Figure 4 Examples of reflux episodes on pH and pH-impedance monitoring

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Presentation transcript:

Figure 4 Examples of reflux episodes on pH and pH-impedance monitoring Figure 4 | Examples of reflux episodes on pH and pH-impedance monitoring. In all instances, arrows point to reflux episodes. a | Acid reflux episodes on pH-impedance monitoring. The pH electrode is positioned 5 cm above the lower esophageal sphincter (LES), and the impedance electrodes at 3 cm, 5 cm, 9 cm, 11 cm, 15 cm and 17 cm above the LES, stacked with the most proximal electrode at the top. Note the abrupt drop in the tracing designated pH, and drop in impedance recordings (arrows). b | Distal oesophageal acid reflux episodes on dual-channel pH monitoring, with pH electrodes 15 cm apart, and the distal electrode 5 cm above the LES. Note the drop in pH (arrow) limited to the bottom (distal) tracing only. c | Prolonged reflux events with delayed clearance in both distal and proximal channels on dual-channel pH monitoring. Note the pH drop in both distal and proximal tracings (arrows), and persistent low pH following the drop, especially in the bottom (distal) tracing. d | Weakly acidic and acidic reflux episodes associated with symptom events (symptoms occurring within 2 min of reflux episodes) on pH-impedance monitoring. The first reflux episode consists of drops in impedance recordings without a prominent drop in pH (arrow), indicating that this is a weakly acidic reflux episode. The second episode consists of drops in both pH and impedance (arrow), indicating that this is an acid reflux episode. Vertical lines indicate when the patient reported symptoms. Savarino, E. et al. (2017) Advances in the physiological assessment and diagnosis of GERD Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2017.130