MSAC Assessment Report Template
Catheter-free (wireless) ambulatory oesophageal pH monitoring for gastro-oesophageal reflux disease (GORD)February 2014 MSAC application no. 1203Assessment report? Commonwealth of Australia 2014ISBN (online) 978-1-74186-141-9ISSN (online) 1443-7139Publication approval number 10784Internet site work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600, or posted at copies of the report can be obtained from the Medical Service Advisory Committee’s internet site at about the content of the report should be directed to the above address.This report was commissioned for use by the Medical Services Advisory Committee (MSAC) to inform its deliberations. MSAC is an independent committee that has been established to provide advice to the Minister for Health on the strength of evidence available on new and existing medical technologies and procedures in terms of their safety, effectiveness and cost-effectiveness. This advice will help to inform government decisions about which medical services should attract funding under Medicare.MSAC’s advice does not necessarily reflect the views of all individuals who participated in the MSAC evaluation.This report was prepared for MSAC by Ms Sharon Kessels, Ms Camille Schubert, Ms Skye Newton and Assoc. Prof. Tracy Merlin from Adelaide Health Technology Assessment (AHTA), the University of Adelaide, with the assistance of Health Expert Standing Panel members Prof. Robert Batey and Prof. Robert Fraser. The report was commissioned by the Australian Government Department of Health. It was edited by Ms Jo Mason of MasonEdit, Adelaide.This report should be referenced as follows:Kessels S, Schubert C, Newton S & Merlin T 2014, Catheter-free (wireless) ambulatory oesophageal pH monitoring for gastro-oesophageal reflux disease (GORD), MSAC Application 1203, Assessment Report, Commonwealth of Australia, Canberra, ACT.Contents TOC \o "1-3" Executive summary PAGEREF _Toc383606889 \h xvAssessment of catheter-free (wireless) ambulatory oesophageal pH monitoring for gastro-oesophageal reflux disease PAGEREF _Toc383606890 \h xvRationale for assessment PAGEREF _Toc383606891 \h xvGastro-oesophageal reflux disease (GORD) and pH monitoring PAGEREF _Toc383606892 \h xvCurrent arrangements for public reimbursement PAGEREF _Toc383606893 \h xviClinical need PAGEREF _Toc383606894 \h xviResults of assessment PAGEREF _Toc383606895 \h xviEconomic and financial considerations PAGEREF _Toc383606896 \h xixOther relevant considerations / discussion PAGEREF _Toc383606897 \h xxiGlossary and abbreviations PAGEREF _Toc383606898 \h 23Introduction PAGEREF _Toc383606899 \h 25Rationale for assessment PAGEREF _Toc383606900 \h 25Background PAGEREF _Toc383606901 \h 26Gastro-oesophageal reflux disease (GORD) PAGEREF _Toc383606902 \h 26pH monitoring PAGEREF _Toc383606903 \h 27The current MBS-approved pH-monitoring test for GORD: catheter-based ambulatory oesophageal pH monitoring (MBS item 11810) PAGEREF _Toc383606904 \h 28Catheter-free (wireless) ambulatory oesophageal pH monitoring PAGEREF _Toc383606905 \h 29Intended purpose PAGEREF _Toc383606906 \h 30Indications PAGEREF _Toc383606907 \h 31Clinical need PAGEREF _Toc383606908 \h 31Other existing tests for GORD PAGEREF _Toc383606909 \h 32Oesophageal impedance testing PAGEREF _Toc383606910 \h 32Marketing status of device/technology PAGEREF _Toc383606911 \h 33Current reimbursement arrangements PAGEREF _Toc383606912 \h 33Proposal for public funding PAGEREF _Toc383606913 \h 34Consumer impact statement PAGEREF _Toc383606914 \h 35Approach to assessment PAGEREF _Toc383606915 \h 36Objective PAGEREF _Toc383606916 \h 36Clinical pathway PAGEREF _Toc383606917 \h 36Comparator PAGEREF _Toc383606918 \h 38The reference standard PAGEREF _Toc383606919 \h 38Research questions PAGEREF _Toc383606920 \h 38Diagnostic assessment framework PAGEREF _Toc383606921 \h 40Review of literature PAGEREF _Toc383606922 \h 41Literature sources and search strategies PAGEREF _Toc383606923 \h 41Selection criteria PAGEREF _Toc383606924 \h 42Search results PAGEREF _Toc383606925 \h 44Data extraction and analysis PAGEREF _Toc383606926 \h 46Appraisal of the evidence PAGEREF _Toc383606927 \h 