RU2191537C2 - Method for diagnosing the cases of gastroesophageal reflux - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying impedance measurements. Probe is introduced into the stomach. Intragastric acidity during basal secretion phase is examined. When done, the probe is removed from the stomach and set in the esophagus. Intraesophageal impedance is measured in eight zones all the esophagus length long and time within which the impedance value does not exceed 100 Ohm is determined. Reflux aggressiveness is determined taking into account intragastric acidity, local esophageal clearance and reflux height. Reflux aggressiveness value being greater than 10%, pathological gastroesophageal reflux is to be diagnosed. Local esophageal clearance value being less than 10%, local esophageal clearance disorder is to be diagnosed. EFFECT: high accuracy of diagnosis. 1 dwg 20 tbl

Description

 The invention relates to medicine, namely to gastroenterology, and can be used in gastroenterological hospitals, clinics, diagnostic centers, both for adults and for school children.

The following methods are known for diagnosing gastroesophageal reflux (GER):
1. X-ray diagnostics
The main place in the X-ray diagnosis of gastroesophageal reflux and reflux esophagitis, hiatal hernia is occupied by polyposition fluoroscopy and radiography of the esophagus.

 When examining patients in the Trendelenburg position and in a horizontal position, the GER is detected by the appearance of a radiopaque substance in the esophagus. In patients with clear clinical data for reflux (and its complications), x-ray examination yields positive results in 86% of cases [2, 3, 4, 6, 18].

 The disadvantage of the X-ray diagnostic method for the diagnosis of GER is the unsafe effect of ionizing radiation on the child’s body and the low sensitivity of the method in the absence of complications [2].

2. Endoscopic diagnosis of GER
An endoscopic method for examining the esophagus allows you to identify and establish the severity of reflux esophagitis, one of the main complications of GER. With esophagofibroscopy in most patients, it is possible to observe a yawning cardia and throwing of gastric contents into the esophagus. The frequency of GER detection during x-ray and endoscopic examination is approximately the same and amounts to 47-60%.

 The main area of application for esophagoscopy is the detection of esophagitis and the treatment of esophageal strictures associated with GER. The disadvantage of this method is its invasiveness and high cost [1, 2, 7, 9].

3. Measurement of pH in the lumen of the esophagus (Daily monitoring of pH in the esophagus)
With daily intra-esophageal pH monitoring, episodes of reflux to the distal esophagus are revealed, as evidenced by a decrease in pH to 4 or less. The total number of refluxes is recorded, the number of episodes lasting more than 5 minutes, the duration of the largest episode, the average duration of reflux, and the total study time during which the pH was below 4 [2, 4, 13, 16, 17].

 The disadvantage of GER detection methods for measuring pH in the lumen of the esophagus is the need for x-ray or manometric monitoring of the position of the probe, the presence of only one electrode, and the excessively high cost of equipment for daily monitoring of pH.

4. Esophageal manometry
The study of the lower esophageal sphincter is performed by introducing a water-perfusion catheter and a computer. Measurements are taken of the total length of the lower esophageal sphincter (normal 2-5 cm), the length of its abdominal part (normal 1-5 cm), the average level of basal pressure (normal 14.3-34.5 mm). Periods of transient relaxation unrelated to swallowing are recorded (sphincter relaxation lasting more than 10 seconds), the ability of the sphincter to relax when swallowing is assessed [10, 11, 12, 14, 15, 19].

 The disadvantage of this method is the uncomfortability for the patient, the complexity and high cost.

 According to the closest technical nature and the achieved effect, as a prototype we have chosen a method for the diagnosis of GER using impedanometry [5].

 The methodology for the study of gastroesophageal reflux by the impedance method is based on recording a decrease in the intraesophageal impedance during reverse reflux of the acidic contents of the stomach into the esophagus.

