Multichannel intraluminal impedance-pH testing is clinically useful in the management of patients with gastroesophageal reflux symptoms

Background: Multichannel intraluminal impedance-pH testing (MII-pH) allows for the detection of acid and non-acid reflux, thus, increasing yield over pH testing. Limited data exist on how physicians use test results in practice. Aim: The aim of our study was to evaluate the influence of MII-pH testing on patient care. Methods: We reviewed records of patients with symptoms of gastroesophageal reflux disease who underwent MII-pH testing. Management decisions evaluated included changes in prescribed medications and surgical consultation for anti-reflux surgery. Statistical analysis was performed using Pearson Chi square test, and multivariable logistic regression. Results: MII-pH testing resulted in a medication change in 41 % of patients, surgical consultation in 19.7 %, and anti-reflux surgery in 11.1 %. In patients who were not on proton pump inhibitor (PPI) therapy, MII-pH results were most useful in the decision to start a PPI. On PPI therapy, results were more often used to decide whether to increase (32.3 %) or switch the PPI (23.5 %) in patients with continued acid reflux. Results were most useful to stop the PPI in normal studies (11.1 %). More patients with non-acid reflux (14.3 %) and normal results (19.7 %) were started on a neuromodulator compared to other diagnoses. The MII-pH result was most useful in the decision to start baclofen or bethanecol when the patient was found to have non-acid reflux (25 %). Patients with an abnormal MII-pH or abnormal MII alone were more likely to be referred to surgery (OR 19.5, p < 0.001; OR 19.77, p < 0.001). Conclusions: MII-pH testing impacted medical or surgical management in over half the patients tested.