48Expert advice: Health Expert Standing Panel (HESP) PAGEREF _Toc383606928 \h 54Results of assessment PAGEREF _Toc383606929 \h 55Is it safe? PAGEREF _Toc383606930 \h 55Safety of catheter-free (wireless) pH monitoring PAGEREF _Toc383606931 \h 57Is it effective? PAGEREF _Toc383606932 \h 73Direct evidence of diagnostic effectiveness PAGEREF _Toc383606933 \h 73Linked evidence PAGEREF _Toc383606934 \h 82Other relevant considerations PAGEREF _Toc383606935 \h 107Defining the population and the potential for ‘leakage’ PAGEREF _Toc383606936 \h 107What are the economic considerations? PAGEREF _Toc383606937 \h 108Economic evaluation PAGEREF _Toc383606938 \h 108Overview PAGEREF _Toc383606939 \h 108Economic literature review PAGEREF _Toc383606940 \h 109Populations and settings PAGEREF _Toc383606941 \h 110Structure and rationale of the economic evaluation PAGEREF _Toc383606942 \h 111Inputs to the economic evaluation PAGEREF _Toc383606943 \h 118Outputs from the economic evaluation PAGEREF _Toc383606944 \h 126Financial and costing impact PAGEREF _Toc383606945 \h 132Data sources used in the financial analysis PAGEREF _Toc383606946 \h 132Use and costs of the proposed wireless pH-monitoring strategy PAGEREF _Toc383606947 \h 132Changes in use and cost of current monitoring strategy PAGEREF _Toc383606948 \h 139Financial implications to the Medical Benefits Schedule (MBS) PAGEREF _Toc383606949 \h 141Other Australian healthcare system costs PAGEREF _Toc383606950 \h 142Discussion PAGEREF _Toc383606951 \h 144Safety PAGEREF _Toc383606952 \h 144Effectiveness PAGEREF _Toc383606953 \h 145Economic considerations PAGEREF _Toc383606954 \h 150Estimated cost-effectiveness PAGEREF _Toc383606955 \h 150Estimated financial impact PAGEREF _Toc383606956 \h 151Conclusions PAGEREF _Toc383606957 \h 154Is catheter-free monitoring safe? PAGEREF _Toc383606958 \h 154Is catheter-free monitoring effective? PAGEREF _Toc383606959 \h 154Is catheter-free monitoring cost-effective? PAGEREF _Toc383606960 \h 156Costing PAGEREF _Toc383606961 \h 156Appendix AHealth Expert Standing Panel and Assessment Group PAGEREF _Toc383606962 \h 158Health Expert Standing Panel (HESP) PAGEREF _Toc383606963 \h 158Assessment group PAGEREF _Toc383606964 \h 158Appendix BSearch strategies PAGEREF _Toc383606965 \h 159Bibliographic databases PAGEREF _Toc383606966 \h 162Additional sources of literature PAGEREF _Toc383606967 \h 162Additional databases searched for economic evaluations PAGEREF _Toc383606968 \h 162Specialty websites PAGEREF _Toc383606969 \h 163Appendix CStudies included in the review PAGEREF _Toc383606970 \h 164Study profiles of included studies on safety PAGEREF _Toc383606971 \h 164Study profiles of included studies on direct effectiveness PAGEREF _Toc383606972 \h 183Study profiles of included studies on linked evidence PAGEREF _Toc383606973 \h 202Appendix DExcluded studies PAGEREF _Toc383606974 \h 224Conference abstracts PAGEREF _Toc383606975 \h 224Incorrect/irrelevant intervention PAGEREF _Toc383606976 \h 227Irrelevant outcomes PAGEREF _Toc383606977 \h 227Unable to retrieve full text PAGEREF _Toc383606978 \h 227Not in English, and not of a higher level of evidence than the English language literature PAGEREF _Toc383606979 \h 228Irrelevant or incorrect study design PAGEREF _Toc383606980 \h 228Did not meet inclusion criteria regarding population PAGEREF _Toc383606981 \h 230Appendix E Safety data PAGEREF _Toc383606982 \h 231Appendix F Non-comparative technical efficacy data PAGEREF _Toc383606983 \h 241Appendix G Day-to-day variability in oesophageal acid exposure PAGEREF _Toc383606984 \h 246Appendix H Non-comparative diagnostic yield PAGEREF _Toc383606985 \h 251Appendix I MBS items for anti-reflux surgery PAGEREF _Toc383606986 \h 253Appendix JEconomic literature search PAGEREF _Toc383606987 \h 254Appendix KAdditional information relating to the economic evaluation PAGEREF _Toc383606988 \h 255Appendix LAdditional information for the financial and costing analysis PAGEREF _Toc383606989 \h 257References PAGEREF _Toc383606990 \h 258Tables TOC \f F \c "Table" Table 1Catheter-free monitoring device listed on the ARTG PAGEREF _Toc383607099 \h 33Table 2Relevant MBS item for the currently