus clearance time increases in parallel with reflux severity at impedance-pH monitoring.

de Bortoli, Nicola; Martinucci, Irene; Savarino, Edoardo V; Frazzoni, Marzio; Tutuian, Radu; Tolone, Salvatore; Piaggi, Paolo; Furnari, Manuele; Russo, Salvatore; Bertani, Lorenzo; Macchia, Lorenzo; Savarino, Vincenzo; Marchi, Santino (2015). Manually calculated oesophageal bolus clearance time increases in parallel with reflux severity at impedance-pH monitoring. Digestive and liver disease, 47(12), pp. 1027-1032. Elsevier 10.1016/j.dld.2015.08.010

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BACKGROUND

Oesophageal clearance has been scarcely studied.

AIMS

Oesophageal clearance in endoscopy-negative heartburn was assessed to detect differences in bolus clearance time among patients sub-grouped according to impedance-pH findings.

METHODS

In 118 consecutive endoscopy-negative heartburn patients impedance-pH monitoring was performed off-therapy. Acid exposure time, number of refluxes, baseline impedance, post-reflux swallow-induced peristaltic wave index and both automated and manual bolus clearance time were calculated. Patients were sub-grouped into pH/impedance positive (abnormal acid exposure and/or number of refluxes) and pH/impedance negative (normal acid exposure and number of refluxes), the former further subdivided on the basis of abnormal/normal acid exposure time (pH+/-) and abnormal/normal number of refluxes (impedance+/-).

RESULTS

Poor correlation (r=0.35) between automated and manual bolus clearance time was found. Manual bolus clearance time progressively decreased from pH+/impedance+ (42.6s), pH+/impedance- (27.1s), pH-/impedance+ (17.8s) to pH-/impedance- (10.8s). There was an inverse correlation between manual bolus clearance time and both baseline impedance and post-reflux swallow-induced peristaltic wave index, and a direct correlation between manual bolus clearance and acid exposure time. A manual bolus clearance time value of 14.8s had an accuracy of 93% to differentiate pH/impedance positive from pH/impedance negative patients.

CONCLUSIONS

When manually measured, bolus clearance time reflects reflux severity, confirming the pathophysiological relevance of oesophageal clearance in reflux disease.

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