Cristian Vailati

Transoral incisionless fundoplication (TIF) with the EsophyX™ device creates an antireflux valve with good functional results in patients with gastro-esophageal reflux disease (GERD). The aim of this study was to assess the long-term effect of TIF 2.0 on pathological reflux and symptoms in GERD patients with daily dependence on proton pump inhibitors (PPI). Fifty patients underwent TIF. All underwent GERD-HRQL and GERD-QUAL questionnaires, upper GI endoscopy, esophageal manometry, and 24-h pH-impedance before and 6, 12, and 24 months after TIF, and subsequent yearly clinical re-evaluation. Patients were followed for up to six years (mean 52.7 ± 19.7 months). In all, 83.7, 79.6, 87.8, and 84.4 % of patients stopped or halved the PPI therapy 6, 12, 24, and 36 months after TIF. Three-year figure remained stable up to 6 years. Symptom scores off PPI were significantly lower at 6, 12, 24, and 36 months. At 6 months, Hill’s grade I of the newly created valve persisted in all pre-procedure Hill’s grade I patients, in 66.7 % of grade II and 58.3 % of grade III. This figure remained substantially unchanged at 12 and 24 months, too. Impedance monitoring indicated significantly fewer total and acid refluxes after treatment (p = 0.01). Factors predicting good outcomes were pre-procedure Hill’s grade I-II, no hiatal hernia or hernia ≤2 cm (p = 0.03), absence of ineffective esophageal motility (p < 0.0001), and number of fasteners deployed (p = 0.01). TIF by the EsophyX achieved lasting elimination of daily dependence on PPI in 75–80 % of patients for up to 6 years. TIF seems an effective therapy for selected symptomatic GERD patients.

Background: 24‐hour esophageal pH‐impedance (pH‐MII) is not totally reliable for laryngopharyngeal reflux (LPR). Oropharyngeal (OP) pH‐monitoring with the Dx‐pH probe may detect LPR better. The correlation between these two techniques is not thoroughly established. Aim of this study is to examine the correlation between OP pH‐metry and esophageal pH‐MII monitoring.Methods: Thirty‐six consecutive patients with suspected gastroesophageal reflux disease‐related extra‐esophageal symptoms were evaluated using 24‐h OP‐pH and concomitant esophageal pH‐MII monitoring. OP events were defined as: drop in pH below thresholds of 5.5, 5.0, 4.5, 4.0 or drop in pH of at least 10% from a running baseline. Temporal relationship between OP and esophageal reflux events and outcomes of the two tests were evaluated.Key Results: 2394 refluxes were detected by pH‐MII; of these only 120 were detected also by OP Dx‐probe. On the other hand, the proportion of OP‐pH events which were temporally related to an episode of distal reflux ranged from 0% to 17%, depending on the proximal pH criteria used. In 8/36 patients both tests were pathological, while in 10/36 they were both normal; 14/36 patients had pathological OP reflux, but a normal pH‐MII test; 4/36 patients had pathological pH‐MII, but a normal OP reflux.Conclusions & Inferences: The correlation between OP pH‐metry and pH‐MII was weak. At present, the absence of a reliable gold standard for the diagnosis of LPR and the uncertain etiology of the pharyngeal pH alterations make it difficult to decide which is the most reliable technique for the diagnosis of true LPR.

A multicenter study with a limited sample size found that absence of esophagitis, presence of functional digestive disorders, and overweight were associated with proton pump inhibitors (PPI) failure. To assess clinical and reflux patterns associated with PPI-responsiveness. Patients with typical gastroesophageal reflux disease (GORD) symptoms had 24 hours pH-impedance monitoring off therapy. Responders had 25 kg/m(2)) and the presence of esophagitis (P=0.019 and 0.043, respectively). We confirm that no reflux pattern demonstrated by 24 hours pH-impedance monitoring is associated to PPI response in GORD patients. Presence of esophagitis in the whole population and overweight in patients with pathologic GORD, but not dyspepsia, are strongly associated with PPI-responsiveness.