{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:54:29Z","timestamp":1761630869391,"version":"3.37.3"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Oesophageal manometry is the gold standard for accurate positioning of multichannel intraluminal impedance pH (MII\u2010pH) monitoring. The pH step\u2010up method is not as accurate as oesophageal manometry and needs patients to be off proton pump inhibitor (PPI) therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to evaluate the feasibility of the impedance step\u2010up method for lower oesophageal sphincter (LOS) localisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 100 patients who underwent 24\u2010hour MII\u2010pH monitoring were enrolled. High\u2010resolution manometry (HRM) was performed before MII\u2010pH monitoring in order to locate the LOS by a different operator. The impedance step\u2010up was defined as an increase of \u226550% with respect to gastric baseline. Lin's concordance correlation coefficient (<jats:italic>\u03c1<jats:sub>c<\/jats:sub><\/jats:italic>) with 95% Bland\u2013Altman limits of agreement (LOA) and Spearman's rho correlation coefficient were used when appropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median impedance step\u2010up was on average 0.8\u2009cm caudal to the manometric upper border of the LOS. Agreement between two step\u2010up impedance performances and inter\u2010observer agreement were excellent (<jats:italic>\u03c1<jats:sub>c<\/jats:sub><\/jats:italic>\u2009=\u20090.98 and 0.95), although the LOA ranges were wide (\u20132.4 to 4.0\u2009cm). Impedance step\u2010up performances were similar between patients off and on PPI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have described an alternative new method for pH impedance probe positioning using impedance step\u2010up. Although less accurate than HRM in locating the LOS, it has excellent intra\u2010 and inter\u2010observer agreement.<\/jats:p><\/jats:sec>","DOI":"10.1177\/2050640619860034","type":"journal-article","created":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T06:56:43Z","timestamp":1560841003000},"page":"1373-1379","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Lower oesophageal sphincter identification for gastro\u2010oesophageal reflux monitoring: The step\u2010up method revisited with use of basal impedance"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-5464","authenticated-orcid":false,"given":"Aurelio","family":"Mauro","sequence":"first","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico Milan Italy"},{"name":"Endoscopy Unit First Department of Internal Medicine San Matteo Hospital Foundation University of Pavia Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Franchina","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Consonni","sequence":"additional","affiliation":[{"name":"Epidemiology Unit Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Penagini","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi di Milano Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,12]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/nmo.13067","article-title":"Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group","volume":"29","author":"Roman S","year":"2017","journal-title":"Neurogastroenterol Motil"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1996.1101982"},{"key":"e_1_2_9_5_2","first-page":"1463","article-title":"Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode?","volume":"85","author":"Klauser AG","year":"1990","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200404000-00002"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01296558"},{"key":"e_1_2_9_8_2","first-page":"789","volume-title":"Can esophageal pH electrode be accurately positioned without manometry? 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