 Golubev D.A., Mutalimov M.E. [5] improved the methodology for studying GER by tightly linking the zone of registration of the esophageal impedance to the esophageal-gastric transition. To do this, first the probe is inserted into the stomach cavity, then the probe is slowly removed into the esophagus while continuously recording the impedance in the first pair of electrodes located in the distal part of the probe; an abrupt increase in impedance from 50-70 Ohms to 120-150 Ohms indicates the transition of the probe through the esophageal sphincter. After that, the probe is lifted 2-3 cm higher and fixed in this position. Registration of the intraesophageal impedance in the indicated zone is carried out continuously for one hour. Gastroesophageal reflux is diagnosed by a rapid and significant decrease in impedance (Z) with a total duration of at least 2 minutes.

 According to the data Golubeva D.A. and Mutalimova M.E. in the absence of pathological GER, the total duration of episodes of reflux of gastric contents into the esophagus does not exceed 5% of the study time, when registering the esophageal impedance within 1 hour, there should not be more than one reflux.

 However, this method does not allow to determine the height of gastroesophageal reflux, the speed of esophageal clearance throughout the organ and the aggressiveness of reflux, depending on the acidity of the gastric juice and the volume of reflux.

 The objective of the invention is to develop a method that allows you to obtain information about the distal and proximal GER, their combinations in a particular patient, the aggressiveness of the GER, the speed of esophageal clearance and the height of reflux, which will improve the accuracy of diagnosis of GER.

 The essence of these GER indicators used to assess the severity of motor disorders of the esophagus can be explained by the following formulas.

где C_b - средняя интрагастральная кислотность желудочного сока в базальную фазу секреции;
С_о - средняя интрагастральная кислотность желудочного сока в базальную фазу секреции практически здорового человека;
ΔV - средний объем рефлюксата в одной зоне обследования в единицу времени;
V_o - объем внутренней полости пищевода при отсутствии ГЭР (фактически равен объему измерительного зонда). Скорость локального пищеводного клиренса (CL):

где Δd - средняя толщина рефлюксата, заключенного между стенками пищевода и зондом, в исследуемой зоне в единицу времени;
d_o - диаметр внутрипищеводного пространства при отсутствии рефлюкса (фактически равен наружному диаметру зонда);
Т - время исследования;
t - обща продолжительность рефлюкса в исследуемой зоне пищевода.Reflux Aggression (AR):

where C _b is the average intragastric acidity of the gastric juice in the basal phase of secretion;
With _about - the average intragastric acidity of gastric juice in the basal phase of the secretion of a healthy person;
ΔV is the average volume of refluxate in one examination area per unit time;
V _o - the volume of the internal cavity of the esophagus in the absence of GER (actually equal to the volume of the measuring probe). The rate of local esophageal clearance (CL):

where Δd is the average thickness of the refluxate enclosed between the walls of the esophagus and the probe in the study area per unit time;
d _o - the diameter of the intraesophageal space in the absence of reflux (actually equal to the outer diameter of the probe);
T is the time of the study;
t is the total duration of reflux in the studied area of the esophagus.

Gastroesophageal Reflux (HR) Height:
HR = M • l,
where M is the maximum number of the examination zone of the esophagus, where the reflux of gastric contents was recorded;
l is the distance between the areas of examination of the esophagus.

 The problem is solved by the fact that initially the probe is inserted into the stomach and intragastric acidity is determined in the basal phase of secretion, after which the probe is removed from the stomach and placed in the esophagus so that the distal end of the probe is 2-3 cm above the level of the esophago-gastric transition . Then, the intraesophageal impedance is recorded in eight zones along the entire length of the esophagus and the time during which the impedance does not exceed 100, the aggressiveness of reflux (AR) is determined, taking into account the value of intragastric acidity, the rate of local esophageal clearance (CL) and the height of reflux (HR) are determined and at values of AR> 10%, pathological gastroesophageal reflux is diagnosed, and if CL <10%, then a violation of the esophageal clearance is diagnosed.