reimbursed test for GORD PAGEREF _Toc383607100 \h 33Table 3Proposed MBS item descriptor PAGEREF _Toc383607101 \h 35Table 4Electronic databases searched PAGEREF _Toc383607102 \h 41Table 5Search terms used PAGEREF _Toc383607103 \h 41Table 6Search terms used to identify studies for the last step of the linked analysis (health outcomes) PAGEREF _Toc383607104 \h 42Table 7Diagnostic accuracy data extraction for GORD PAGEREF _Toc383607105 \h 47Table 8Evidence dimensions PAGEREF _Toc383607106 \h 49Table 9Designations of levels of evidence according to type of research question (including table notes) PAGEREF _Toc383607107 \h 50Table 10Grading system used to rank included studies PAGEREF _Toc383607108 \h 51Table 11Body of evidence matrix PAGEREF _Toc383607109 \h 53Table 12Chest discomfort or chest pain resulting from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607110 \h 58Table 13Chest pain or chest discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607111 \h 59Table 14Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in children PAGEREF _Toc383607112 \h 60Table 15A foreign-body sensation resulting from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607113 \h 60Table 16A foreign-body sensation resulting from catheter-free (wireless) oesophageal pH monitoring in adults PAGEREF _Toc383607114 \h 60Table 17 Nose and throat pain or discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607115 \h 62Table 18Nose and throat pain or discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607116 \h 63Table 19Throat pain and epistaxis resulting from catheter-free (wireless) oesophageal pH monitoring in adults PAGEREF _Toc383607117 \h 63Table 20Dysphagia resulting from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607118 \h 64Table 21Eating and drinking difficulties resulting from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607119 \h 65Table 22Eating and drinking difficulties resulting from catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607120 \h 66Table 23Impact on daily life from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607121 \h 67Table 24Impact on daily life from catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607122 \h 69Table 25Overall discomfort and satisfaction from catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607123 \h 69Table 26Overall discomfort and satisfaction from catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607124 \h 71Table 27Failure rates / recording efficacy of catheter-free monitoring compared with catheter-based monitoring PAGEREF _Toc383607125 \h 76Table 28Diagnostic accuracy of catheter-free monitoring compared with catheter-based monitoring for diagnosing GORD in adults PAGEREF _Toc383607126 \h 86Table 29Diagnostic accuracy of catheter-free monitoring compared to clinical diagnosis for diagnosing GORD in adults PAGEREF _Toc383607127 \h 87Table 30Concordance of acid exposure times using both monitoring tests in adults PAGEREF _Toc383607128 \h 90Table 31Concordance of acid exposure times using both monitoring tests in children PAGEREF _Toc383607129 \h 92Table 32Number of reflux events in catheter-free monitoring compared with catheter-based monitoring PAGEREF _Toc383607130 \h 93Table 33Diagnostic yield using catheter-free monitoring compared to catheter-based monitoring PAGEREF _Toc383607131 \h 94Table 34Yield comparison between 24 hours and 48 hours with catheter-free monitoring PAGEREF _Toc383607132 \h 95Table 35Concordance between results of the test and treatment for GORD PAGEREF _Toc383607133 \h 98Table 36Specific management changes after wireless oesophageal pH monitoring PAGEREF _Toc383607134 \h 98Table 37Prevalence of symptoms at 5-year follow-up of LOTUS and REFLUX trials PAGEREF _Toc383607135 \h 104Table 38Summary of the economic evaluation (applies to both models) PAGEREF _Toc383607136 \h 113Table 39Implications for true positive and true negative test results for patients in the economic evaluation (base-case) PAGEREF _Toc383607137 \h 120Table 40Additional implications for false positive and false negative patients in the supplementary economic evaluation PAGEREF _Toc383607138 \h 120Table 41Health outcomes associated