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The effect of endoscopic fundoplication and proton pump inhibitors on baseline impedance and heartburn severity in GERD patients . BACKGROUND Antireflux therapy may lead to recovery of impaired mucosal integrity in gastro-esophageal reflux disease ( GERD ) patients as reflected by an increase in baseline impedance . The study objective was to evaluate the effect of endoscopic fundoplication and proton pump inhibitor ( PPI ) PPI therapy on baseline impedance and heartburn severity in GERD patients . METHODS Forty-seven GERD patients randomized to endoscopic fundoplication ( n = 32 ) or PPI therapy ( n = 15 ) , and 29 healthy controls were included . Before randomization and 6 months after treatment , baseline impedance was obtained during 24-h pH-impedance monitoring . Heartburn severity was evaluated using the GERD-HRQL questionnaire . KEY RESULTS Before treatment , baseline impedance in GERD patients was lower than in healthy controls ( p < 0.001 ) . Antireflux therapy increased baseline impedance ( from 1498 [ IQR 951-2472 ] to 2393 [ IQR 1353-3027 ] Ω , p = 0.001 ) , however it only led to a partial recovery when compared to healthy controls ( 2393 [ IQR 1353-3027 ] vs 2983 [ 2335-3810 ] Ω , p < 0.01 ) . The effect of both treatment options was not significantly different ( p = 0.13 ) despite the increased number of non-acid reflux events in the PPI group . No correlation was found between baseline impedance and GERD symptoms before or after treatment . CONCLUSIONS & INFERENCES Reduction in acid reflux by endoscopic fundoplication or PPI therapy leads to an increase in baseline impedance in GERD patients , likely to reflect recovery of mucosal integrity . The impact of non-acid reflux events on esophageal mucosal integrity may be limited as no difference in the increase in baseline impedance was observed after both treatment options . The lack of association between impedance baseline and heartburn severity indicates that other factors may contribute to heartburn perception in GERD .
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Intervention_Surgical
endoscopic fundoplication
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Intervention_Pharmacological
proton pump inhibitors
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Intervention_Surgical
endoscopic fundoplication
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Intervention_Pharmacological
proton pump inhibitor ( PPI ) PPI therapy
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Intervention_Surgical
endoscopic fundoplication
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Intervention_Pharmacological
PPI therapy
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Outcome_Physical
baseline impedance and
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Outcome_Other
severity
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Outcome_Physical
increase in baseline impedance .
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Outcome_Physical
baseline impedance and heartburn severity
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Participant_Condition
GERD
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Participant_Condition
gastro-esophageal reflux disease ( GERD ) patients
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Participant_Condition
GERD patients
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Participant_Sample-size
32
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Participant_Sample-size
15
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Participant_Condition
baseline impedance in