The method is as follows:
An impedance measurement of GER is performed on an empty stomach using a RGG9-01 rheogastrograph and an 6G11 (or 7G11) impedance intragastric probe. First, the probe is inserted into the stomach and is installed in the standard position (1, 2, the examination area is located in the antrum; 3, 4, 5, 6 in the body of the stomach; 7, 8, in the cardiac section). Intragastric acidity is determined in the basal phase of secretion. Then the probe is removed from the stomach and placed in the esophagus so that its distal electrode is 2-3 cm above the cardiac pulp, and the remaining eight electrodes are proximal throughout the entire lower esophagus. The installation of the probe 2-3 cm above the esophageal-gastric junction excludes the situation when the probe is in the region of this junction and provokes GER.

 Monitoring the installation of the probe in the esophagus is carried out with continuous recording of impedance in the first examination area according to the method of Golubev D.A. and Mutalimova M. E. [5]. 5 minutes after fixing the probe (adaptation time), the impedance measurement begins in eight study areas. The minimum registration time is 30 minutes. A decrease in the esophageal impedance (Z) below 100 Ohms in any study area indicates the presence of gastroesophageal reflux, which is indicated by white rectangles in Fig. 1a.

 The threshold Z = 100 Ohms was determined experimentally for the 6G11 impedance probe when it was placed in flexible polyvinyl chloride tubes with an inner diameter of more than 6 mm filled with electrolytes of various concentrations that simulated the real limits of the electrical conductivity of refluxate during GER. This threshold guarantees complete contact of the esophagus walls around the probe electrodes and excludes both false positive and false negative results of GER registration.

 In relation to the RGG9-01 rheogastrograph and 6G11 probe, the formulas for calculating GER indices take the following form.

где C_b - средняя интрагастральная кислотность желудочного сока в базальную фазу секреции, ммоль/л экв. НСl;
С_о - средняя интрагастральная кислотность желудочного сока в базальную фазу секреции практически здорового человека (С_о=30 ммоль/л экв. НСl);
n - число выборок (рекомендуется n=120...180);
Z_ij - низкочастотный внутрипищеводный импеданс при ГЭР в i-й выборке в j-й зоне обследования (Z_ij<100 Ом), Ом;
Z_o= 100 Ом - пороговое значение низкочастотного внутрипищеводного импеданса при отсутствии ГЭР;
k - число зон обследования (для зонда 6Г11 k=8). Чем выше кислотность рефлюксата и больше его объем, тем выше значения показателя агрессивности (AR). Если AR>10%, то диагностируют патологический ГЭР.Reflux Aggression (AR):

where C _b is the average intragastric acidity of the gastric juice in the basal phase of secretion, mmol / l equiv. Hcl;
With _about - the average intragastric acidity of gastric juice in the basal phase of the secretion of a healthy person (With _about = 30 mmol / l equiv. Hcl);
n is the number of samples (n = 120 ... 180 is recommended);
Z _ij - low-frequency intra-esophageal impedance with GER in the i-th sample in the j-th examination area (Z _ij <100 Ohm), Ohm;
Z _o = 100 Ohms - the threshold value of the low-frequency intraesophageal impedance in the absence of GER;
k is the number of examination zones (for a probe 6Г11 k = 8). The higher the acidity of refluxate and the greater its volume, the higher the value of the aggressiveness index (AR). If AR> 10%, then pathological GER is diagnosed.

где Z_i - низкочастотный внутрипищеводный импеданс в i-й выборке в данной зоне при забросе желудочною содержимого в пищевод (Z<100 Ом), Ом;
Z_o= 100 Ом - пороговое значение низкочастотного внутрипищеводного импеданса при отсутствии ГЭР;
m - количество эпизодов заброса желудочного содержимого в пищевод в данной зоне за все время исследования;
n- объем выборки.The rate of local esophageal clearance (CL):

where Z _i is the low-frequency intra-esophageal impedance in the i-th sample in this area when the gastric contents are thrown into the esophagus (Z <100 Ohm), Ohm;
Z _o = 100 Ohms - the threshold value of the low-frequency intraesophageal impedance in the absence of GER;
m is the number of episodes of reflux of gastric contents into the esophagus in this area for the entire duration of the study;
n is the sample size.