with treatment pathways in the model PAGEREF _Toc383607139 \h 123Table 42Testing-related healthcare resources used in the economic model PAGEREF _Toc383607140 \h 124Table 43Health state utilities used in the economic evaluation PAGEREF _Toc383607141 \h 125Table 44Utility adjustments used in the economic evaluation PAGEREF _Toc383607142 \h 126Table 45 Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERD PAGEREF _Toc383607143 \h 127Table 46 Model 2: Cost-effectiveness of wireless pH monitoring vs catheter-based pH monitoring in patients with refractory NERD PAGEREF _Toc383607144 \h 127Table 47 Societal ICERs following the proposed listing, allowing for various levels of leakage to include patients tolerant of catheter-based pH monitoring accessing wireless monitoring PAGEREF _Toc383607145 \h 128Table 48Sensitivity analyses around wireless pH-test accuracy for Model 1 PAGEREF _Toc383607146 \h 129Table 49Sensitivity analyses around the assumption of PPI discontinuation for Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERD PAGEREF _Toc383607147 \h 130Table 50Sensitivity analyses around the time horizon measured in Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERD PAGEREF _Toc383607148 \h 130Table 51Sensitivity analyses around the accuracy of wireless pH monitoring and catheter-based monitoring in Model 2 PAGEREF _Toc383607149 \h 131Table 52Additional MBS item resources expected to be used concurrently with all occasions of the proposed intervention PAGEREF _Toc383607150 \h 134Table 53 Other resources expected to be used concurrently with all occasions of the proposed intervention PAGEREF _Toc383607151 \h 134Table 54 Additional MBS item resources expected to be used concurrently in approximately 5%–10% of the proposed interventions PAGEREF _Toc383607152 \h 135Table 55 Total costs directly associated with a service of wireless pH monitoring under the proposed MBS listing PAGEREF _Toc383607153 \h 135Table 56Projected number of wireless pH tests annually under the proposed listing (base-case estimates) PAGEREF _Toc383607154 \h 136Table 57Sensitivity analyses for the projected number of wireless pH tests under the proposed listing PAGEREF _Toc383607155 \h 137Table 58 Total cost of the proposed intervention to the MBS (base-case) PAGEREF _Toc383607156 \h 138Table 59 Sensitivity analysis: Projected MBS costs associated with wireless pH monitoring if patient numbers grow at increased annual rate of 8% PAGEREF _Toc383607157 \h 138Table 60 Sensitivity analysis: Projected MBS costs associated with potential leakage (upper plausible extent) of wireless pH monitoring beyond the restriction (i.e. use in 90% of patients who are tolerant to catheter-based monitoring) PAGEREF _Toc383607158 \h 139Table 61 Sensitivity analysis: Changes in MBS costs of catheter-based monitoring associated with upper plausible limit of potential leakage to wireless pH monitoring beyond the restriction PAGEREF _Toc383607159 \h 140Table 62 Sensitivity analysis: Net changes in MBS costs associated with the proposed listing of wireless pH monitoring (including cost offsets associated with catheter-based monitoring) assuming the upper plausible extent of leakage to wireless pH monitoring beyond the restriction PAGEREF _Toc383607160 \h 141Table 63Costs of hospitalisation incurred by private insurer or patient (base-case) PAGEREF _Toc383607161 \h 142Table 64 Costs of hospitalisation incurred by private insurer or patient—alternative scenarios PAGEREF _Toc383607162 \h 142Table 65 Total Australian healthcare system costs (base-case) PAGEREF _Toc383607163 \h 143Table 66Total Australian healthcare system costs—alternative scenarios PAGEREF _Toc383607164 \h 143Table 67Body of evidence matrix PAGEREF _Toc383607165 \h 149Table 68Financial impact on the MBS, patients and private health insurers, assuming use is strictly limited to patients who cannot tolerate catheter-based monitoring PAGEREF _Toc383607166 \h 152Table 69Financial impact on the MBS, patients and private health insurers, assuming extensive use of wireless monitoring in patients who would otherwise have a catheter-based pH test PAGEREF _Toc383607167 \h 153Table 70Complications and adverse events