Background: Combined 24-h intraesophageal pH-multichannel intraluminal impedance (24MII-pH) used for assessing gastroesophageal reflux disease by measuring baseline impedance (BI) requires a 24-h measuring period. In the present study, we developed a quick method of measuring BI and evaluated its usefulness in classifying patients with proton pump inhibitor (PPI)-refractory non-erosive reflux diseases (NERD) as having functional heartburn (FH) or endoscopic-negative reflux disease (ENRD). Methods: Ninety-one NERD patients without esophageal motility disorder underwent 24MII-pH monitoring while on a PPI. The measurements of the mean nocturnal BI (MNBI) and short MNBI were assessed at 3 times (at about 1: 00, 2: 00, and 3: 00 am) for 10 min and 30 s respectively. The measurement of the simple mean BI (MBI) was performed once 30 s at about 11: 00 am. Results: Ninety-one patients were divided into 2 groups: 59 with ENRD and 32 with FH. The cutoff, specificity, and sensitivity for distinguishing patients with FH were as follows: MNBI, 2,874.1 Ω, 72%, and 72%; short MNBI, 2,857.6 Ω, 74%, and 84%; and simple MBI, 2,874.1 Ω, 86%, and 78% respectively. Conclusion: Measuring the simple MBI is a quick method and is useful for distinguishing patients with FH from those in a cohort with PPI-refractory NERD.

1.
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R: The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900–1920.
2.
Mishima I, Adachi K, Arima N, Amano K, Takashima T, Moritani M, Furuta K, Kinoshita Y: Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the japanese. Scand J Gastroenterol 2005; 40: 1005–1009.
3.
Dean BB, Gano AD Jr, Knight K, Ofman JJ, Fass R: Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol 2004; 2: 656–664.
4.
Uemura N, Inokuchi H, Serizawa H, Chikama T, Yamauchi M, Tsuru T, Umezu T, Urata T, Yurino N, Tanabe S, Yoshida T, Kawamura S, Murakami A, Yamamoto M, Chiba T: Efficacy and safety of omeprazole in japanese patients with nonerosive reflux disease. J Gastroenterol 2008; 43: 670–678.
5.
Miwa H, Sasaki M, Furuta T, Koike T, Habu Y, Ito M, Fujiwara Y, Wada T, Nagahara A, Hongo M, Chiba T, Kinoshita Y: Efficacy of rabeprazole on heartburn symptom resolution in patients with non-erosive and erosive gastro-oesophageal reflux disease: A multicenter study from Japan. Aliment Pharmacol Ther 2007; 26: 69–77.
6.
Yamashita H, Kanamori A, Kano C, Hashimura H, Matsumoto K, Tsujimae M, Yoshizaki T, Momose K, Obata D, Eguchi T, Fujita M, Okada A: The effects of switching to vonoprazan, a novel potassium-competitive acid blocker, on gastric acidity and reflux patterns in patients with erosive esophagitis refractory to proton pump inhibitors. Digestion 2017; 96: 52–59.
7.
Hoshino S, Kawami N, Takenouchi N, Umezawa M, Hanada Y, Hoshikawa Y, Kawagoe T, Sano H, Hoshihara Y, Nomura T, Iwakiri K: Efficacy of vonoprazan for proton pump inhibitor-resistant reflux esophagitis. Digestion 2017; 95: 156–161.
8.
Kawami N, Hoshino S, Hoshikawa Y, Takenouchi N, Umezawa M, Hanada Y, Kaise M, Iwakiri K: Pathogenesis of potassium-competitive acid blocker-resistant non-erosive reflux disease. Digestion 2018; 98: 194–200.
9.
Miwa H, Kusano M, Arisawa T, Oshima T, Kato M, Joh T, Suzuki H, Tominaga K, Nakada K, Nagahara A, Futagami S, Manabe N, Inui A, Haruma K, Higuchi K, Yakabi K, Hongo M, Uemura N, Kinoshita Y, Sugano K, Shimosegawa T: Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol 2015; 50: 125–139.
10.
Galmiche JP, Clouse RE, Balint A, Cook IJ, Kahrilas PJ, Paterson WG, Smout AJ: Functional esophageal disorders. Gastroenterology 2006; 130: 1459–1465.
11.
Kahrilas PJ: Review article: Gastro-oesophageal reflux disease as a functional gastrointestinal disorder. Aliment Pharmacol Ther 2004; 20(suppl 7): 50–55.
12.
Hershcovici T, Fass R: An algorithm for diagnosis and treatment of refractory gerd. Best Pract Res Clin Gastroenterol 2010; 24: 923–936.
13.
Tamura Y, Funaki Y, Izawa S, Iida A, Yamaguchi Y, Adachi K, Ogasawara N, Sasaki M, Kaneko H, Kasugai K: Pathophysiology of functional heartburn based on rome iii criteria in japanese patients. World J Gastroenterol 2015; 21: 5009–5016.
14.
Zhong C, Duan L, Wang K, Xu Z, Ge Y, Yang C, Han Y: Esophageal intraluminal baseline impedance is associated with severity of acid reflux and epithelial structural abnormalities in patients with gastroesophageal reflux disease. J Gastroenterol 2013; 48: 601–610.
15.
Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, Kuribayashi S, Higuchi T, Zai H, Ino K, Horikoshi T, Sugiyama T, Toki M, Ohwada T, Mori M: Development and evaluation of fssg: Frequency scale for the symptoms of gerd. J Gastroenterol 2004; 39: 888–891.
16.
Bredenoord AJ, Tutuian R, Smout AJ, Castell DO: Technology review: esophageal impedance monitoring. Am J Gastroenterol 2007; 102: 187–194.
17.