 The higher the CL, the faster the cleansing of the esophagus from reflux. If CL <10%, then in this area of the esophagus, a violation of the esophageal clearance is recorded.

Reflux Height (HR):
HR = 1.5 • M,
where M is the maximum number of the examination area where the reflux of gastric contents into the esophagus was recorded.

The analysis of the impedanceometric curves allows you to further determine the change in the relative volume of the refluxate ΔV / V _o (fig.1b).

 The result of the GER study of the prototype is a statement of the fact of the presence or absence of reflux of the contents of the stomach into the esophagus, and only into its distal section, i.e. there is no way to detect proximal reflux. In the claimed method for the diagnosis of GER, intragastric acidity is preliminarily determined in the basal phase of secretion, then the impedance probe is installed in the esophagus 2-3 cm above the esophageal-gastric junction and intra-esophageal impedance is recorded in eight zones throughout the esophagus and the time during which the impedance value does not exceed 100 ohms for each examination area. Based on the obtained data, the reflux aggressiveness (AR), the rate of local esophageal clearance (CL), and the reflux height (HR) are determined. Pathological gastroesophageal reflux is diagnosed with AR> 10%. The value of AR is determined by the acidity and volume of refluxate. Violation of the esophageal clearance is established at values of CL <10%.

 The inventive method allows to obtain additional information, which is of great importance for assessing the severity of GER in children and adolescents and analysis of the effectiveness of therapy for GERD.

Clinical example 1
Patient Minaeva Lyuba, 14 years old, medical history 3379
This patient was treated in the gastroenterological department of Children's State Children's Hospital 3 from 15.05.00 but 09.06.00 with a diagnosis of gastroesophageal reflux disease. Erosive reflux esophagitis. Axial hiatal hernia. Chronic gastroduodenitis (superficial gastritis, erosive bulbitis) with preserved acid-forming function of the stomach in the acute phase, associated with Helicobacter pylori infection.

 Received complaints of pain in the epigastric region that occur after eating and with torso, and severe dyspeptic disorders: nausea after eating, belching with air and eaten food, sour taste in the mouth, heartburn. To reduce discomfort, the patient drinks food with water. The duration of the disease is 2-3 years. Anamnesis of life without features.

 An objective examination revealed scoliosis of 1 tbsp., Pain in the epigastric region. An X-ray examination of the esophagus revealed an unfixed axial hernia of the esophageal opening of the diaphragm. With fibrogastroduodenoscopy, erosive reflux esophagitis, cardia failure, superficial widespread gastroduodenitis, acute erosion in the duodenal bulb were found. The urease test with a biopsy from the antrum is sharply positive.

 A therapy was conducted aimed at eradicating helicobacter infection: famotidine, hikoncil, denol, trichopolum for 7 days, then a 5-day course of motilium 10 mg 3 times a day inside.

 The results of the GED impedance study of the prototype before and after the treatment are shown in Table 1. Using this technique, the state of the esophageal impedance is analyzed only in 1 zone during the entire observation time. The reflux of gastric contents into the esophagus is recorded by a rapid and significant decrease in impedance (Z), the duration of which is at least 2 minutes. If the total duration of episodes of reflux of gastric contents into the esophagus exceeds 5% of the study time and more than one episode of reflux is recorded, then pathological GER is diagnosed.

 The results of the impedance measurement of the GER according to the claimed method before and after treatment are presented in tables 2 and 3. To calculate the values of AR, HR and CL, we used impedance measurement information obtained from eight examination areas. At values of AR> 10%, pathological GER is diagnosed, if CL <10%, then a violation of the esophageal clearance is determined.

 As can be seen from table 1, the treatment was effective. The ERT was completely eliminated.

 The inventive method, like the prototype, revealed a positive effect of therapy on the pathological nature of GER. In contrast to the prototype, a decrease in the height of reflux and its aggressiveness was established against the background of treatment.