of catheter-free monitoring compared with catheter-based monitoring in adults PAGEREF _Toc383607168 \h 231Table 71Complications and adverse events of catheter-free monitoring compared with catheter-based monitoring in children PAGEREF _Toc383607169 \h 234Table 72Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in adults PAGEREF _Toc383607170 \h 235Table 73Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in children PAGEREF _Toc383607171 \h 238Table 74Case reports reporting complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring PAGEREF _Toc383607172 \h 238Table 75Chest discomfort / complications resulting from catheter-free (wireless) oesophageal pH monitoring in adults PAGEREF _Toc383607173 \h 239Table 76Technical efficacy of catheter-free (wireless) oesophageal pH monitoring in adults PAGEREF _Toc383607174 \h 241Table 77Technical efficacy of catheter-free (wireless) oesophageal pH monitoring in children PAGEREF _Toc383607175 \h 245Table 78Day-to-day variability in oesophageal acid exposure with catheter-free monitoring in adults PAGEREF _Toc383607176 \h 246Table 79Day-to-day variability in oesophageal acid exposure with catheter-free monitoring in children PAGEREF _Toc383607177 \h 250Table 80Non-comparative diagnostic yield with catheter-free monitoring in adults PAGEREF _Toc383607178 \h 251Table 81Non-comparative diagnostic yield with catheter-free monitoring in children PAGEREF _Toc383607179 \h 252Table 82Anti-reflux surgery MBS item descriptors and claims from July 2012 to June 2013 PAGEREF _Toc383607180 \h 253Table 83Literature search in PubMed 21 November 2013 PAGEREF _Toc383607181 \h 254Table 84Literature containing economic models relating to pH monitoring and management of GORD symptoms PAGEREF _Toc383607182 \h 254Table 85A summary of variables used in the model PAGEREF _Toc383607183 \h 255Table 86Scenario/sensitivity tests around other inputs into the economic model (Model 1 vs empirical treatment) PAGEREF _Toc383607184 \h 256Table 87ASGE Technology Status Evaluation Report: wireless oesophageal pH-monitoring system PAGEREF _Toc383607185 \h 257 Boxes TOC \h \z \c "Box" Box 1Inclusion criteria for studies assessing the safety of catheter-free (wireless) oesophageal pH monitoring PAGEREF _Toc383607078 \h 56Box 2Eligibility criteria for identification of studies relevant to an assessment of effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring PAGEREF _Toc383607079 \h 73Box 3Eligibility criteria for identification of studies relevant to an assessment of the technical efficacy of catheter-free (wireless) ambulatory oesophageal pH monitoring PAGEREF _Toc383607080 \h 75Box 4Inclusion criteria for identification of studies relevant to an assessment of the accuracy of catheter-free (wireless) ambulatory oesophageal pH monitoring PAGEREF _Toc383607081 \h 83Box 5Inclusion criteria for identification of studies relevant to an assessment of change in management following catheter-free (wireless) ambulatory oesophageal pH monitoring PAGEREF _Toc383607082 \h 97Box 6Inclusion criteria for identification of studies relevant to an assessment of health outcomes following a change in management PAGEREF _Toc383607083 \h 101Figures TOC \f \c "Figure" Figure 1Catheter-based pH monitoring PAGEREF _Toc383607084 \h 29Figure 2Usage of catheter-based pH monitoring, July 2012 – June 2013 PAGEREF _Toc383607085 \h 34Figure 3Clinical management algorithm for the proposed new intervention PAGEREF _Toc383607086 \h 37Figure 4Summary of the process used to identify and select studies for the review (in first search) PAGEREF _Toc383607087 \h 44Figure 5Summary of the process used to identify and select studies for the review (in search 'true positives') PAGEREF _Toc383607088 \h 45Figure 6Summary of the process used to identify and select studies for the review (in search 'false negatives and false positives') PAGEREF _Toc383607089 \h 46Figure 7Meta-analysis of technical efficacy of catheter-free monitoring compared with catheter-based monitoring PAGEREF _Toc383607090 \h 78Executive summaryAssessment of catheter-free (wireless) ambulatory oesophageal pH monitoring for gastro-oesophageal reflux diseaseRationale for