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Technology Insight: the role of impedance testing for esophageal disorders

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 210–219 (2006)Cite this article

Abstract

Classic techniques like videofluoroscopy, stationary manometry, and ambulatory 24 h pH-metry are routinely used in the clinic to study patients with dysphagia, chest pain and reflux-related symptoms. Although these techniques have been very useful over the years, both for diagnosis and for therapeutic guidance, there are still many patients with dysphagia or chest pain who remain undiagnosed even after testing, and patients with typical and atypical symptoms of gastroesophageal reflux disease, with normal pH-metry findings, who do not respond adequately to antisecretory therapy. Esophageal impedance monitoring is a new technique that can be used alone and in combination with pH-metry and manometry to evaluate bolus transport and all types of gastroesophageal reflux (acid and nonacid). This review describes the esophageal impedance monitoring technique and summarizes the published validation studies that compare impedance monitoring with other methods, as well as normal values and reproducibility of impedance patterns and their association with symptoms.

Key Points

  • Impedance recording is a technique that allows evaluation of bolus transit without the use of radiation, and the detection of all types of gastroesophageal reflux

  • Combined impedance–manometry recordings allow evaluation of bolus transit in patients with manometric abnormalities

  • Combined impedance–pH-metry allows for distinction between the different types of reflux: acid, weakly acidic, weakly alkaline, superimposed or gas

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Figure 1: A combined impedance–pH catheter consisting of six impedance channels and two pH sensors.
Figure 2: Impedance patterns.
Figure 3: Combined impedance–pH-metry recordings.
Figure 4: An example of a swallow of a viscous bolus as detected by combined impedance–manometry recording.

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Authors and Affiliations

  1. Centre for Gastroenterological Research, KU Leuven, Belgium

    Daniel Sifrim & Kathleen Blondeau

  2. Catholic University of Leuven,

    Daniel Sifrim & Kathleen Blondeau

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  1. Daniel Sifrim
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  2. Kathleen Blondeau
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Correspondence to Daniel Sifrim.

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Sifrim, D., Blondeau, K. Technology Insight: the role of impedance testing for esophageal disorders. Nat Rev Gastroenterol Hepatol 3, 210–219 (2006). https://doi.org/10.1038/ncpgasthep0446

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