 As can be seen from table 3, the inventive method revealed a significant improvement in esophageal clearance in all areas of the examination after treatment.

Clinical example 2
Patient Zakharova Ekaterina, 16 years old, medical history 493
This patient was treated in the gastroenterological department of Children's hospital No 15 from 18.05.00 to 06.06.00 with a diagnosis of Chronic gastritis with increased acid-forming function in the phase of subsiding exacerbation. Gastroesophageal reflux. Neurocirculatory dystonia by hypotonic type. Hyperplasia of the thyroid gland 2 tbsp.

 Received with complaints of recurrent pain in the epigastric region and under the xiphoid process of the sternum arising from overeating. Dyspeptic disorders were noted: belching with air, heartburn after eating. The duration of the disease is about two years. Heredity is not burdened. Anamnesis of life without features.

 An objective examination revealed signs of vagotonia, an enlarged thyroid gland. The abdomen is soft, painless. When fibrogastroduodenoscopy detected hyperplastic antral gastritis.

 The therapy was carried out with motilium 10 mg 3 times a day inside and almagel 5 ml 3 times a day inside for 10 days.

 The results of the impedance measurement of the GER of the prototype and the claimed method before and after treatment are presented in tables 4, 5 and 6.

 As can be seen from table 4, the treatment was effective. The ERT was completely eliminated.

 The inventive method, like the prototype, revealed a positive effect of therapy on pathological GER, but in contrast to the prototype, a decrease in the height of reflux and its aggressiveness was established against the background of treatment.

 As can be seen from table 6, the inventive method revealed a significant improvement in esophageal clearance in all areas of the examination after treatment.

Clinical example 3
Patient Vinogradov Vladislav, 13 years old, medical history 4145
This patient was treated in the gastroenterological department of Children's State Children's Hospital 3 from 06.26.00 to 07.29.00 with a diagnosis of chronic gastroduodenitis (superficial antral gastritis, superficial bulbitis) with increased acid-forming gastric function in the exacerbation phase associated with Helicobacter pylori infection. Gastroesophageal reflux.

 He received complaints of prolonged aching and paroxysmal pain in the epigastric region with a predominance under the xiphoid process of the sternum, umbilical region, provoked by emotional and physical exertion, passing independently, expressed dyspeptic symptoms: constant belching of the air, bitter aftertaste in the mouth, heartburn. Heredity burdened by non-ulcer dyspepsia. The duration of the disease is more than 3 years, during which the patient was repeatedly treated in a hospital. A history of recurrent giardiasis, manifestations of the syndrome of minor cerebral dysfunction, vegetovascular dystonia.

 An objective examination revealed: violation of posture, manifestations of vagotonia, palpation tenderness in the epigastrium and in the epigastric region, tongue coated with white coating. During fibrograduodenoscopy, surface changes in the mucosa of the antrum of the stomach and duodenal bulb in the presence of persistence of the pyloric helicobacter were diagnosed; esophagus mucosa without endoscopic changes.

 After treatment with antacids (Almagel 5.0 orally 4 times a day) and prokinetics (Motilium 10 mg orally 3 times a day), abdominal pain and dyspeptic symptoms were stopped within 10 days.

The results of the impedance measurement of the GER according to the prototype and the claimed method before and after treatment are presented in tables 7, 8 and 9
As can be seen from table 7, the treatment was ineffective, since the pathological GER was not eliminated.

 The data of table 8 show that the proposed method, in contrast to the prototype, was more sensitive in evaluating the effectiveness of treatment: revealed a decrease in the height of reflux and aggressiveness after therapy. However, it should be noted that the pathological GER was preserved in this patient.

 The data in table 9 indicate a positive effect of the treatment on the esophageal clearance in 5-8 examination areas, however, a decrease in esophageal clearance remains in the lower esophagus.