assessmentAn application requesting Medicare Benefits Schedule (MBS) listing of catheter-free (wireless) ambulatory oesophageal pH monitoring for gastro-oesophageal reflux disease (GORD) was received from Given Imaging Pty Ltd (the applicant) by the Department of Health in January 2012. Catheter-free monitoring is proposed for patients who have previously failed catheter-based monitoring or in whom the use of the latter is anatomically inappropriate. Gastro-oesophageal reflux disease (GORD) and pH monitoringGastric acid reflux in the oesophagus is a normal physiological event and it usually occurs after the consumption of a meal. Acid reflux can lead to impairment in quality of life or physical complications such as oesophagitis, Barrett’s oesophagus or oesophageal adenocarcinoma. Although there is no clear internationally applied definition for GORD, one of the accepted definitions is: ‘a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications’. Reflux is considered to impact on quality of life when symptoms are present on two or more days a week. When a GORD patient’s symptoms are resistant to acid suppression therapy, endoscopy is the primary test to exclude reflux disease and identify other causes. If the endoscopy result is negative, oesophageal pH monitoring is widely used to provide additional information. Oesophageal pH-monitoring measures the exposure of the oesophagus to acid reflux over a defined period of time, whereas endoscopy can only provide information at a single point in time. Currently, the 24-hour catheter-based pH-monitoring test is the most commonly used method of oesophageal pH monitoring. Catheter-based monitoring quantifies the time the oesophagus is exposed to acid and analyses the association between symptoms and reflux events. However, not every patient is able to tolerate catheter-based monitoring, e.g. due to gagging or anatomical challenges; as a consequence, they do not receive any pH monitoring.Catheter-free (wireless) ambulatory oesophageal pH monitoring is a system that consists of a small capsule that is usually delivered transorally during an oesophagoscopy, and a wireless receiver. The pH-monitoring capsule is temporarily attached to the oesophageal wall to measure and transmit pH information for at least 48 hours, sending it to the receiver and thereby circumventing the need for an oesophageal catheter.The primary comparator for catheter-free monitoring is ‘no pH monitoring’, although the Protocol Advisory Sub-Committee (PASC) of the Medicare Services Advisory Committee (MSAC) requested that the accuracy of catheter-free monitoring be compared against 'catheter-based monitoring’. Current arrangements for public reimbursementThere have been no previous MSAC considerations of catheter-free monitoring. The current test for GORD, 24-hour catheter-based monitoring, is listed on the MBS (item 11810) (see REF _Ref350151252 \h \* MERGEFORMAT Table 2). There were 3,590 claims for catheter-based monitoring from July 2012 to June 2013. The device used in catheter-free monitoring was listed on the Australian Register of Therapeutic Goods (ARTG) by the Therapeutic Goods Administration (TGA), and is currently classified as a Medical Device Class IIa (see REF _Ref364240778 \h Table 1). Its use in Australia is still limited: only 27, 22 and 46 catheter-free monitoring capsules were sold to Australian sites in 2011, 2012 and 2013, respectively. Clinical needReflux disease is common. Of patients attending GPs, 10.4% have GORD ADDIN EN.CITE <EndNote><Cite><Author>Knox</Author><Year>2008</Year><RecNum>36</RecNum><DisplayText>(Knox et al. 2008)</DisplayText><record><rec-number>36</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">36</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knox, S. A.</author><author>Harrison, C. M.</author><author>Britt, H. C.</author><author>Henderson, J. V.</author></authors></contributors><auth-address>Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW, Australia.