From the Guidelines
Gastroesophageal Reflux Disease (GERD) is typically indicated by a reflux time with increased total acid exposure time, as measured by pH/impedance monitoring 1.
Key Parameters
- Increased total acid exposure time
- Correlation between symptoms and all reflux episodes (acid and non-acid) detected by impedance 1
Diagnostic Approach
In patients with heartburn or regurgitation not responding to twice daily proton pump inhibitors, reflux monitoring should be performed with pH/impedance monitoring, rather than pH monitoring alone 1.
- A therapeutic trial of a proton pump inhibitor is cheaper, less invasive and more widely available than reflux monitoring 1
- High dose, twice daily proton pump inhibitor trials are more sensitive compared with pH monitoring 1
Treatment Guidance
- Approximately 60% of non-erosive reflux disease patients, who are refractory to proton pump inhibitors, have a positive reflux/symptom association, primarily due to non-acid reflux 1
- Classifying patients with symptomatic non-acid reflux as having a hypersensitive oesophagus reduces the number of patients classified as having functional heartburn and guides therapy 1
- pH/impedance monitoring off proton pump inhibitor therapy best predicts response to antireflux therapy 1
From the Research
Gastroesophageal Reflux Disease (GERD) Diagnosis
There are no research papers provided to assist in answering this question regarding the reflux time that indicates Gastroesophageal Reflux Disease (GERD). The studies provided focus on the management and treatment of esophageal variceal bleeding, particularly in patients with liver cirrhosis, and do not address the diagnosis of GERD or reflux time.
Esophageal Variceal Bleeding Management
- The European Society of Gastrointestinal Endoscopy (ESGE) recommends endoscopic band ligation (EBL) as the first-line treatment for acute esophageal variceal bleeding 2.
- A study found that adjuvant therapy with proton pump inhibitor (PPI) infusion was similar to combination with vasoconstrictor infusion in terms of initial hemostasis and very early rebleeding rate, but was associated with fewer adverse events 3.
- Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding involve a multidisciplinary approach, including the use of vasoactive drugs, endoscopic therapies, and antibiotic prophylaxis 4.
- Endoscopic management of acute oesophageal variceal bleeding within 12 hours of admission is superior to 12-24 hours, with reduced hospital stay, ammonia levels, and improvement in associated hepatic encephalopathy 5.
- A randomized clinical trial found that a 24-hr infusion of octreotide is non-inferior to a 72-hr infusion for prevention of re-bleeding in patients with esophageal variceal hemorrhage, and may help reduce hospital stay and related costs 6.