Clinical example 4
Patient Egorova Ekaterina, 14 years old, (medical history 4221)
This patient was treated in the gastroenterological department of Children's State Children's Hospital 3 from 29.06.00 to 21.07.00 with a diagnosis of Chronic gastroduodenitis (hyperplastic erosive antrum gastritis, hyperplastic bulbitis) with preserved acid-forming gastric function in the exacerbation phase associated with Helicobacter pylori infection. Superficial reflux esophagitis. Papilloma of the cardia. Hypertensive type dyskinesia of the biliary tract. Drug sensitization. Cystitis. Lumbar dystopia of the right kidney. Choreoretinitis. Hyperplasia of the thyroid gland, euthyroidism.

 Received with complaints of recurrent pain in the epigastric region and under the xiphoid process of the sternum arising from the use of carbonated drinks. Abdominal pain is provoked by physical exertion. Dyspeptic disorders are expressed: belching of air, bitter taste in the mouth. Appetite is reduced. The duration of the disease is more than three years. Heredity burdened by non-ulcer dyspepsia, peptic ulcer. A history of perinatal encephalopathy, urinary tract infection, giardiasis. An objective examination revealed signs of systemic dysplasia of the connective tissue: joint hypermobility, scoliosis 1 tbsp., Right-sided nephroptosis. On palpation of the abdomen, soreness in the epigastrium, positive vesical symptoms were noted. With fibrogastroduodenoscopy, signs of superficial reflux esophagitis, cardia papilloma, hyperplastic erosive antral gastritis, and hyperplastic bulbitis were found.

 Helicobacter pylori infection was eradicated (omeprazole, rulide, tinidazole, donol) for 10 days, then motilium 10 mg 2 times a day inside and maalox 1 tablet 2 times a day inside for 10 days.

 The results of the impedance measurement of the GER according to the prototype and the claimed method before and after treatment are presented in tables 10, 11 and 12.

 As can be seen from table 10, the treatment was effective. The ERT was completely eliminated.

 The results of the study according to the claimed method confirm the survey data on the prototype.

 As can be seen from table 12, after treatment, there is a complete normalization of motility of the esophagus.

Clinical example 5
Patient Alekseeva Daria, 11 years old, (medical history 2988)
This patient was treated in the gastroenterological department of Children's State Children's Hospital 3 from 04/26/00 to 05/15/00 with a diagnosis of Chronic gastroduodenitis (superficial spread) with reduced acid-forming function of the stomach in the acute phase. GER. Gastroesophageal prolapse. Cardia insufficiency. Hypertensive type dyskinesia of the biliary tract. Colon dyskinesia. Dispancreatism. Obesity 1-2 tbsp. Vegetovascular dystonia. Neurosis.

 Received with complaints of periodic aching pain in the epigastric region that occurs after eating with overeating. Abdominal pain was stopped by antispasmodics. Dyspeptic disorders were noted: flatulence, unstable stool. The duration of the disease is less than 3 years. A history of perinatal encephalopathy, manifestations of autonomic dysfunction.

 An objective examination revealed signs of obesity 1-2 tbsp. and vegetovascular dystonia. On palpation of the abdomen, pain was noted in the umbilical region. When fibrogastroduodenoscopy revealed signs of motor disorders of the esophagus (GER, gastroesophageal prolapse, cardia failure), signs of inflammatory changes in the mucous membrane of the stomach and duodenum of a superficial nature.

 Motilium therapy was administered at a dose of 10 mg 2 times a day by mouth in two courses of 7 days with a seven-day break.

 The results of the impedance measurement of GER according to the prototype and the claimed method before and after treatment are presented in tables 13, 14 and 15.

 As can be seen from table 13, the treatment was effective. The ERT was completely eliminated.

 In contrast to the results of the examination of the prototype, the inventive method shows that the pathological GER was preserved after the treatment.

 As can be seen from table 15, the treatment had a positive effect on the motor function of the esophagus in its lower part (from 1 to 4 examination areas), while in the middle part of the esophagus (5-6 examination areas), CL indices worsened.