</auth-address><titles><title>Estimating prevalence of common chronic morbidities in Australia</title><secondary-title>Med J Aust</secondary-title><alt-title>The Medical journal of Australia</alt-title></titles><periodical><full-title>Med J Aust</full-title><abbr-1>The Medical journal of Australia</abbr-1></periodical><alt-periodical><full-title>Med J Aust</full-title><abbr-1>The Medical journal of Australia</abbr-1></alt-periodical><pages>66-70</pages><volume>189</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Australia/epidemiology</keyword><keyword>Cardiovascular Diseases/epidemiology</keyword><keyword>Chronic Disease/*epidemiology</keyword><keyword>Female</keyword><keyword>Gastroesophageal Reflux/epidemiology</keyword><keyword>Health Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Morbidity</keyword><keyword>Prevalence</keyword><keyword>Pulmonary Disease, Chronic Obstructive/epidemiology</keyword></keywords><dates><year>2008</year><pub-dates><date>Jul 21</date></pub-dates></dates><isbn>0025-729X (Print)
0025-729X (Linking)</isbn><accession-num>18637769</accession-num><urls><related-urls><url>;(Knox et al. 2008). Studies indicate that between 14% and 25% of adults experience reflux symptoms at least once a week. Although the prevalence of GORD is high, there is a relatively low usage of MBS item 11810 (catheter-based pH monitoring), so it would appear that pH monitoring is not often used for the study of this condition. The new intervention (catheter-free or wireless monitoring) will be used in patients who either fail catheter-based monitoring or in whom its use is anatomically inappropriate. It may avoid lengthy periods of unnecessary pharmacologic therapy in this group, expected to be 5–10% of the patients eligible for pH monitoring. An algorithm outlining the clinical management of patients with GORD, including the use of pH monitoring, can be found on page 37, ( REF _Ref379455005 \h \* MERGEFORMAT Figure 3).Results of assessmentSafety: Only one study was identified that assessed the safety of catheter-free monitoring compared with no monitoring. The findings indicated that chest pain was more likely to occur in those undergoing catheter-free monitoring than in those who did not undergo monitoring (RR=2.33, 95%CI 0.81, 6.76). Twelve studies compared the safety of catheter-free monitoring with catheter-based monitoring. No deaths or life-threatening events caused by pH monitoring were reported. Chest pain was significantly more prevalent in patients undergoing catheter-free monitoring compared with catheter-based monitoring, possibly due to the attachment of the capsule to the oesophageal wall. In a high-quality randomised controlled trial by Andrews et al. (2012), the median chest pain score during the pH test was 29?±?4?mm on a 100-point visual analogue scale (VAS) in the catheter-free monitoring group, compared with only 14?±?3?mm in the catheter-based monitoring group (p=0.001). The difference is likely to be clinically meaningful. However, other adverse events such as nose and throat pain, dysphagia, eating and drinking difficulties, and headache were more prevalent with catheter-based monitoring. Furthermore, catheter-based monitoring caused more overall discomfort and had a greater negative impact on normal daily activities and work attendance. Twenty-nine non-comparative studies of level IV interventional evidence were included to determine the rate of other complications and/or adverse events caused by catheter-free monitoring. Most adverse events reported were related to discomfort caused by the capsule attaching to the oesophageal mucosa, e.g. pharyngeal irritation, retrosternal discomfort and throat pain. More-severe complications from catheter-free monitoring, such as a rupture in the oesophageal mucosa, were rare. Effectiveness: Studies assessing the direct health impact of catheter-free monitoring versus no monitoring in the selected study population were not available. Two studies that did not meet the pre-specified inclusion criteria, but reported on the health effects of catheter-free monitoring, were included in the absence of more relevant data. One comparative study reported an improvement or disappearance of the principal symptom in 73% of patients in the wireless group (n=51) and 69% in the catheter-based group (n=51). A case series reported 9 patients with a good or