valueofMII..doc

What is the value of intraluminal impedance measurements in the diagnosis of esophageal motility disorders in gastroesophageal reflux patients? J. Fass, B. Dreuw, J. Silny, V. Schumpelick (Aachen) Despite the development of sophisticated manometry systems there are still methodologic problems in the investigation of esophageal motor function [1, 2]. Especially in gastroesopahgeal reflux (GER) patients so far manometric studies have failed to establish clear cut-off points, owing to a large overlap of manometric variables with healthy volunteers [2]. The possible cause of this situation is that the changes in the intraluminal pressure only describe one phenomenon of the esophageal motility. The real motions of the esophageal wall and their correlation with time and the characteristics of the bolus transport can be imagined but not measured. On the other hand the conventional detection of GER by pH-monitoring is limited to the measurement of acid exposure. Results of newer studies indicate that alkaline reflux might be even more important, especially as far as late complications of GER are concerned [3]. There is still a lack of a practicable and reliable procedure for the detection of alkaline reflux. In 1971 a first attempt was made by Harris et al. [4] to use intraluminal impedance tracings for the measurement of ureteral cross-section areas and flow characteristics of intraluminal contents. Meanwhile some studies have proven, that intraluminal impedance tracings show valuable and reproducible results in the detection of bolus transport patterns and esophageal motility [5-10]. The open impedance system, presented by Silny [11], has the property to detect both intraluminal bolus movements (swallowed or refluxed) and motility phenomena. The aim of the present study was to evaluate the role of intraluminal impedance measuring in the detection of GER and esophageal motility. Technique and properties of impedance measurement The impedance procedure used in the pr