Clinical example 6
Patient Dmitry Ozerov, 13 years old, (medical history 2487)
This patient was treated in the gastroenterological department of Children's State Children's Hospital 3 from 04/06/00 to 04/26/00 with a diagnosis of superficial reflux esophagitis. Chronic gastroduodenitis (superficial, widespread) with increased acid-forming function of the stomach in the acute phase, associated with Helicobacter pylori infection. Hypertensive type dyskinesia of the biliary tract. Gilbert's syndrome. Ascaridosis. Vegetative-vascular dystonia according to the vagotonic type.

 Received complaints of periodic moderate aching pain under the xiphoid process of the sternum, in the epigastrium, in the right hypochondrium, occurring after eating and after exercise. Abdominal pains stopped on their own. Dyspeptic disorders were noted: nausea after eating, belching of air, flatulence. The duration of the disease is more than 5 years. Heredity is burdened by non-ulcer dyspepsia, peptic ulcer disease, chronic cholecystitis, diseases of the cardiovascular system. A history of giardiasis, herniation, manifestations of autonomic dysfunction.

 An objective examination revealed signs of vegetovascular dystonia and systemic dysplasia of the connective tissue (joint hypermobility, impaired posture, diastasis of the rectus abdominis muscles). On palpation of the abdomen, bloating, soreness under the xiphoid process of the sternum and in the epigastrium, and moderate enlargement of the liver were noted. With fibrogastroduodenoscopy, signs of motor disorders and inflammatory changes in the mucous membrane of the esophagus, signs of inflammatory changes in the gastric mucosa and superficial duodenum were found.

 Maalox therapy was administered 10.0 times orally 3 times a day and at night for 14 days and motilium 10 mg 3 times a day inside 10 days.

 The results of the impedance measurement of the GER according to the prototype and the claimed method before and after treatment are presented in tables 16, 17 and 18.

 The data in table 16 show that the treatment of the patient was ineffective.

 The data in table 17 demonstrate that the inventive method allowed to identify the positive effect of therapy on the motility of the esophagus: a decrease in the height and aggressiveness of the GER, however, after the treatment, the pathological nature of the GER remained.

 As can be seen from table 18, the treatment slightly increased the rate of esophageal clearance from 4 to 5 of the examination area, however, in the lower part of the esophagus, clearance remained impaired.

 The inventive method for the diagnosis of GER increases the accuracy of diagnosis. The proof of this is the following: the claimed method and prototype examined a group of patients (n = 24) with gastroesophageal reflux disease (GERD), in whom GER was confirmed by clinical data and endoscopic examination.

 It turned out that when examining the prototype GER was detected in 58.3% of cases; according to the claimed method, GER was diagnosed in 91.6% of cases (table 19).

 After a course of treatment in 10 patients from this group, a second study was conducted by the prototype and the claimed method. The survey results are presented in table 20.

 As can be seen from table 20, the claimed method, in contrast to the prototype, was more sensitive in evaluating the effectiveness of therapy, because in 40% of patients, this method revealed a lack of positive dynamics, while the prototype in only 20% of patients.

 Thus, we can conclude that, unlike the prototype, the claimed method for the diagnosis of gastroesophageal reflux is more informative and accurate.

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Claims (1)

 A method for diagnosing gastroesophageal reflux by the impedanceometric method, including determining the intragastric acidity using a probe, further setting its distal end 2-3 cm above the level of the esophageal-gastric junction and registering the intraesophageal impedance, characterized in that the probe is introduced into the stomach, determines intragastric acidity in the basal phase of secretion, after which the probe is removed from the stomach and placed in the esophagus, intra-esophageal impedance is recorded in eight zones throughout of the esophagus and the time during which the impedance value does not exceed 100 Ohms, the aggressiveness of reflux (AR) is determined, taking into account the value of intragastric acidity, the rate of local esophageal clearance (CL) and the height of reflux (HR), and pathological gastroesophageal is diagnosed with AR> 10% reflux, and if CL <10%, then a violation of the esophageal clearance is determined.

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