A model combining nocturnal baseline impedance, post-reflux swallow-induced peristaltic wave, and acid exposure time enhances prediction of proton pump inhibitor response for extraesophageal symptoms in a Chinese population

TL;DR

This study shows that combining specific impedance and swallow metrics improves predicting proton pump inhibitor response in Chinese patients with extraesophageal GERD symptoms.

Contribution

A novel combined model using MNBI, PSPW index, and AET improves PPI response prediction in extraesophageal GERD patients.

Findings

MNBI, PSPW index, and AET are independent predictors of PPI response in extraesophageal GERD.

Combining MNBI and PSPW index significantly improves prediction accuracy in patients with normal AET.

The combined model outperforms individual parameters in predicting PPI response.

Abstract

Gastroesophageal reflux disease(GERD) with extraoesophageal symptoms tends to respond poorly to proton pump inhibitors (PPIs).

This study aimed to evaluate the role of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index in predicting PPIs response among GERD patients with extraoesophageal symptoms.

We investigated the predictive significance of clinical, endoscopic, and pre-treatment 24-h impedance-pH monitoring data in determining PPIs response, evaluating both the individual and combined predictive capacities of MNBI and PSPW index.

A total of 92 Chinese patients were analyzed, revealing pathological MNBI (p = 0.013, OR = 4.217, 95%CI: 1.359–13.089), PSPW index (p = 0.015, OR = 4.026, 95%CI: 1.308–12.396), AET (p = 0.017, OR = 4.246, 95%CI: 1.290–13.982), and typical GERD symptoms (p = 0.040, OR = 3.467, 95%CI: 1.057–11.374) as independent predictors of PPIs response. Notably, the combined AUC of MNBI, PSPW index, and AET was significantly higher than that of the individual parameters (p < 0.05). Among patients with normal AET, the combined AUC of MNBI and PSPW index was significantly higher than that of MNBI alone (p < 0.001). In patients with only extra-oesophageal symptoms, the AUC of the MNBI and the combined parameters of the three indices were higher than that of the AET (p < 0.05).

MNBI and PSPW index serve as independent predictors of PPI response in GERD patients with extraesophageal symptoms, including those with normal AET. Importantly, their combined use significantly enhances predictive performance. MNBI remains a valuable predictor in patients with only extraesophageal symptoms. This study conducted a preliminary investigation into the predictive role of the combined MNBI-PSPW model in a Chinese population, highlighting the clinical importance of impedance parameter integration in managing extraesophageal GERD.

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