Objective tests of esophageal reflux are helpful in patients presenting with atypical symptoms and/or typical gastroesophageal reflux symptoms refractory to proton pump inhibitors. Gastroesophageal reflux disease is a common disorder caused by the reflux of gastric contents into the esophagus. Esophageal pH monitoring systems use two electrodes, one acting as a reference electrode with a constant potential, and the other acting as an indicator electrode whose potential is sensitive to changes in hydrogen ion concentration in the esophageal lumen. In addition to the enhanced ability of pH-impedance monitoring to better characterize the mechanism and character of the reflux events during ambulatory monitoring, novel metrics have been developed that are increasing diagnostic yield and also better defining pathologic features of reflux focused on tissue permeability and bolus clearance. Multichannel intraluminal impedance monitoring consists of measuring impedance from multiple intraluminal recording segments along the esophagus.
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