Zentilin P, Iiritano E, Dulbecco P, Bilardi C, Savarino E, De Conca S, Parodi A, Reglioni S, Vigneri S, Savarino V: Normal values of 24-h ambulatory intraluminal impedance combined with PH-metry in subjects eating a mediterranean diet. Dig Liver Dis 2006; 38: 226–232.
18.
Savarino E, Bazzica M, Zentilin P, Pohl D, Parodi A, Cittadini G, Negrini S, Indiveri F, Tutuian R, Savarino V, Ghio M: Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using PH-impedance monitoring. Am J Respir Crit Care Med 2009; 179: 408–413.
19.
Savarino E, Tutuian R, Zentilin P, Dulbecco P, Pohl D, Marabotto E, Parodi A, Sammito G, Gemignani L, Bodini G, Savarino V: Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: Study using combined impedance-PH off therapy. Am J Gastroenterol 2010; 105: 1053–1061.
20.
Roman S, Bruley des Varannes S, Pouderoux P, Chaput U, Mion F, Galmiche JP, Zerbib F: Ambulatory 24-h oesophageal impedance-PH recordings: Reliability of automatic analysis for gastro-oesophageal reflux assessment. Neurogastroenterol Motil 2006; 18: 978–986.
21.
Martinucci I, de Bortoli N, Savarino E, Piaggi P, Bellini M, Antonelli A, Savarino V, Frazzoni M, Marchi S: Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol Motil 2014; 26: 546–555.
22.
Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D: Twenty-four hour ambulatory simultaneous impedance and PH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 2004; 99: 1037–1043.
23.
Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, Mion F, Caillol F, Verin E, Bommelaer G, Ducrotte P, Galmiche JP, Sifrim D: Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-ph monitoring in a belgian-french cohort of healthy subjects. Aliment Pharmacol Ther 2005; 22: 1011–1021.
24.
Cho YK: How to interpret esophageal impedance PH monitoring. J Neurogastroenterol Motil 2010; 16: 327–330.
25.
Farre R, Blondeau K, Clement D, Vicario M, Cardozo L, Vieth M, Mertens V, Pauwels A, Silny J, Jimenez M, Tack J, Sifrim D: Evaluation of oesophageal mucosa integrity by the intraluminal impedance technique. Gut 2011; 60: 885–892.
26.
Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJ, Loots CM, Smout AJ: Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 2011; 106: 2093–2097.
27.
Bredenoord AJ, Weusten BL, Timmer R, Smout AJ: Reproducibility of multichannel intraluminal electrical impedance monitoring of gastroesophageal reflux. Am J Gastroenterol 2005; 100: 265–269.
28.
Kandulski A, Weigt J, Caro C, Jechorek D, Wex T, Malfertheiner P: Esophageal intraluminal baseline impedance differentiates gastroesophageal reflux disease from functional heartburn. Clin Gastroenterol Hepatol 2015; 13: 1075–1081.
29.
de Bortoli N, Martinucci I, Savarino E, Tutuian R, Frazzoni M, Piaggi P, Bertani L, Furnari M, Franchi R, Russo S, Bellini M, Savarino V, Marchi S: Association between baseline impedance values and response proton pump inhibitors in patients with heartburn. Clin Gastroenterol Hepatol 2015; 13: 1082–1088. e1081.
30.
Frazzoni M, Savarino E, de Bortoli N, Martinucci I, Furnari M, Frazzoni L, Mirante VG, Bertani H, Marchi S, Conigliaro R, Savarino V: Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-PH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol 2016; 14: 40–46.
31.
Zerbib F, Belhocine K, Simon M, Capdepont M, Mion F, Bruley des Varannes S, Galmiche JP: Clinical, but not oesophageal PH-impedance, profiles predict response to proton pump inhibitors in gastro-oesophageal reflux disease. Gut 2012; 61: 501–506.
32.
Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F: Functional esophageal disorders. Gastroenterology 2016, Epub ahead of print.
33.
Kohata Y, Fujiwara Y, Yamagami H, Tanigawa T, Shiba M, Watanabe K, Watanabe T, Tominaga K, Arakawa T: Usefulness of baseline impedance in patients with proton pump inhibitor-refractory nonerosive reflux disease. J Gastroenterol Hepatol 2015; 30(suppl 1): 36–40.
34.
Ates F, Yuksel ES, Higginbotham T, Slaughter JC, Mabary J, Kavitt RT, Garrett CG, Francis D, Vaezi MF: Mucosal impedance discriminates gerd from non-gerd conditions. Gastroenterology 2015; 148: 334–343.
35.
Matsumura T, Ishigami H, Fujie M, Taida T, Kasamatsu S, Okimoto K, Saito K, Maruoka D, Nakagawa T, Suzuki T, Katsuno T, Arai M: Endoscopic-guided measurement of mucosal admittance can discriminate gastroesophageal reflux disease from functional heartburn. Clin Transl Gastroenterol 2017; 8:e94.
36.
Matsumura T, Arai M, Ishigami H, Fujie M, Ishikawa K, Akizue N, Taida T, Ohta Y, Hamanaka S, Okimoto K, Saito K, Maruoka D, Nakagawa T, Kato N: Evaluation of esophageal mucosal integrity in patients with gastroesophageal reflux disease. Digestion 2018; 97: 31–37.
37.
Vela MF, Craft BM, Sharma N, Freeman J, Hazen-Martin D: Refractory heartburn: Comparison of intercellular space diameter in documented gerd vs. Functional heartburn. Am J Gastroenterol 2011; 106: 844–850.
38.
Savarino E, Zentilin P, Mastracci L, Dulbecco P, Marabotto E, Gemignani L, Bruzzone L, de Bortoli N, Frigo AC, Fiocca R, Savarino V: Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn. J Gastroenterol 2013; 48: 473–482.
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