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04 MII Detects Fasting
Multichannel intraluminal impedance accurately detects
fasting, recumbent reflux events and their clearing
STEVEN S. SHAY, STEVEN BOMELI, AND JOEL RICHTER
Gastroenterology Service, Cleveland Clinic Foundation, Cleveland, Ohio 44195
Received 5 November 2001; accepted in final form 1 April 2002
Shay, Steven S., Steven Bomeli, and Joel Richter.
Multichannel intraluminal impedance accurately detects
fasting, recumbent reflux events and their clearing. Am J
Physiol Gastrointest Liver Physiol 283: G376–G383, 2002.
First published April 10, 2002; 10.1152/ajpgi.00470.2001.—
Multichannel intraluminal impedance (MII) is a new diag-
nostic test for gastroesophageal reflux disease (GERD). The
objective of this report is to determine the accuracy of MII in
detecting individual reflux events (REs) identified by pH
probe and manometry, as well as their clearing in patients
with severe GERD compared with normal volunteers. Ten
severe GERD patients and 10 normal volunteers underwent
simultaneous manometry [7 sites: gastric, lower esophageal
sphincter, esophagus (4), pharynx], pH, and MII (6 sites in
esophagus) for 15 min in the left and right recumbent posture
while fasting. We found that patients had 30-fold more REs
than normal volunteers (41 11 vs. 1.3 0.4), and 95% of all
REs were detected by MII. An average 15-fold fall in imped-
ance with liquid and fivefold rise with gas made REs and
their composition easy to detect with MII. In the right re-
cumbent posture, nearly all REs detected by MII were liquid
(98%, 98/100). In contrast, all 283 REs detected by MII in the
left recumbent posture were gas. Nearly all REs detected by
MII were cleared (98%, 368/374). Mean acid clearing time
was threefold longer (47 s) than clearing time by either
manometry (15 s) or MII (13 s), primarily due to acid rereflux,
i.e., additional acid REs during acid clearing. We conclude
that MII is accurate in detecting REs identified by manom-
etry and/or pH probe, their composition, and their clearing
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