{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:11:34Z","timestamp":1753884694688,"version":"3.41.2"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We sought to quantify the characteristics of acid reflux episodes in patients with extraesophageal GERD symptoms (EES), hiatal hernia (HH), and erosive esophagitis (EroE) using multichannel intraluminal impedance pH (MII\u2010pH) and investigate the correlation between impedance parameters and high resolution esophageal manometry (HREM). This was a retrospective analysis of esophageal manometric and impedance data inpatients with typical GERD symptoms who underwent both HREM and 24 h MII\u2010pH tests. Within the three patient subgroups, we evaluated impedance metrics such as average height of reflux, total duration of reflux, maximum duration of reflux, average pH, and average area of reflux. We also introduce a novel composite reflux index (CRI) metric, which is a measure of reflux height, duration, and acidity. Patients with EES exhibited a 29.3% increase in average height of reflux, compared to non\u2010EES patients (<jats:italic>p<\/jats:italic> &lt; 0.01); the average height of reflux was found to be an independent predictor of EES (<jats:italic>p<\/jats:italic> &lt; 0.01). Patients with HH showed a 190% longer total reflux duration (<jats:italic>p<\/jats:italic> &lt; 0.01, vs. non\u2010HH patients). Total reflux duration was twice as long in EroE patients compared to those without (p = 0.02). Average CRI was significantly different within all three subgroup comparisons (<jats:italic>p<\/jats:italic> &lt; 0.01). Impedance metrics shared weak negative correlations with lower esophageal sphincter (LES) rest pressure and distal contractile integral (DCI), and weak positive correlations with % absent peristalsis (<jats:italic>p<\/jats:italic> &lt; 0.05 to <jats:italic>p<\/jats:italic> &lt; 0.01 for various parameters). Quantitative impedance metrics provide useful insight into the pathophysiology of reflux in patients with EES, HH, and EroE.<\/jats:p>","DOI":"10.14814\/phy2.15199","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T04:54:09Z","timestamp":1646024049000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative assessment of multichannel intraluminal impedance pH and its clinical implications"],"prefix":"10.14814","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-8452","authenticated-orcid":false,"given":"Eden","family":"Koo","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Michigan Medicine  Ann Arbor Michigan USA"},{"name":"John A. Burns School of Medicine University of Hawaii  Honolulu Hawaii USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John O.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boli","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Digestive Diseases General Hospital of Jincheng  Jincheng Shanxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj J.","family":"Pasricha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Gastroenterology the Affiliated Drum Tower Hospital of Nanjing University Medical School  Nanjing Jiangsu Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,2,27]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_8_2_1","DOI":"10.1002\/bjs.1800791023"},{"doi-asserted-by":"publisher","key":"e_1_2_8_3_1","DOI":"10.1002\/bjs.1800820317"},{"doi-asserted-by":"publisher","key":"e_1_2_8_4_1","DOI":"10.1136\/gut.2007.133298"},{"doi-asserted-by":"publisher","key":"e_1_2_8_5_1","DOI":"10.1136\/gut.2005.072629"},{"doi-asserted-by":"publisher","key":"e_1_2_8_6_1","DOI":"10.1038\/ncpgasthep0057"},{"doi-asserted-by":"publisher","key":"e_1_2_8_7_1","DOI":"10.4253\/wjge.v2.i12.388"},{"doi-asserted-by":"publisher","key":"e_1_2_8_8_1","DOI":"10.1111\/jgh.12367"},{"doi-asserted-by":"publisher","key":"e_1_2_8_9_1","DOI":"10.1177\/0194599816665819"},{"doi-asserted-by":"publisher","key":"e_1_2_8_10_1","DOI":"10.1111\/dote.12328"},{"doi-asserted-by":"publisher","key":"e_1_2_8_11_1","DOI":"10.1001\/jama.294.12.1534"},{"doi-asserted-by":"publisher","key":"e_1_2_8_12_1","DOI":"10.1016\/j.cgh.2015.06.026"},{"doi-asserted-by":"publisher","key":"e_1_2_8_13_1","DOI":"10.1111\/nmo.13104"},{"doi-asserted-by":"publisher","key":"e_1_2_8_14_1","DOI":"10.1136\/gutjnl\u20102017\u2010314722"},{"doi-asserted-by":"publisher","key":"e_1_2_8_15_1","DOI":"10.1378\/chest.129.1_suppl.80S"},{"doi-asserted-by":"publisher","key":"e_1_2_8_16_1","DOI":"10.1111\/j.1572\u20100241.2001.03926.x"},{"doi-asserted-by":"publisher","key":"e_1_2_8_17_1","DOI":"10.1016\/0016\u20105085(86)90692\u2010x"},{"doi-asserted-by":"publisher","key":"e_1_2_8_18_1","DOI":"10.1136\/gut.44.4.476"},{"doi-asserted-by":"publisher","key":"e_1_2_8_19_1","DOI":"10.1097\/MD.0000000000015543"},{"doi-asserted-by":"publisher","key":"e_1_2_8_20_1","DOI":"10.1016\/j.jaci.2007.09.043"},{"doi-asserted-by":"publisher","key":"e_1_2_8_21_1","DOI":"10.1111\/j.1572\u20100241.1999.00847.x"},{"doi-asserted-by":"publisher","key":"e_1_2_8_22_1","DOI":"10.1007\/BF01893120"},{"doi-asserted-by":"publisher","key":"e_1_2_8_23_1","DOI":"10.1111\/apt.12919"},{"doi-asserted-by":"publisher","key":"e_1_2_8_24_1","DOI":"10.5056\/jnm19153"},{"doi-asserted-by":"publisher","key":"e_1_2_8_25_1","DOI":"10.1111\/j.1365\u20102036.2011.04742.x"},{"doi-asserted-by":"publisher","key":"e_1_2_8_26_1","DOI":"10.1038\/ajg.2009.670"},{"doi-asserted-by":"publisher","key":"e_1_2_8_27_1","DOI":"10.1111\/j.1572\u20100241.2004.04172.x"},{"doi-asserted-by":"publisher","key":"e_1_2_8_28_1","DOI":"10.1097\/SLA.0000000000001907"},{"doi-asserted-by":"publisher","key":"e_1_2_8_29_1","DOI":"10.1136\/gut.44.1.47"},{"doi-asserted-by":"publisher","key":"e_1_2_8_30_1","DOI":"10.23736\/S1121\u2010421X.17.02395\u20109"},{"doi-asserted-by":"publisher","key":"e_1_2_8_31_1","DOI":"10.1053\/s1542\u20103565(03)00177\u20100"},{"doi-asserted-by":"publisher","key":"e_1_2_8_32_1","DOI":"10.1016\/j.cgh.2018.02.001"},{"doi-asserted-by":"publisher","key":"e_1_2_8_33_1","DOI":"10.1007\/BF01535789"},{"issue":"4","key":"e_1_2_8_34_1","first-page":"358","article-title":"The symptom index: A clinically important parameter of ambulatory 24\u2010hour esophageal PH monitoring","volume":"83","author":"Wiener G. 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