Novel Impedance-pH Parameters in Pre-Bariatric Assessment of Patients: A Pilot Study

Novel impedance-pH parameters, Mean Nocturnal Baseline Impedance (MNBI) and Post-Reflux Swallow-Induced Peristaltic Wave (PSPW) index, have been proposed to improve the gastro-esophageal reflux disease (GERD) diagnostic yield. This study aims to determine the integrity of the esophageal epithelial barrier and chemical clearance using these novel parameters and to correlate them with acid exposure time (AET) and acid clearance time (ACT) in obese patients who are candidates for bariatric surgery (BS). Twenty impedance-pHmetry tracings of patients prior to BS were reviewed. Nine (45%) patients with a conclusive diagnosis of GERD had significantly higher ACT, lower MNBI in the distal esophagus and lower PSPW indexes compared to obese patients without GERD. Moreover, 100% of obese patients with GERD had a pathological ACT compared to obese patients without GERD (p = 0.003). However, the percentage of pathological MNBI and PSPW index did not differ between obese patients with and without GERD. The PSPW index and MNBI of the distal channel significantly correlated with ACT and AET. Further studies are needed to assess the role of time-consuming novel parameters in the routine evaluation of morbidly obese patients candidates for BS. The value of acid clearance time is confirmed as a relevant impedance-pH parameter in these patients.

Automated summary

This study aimed to evaluate the integrity of the esophageal epithelial barrier and chemical clearance using novel impedance-pH parameters and their correlation with acid exposure time and acid clearance time in obese patients. The results showed that obese patients with GERD had higher acid clearance time, lower Mean Nocturnal Baseline Impedance (MNBI), and lower Post-Reflux Swallow-Induced Peristaltic Wave (PSPW) indexes compared to those without GERD. The pathological acid clearance time was significantly associated with GERD. Further studies are needed to assess the role of these time-consuming parameters in the routine evaluation of obese patients candidates for bariatric surgery.