moderate improvement in symptoms, out of 26 patients who received medical therapy or conservative advice after a catheter-free monitoring test.The sensitivity and specificity of catheter-free monitoring could be calculated from eight studies. In three of these studies the reference standard was catheter-based monitoring. The highest quality study, of level II diagnostic accuracy, indicated that a catheter-free monitoring test with a diagnostic cut-off point of 4.4% of the time that pH <4 had good sensitivity and specificity, with rates of 86.4% and 77.8%, respectively. The accuracy of catheter-free monitoring in the two other studies was similar, although test sensitivity was slightly lower and specificity slightly higher. Five diagnostic case-control studies, of level III-3 diagnostic accuracy, used clinical diagnosis as a reference standard. The study with the largest patient population reported sensitivity ranging between 59% and 88% and specificity between 75% and 96%, depending on which cut-off value was used (between 1.9% and 4.4% of the time that pH <4). There were nine studies that reported on oesophageal acid exposure times during catheter-free monitoring in adults. Most (five out of eight) of the studies reporting on adults found no difference between the two measurement methods. There was one study that reported concordance data on oesophageal acid exposure in children, finding significantly more reflux with wireless monitoring compared with catheter-based monitoring (p=0.01). Three of four available studies reported significantly more reflux events with the catheter-based monitoring system. Monitoring time was increased in the wireless-based compared with the catheter-based method. Six studies compared the yield of GORD diagnoses after 24 and 48?hours of catheter-free monitoring, and reported an additional yield on day 2 of monitoring, varying from 2.0% to 15.6% with a median of 7.8%.Nine studies reported on the technical efficacy of the wireless system. A meta-analysis was conducted and showed that there was over three times the risk (RR=3.3, 95%CI 1.63, 6.81) of having technical problems with the catheter-free monitoring system compared with catheter-based monitoring in adults. The risk decreased slightly (RR=2.87, 95%CI 1.47, 5.62) when used in a combined population of adults and children. The most commonly reported technical failures associated with catheter-free monitoring were early capsule detachments, causing incomplete data capture, and errors in placement of the system, i.e. in the wrong place in the oesophagus or where the capsule fails to attach to the oesophageal mucosa. On average, problems occurred more often during insertion or placement of the catheter-free system (median 7.5% of procedures, range 0–12%) than the catheter-based system (median 0.9% of procedures, range 0–4%). In most studies (15/20) the oesophageal acid exposure remained the same across 2?days of catheter-free monitoring in adults.Five studies reported on change in patient management after catheter-free monitoring, in patients who were suspected of GORD but who could have potentially tolerated a catheter-based test. The results of these studies were described due to a lack of more-relevant data in patients unable to tolerate a catheter-based test. One study reported that 42.2% (38/90) of patients continued to take proton pump inhibitors (PPIs) despite a negative pH test result. A second study reported that medical therapy or conservative advice was pursued in 68% of cases at a median of 2?years after the test, and two other studies showed that monitoring led to a change in management in 63% of adults and 88% of children. Finally, one other study stated that concordance between the test and treatment was higher after catheter-free monitoring than catheter-based monitoring: 78% vs 58% (p<0.05).To answer the question whether a change in management leads to better health outcomes, a second literature search was conducted. No evidence was found to determine the psychological or physical impact of a false negative test result. For people initially suspected of having GORD but eventually given an alternative diagnosis (i.e. true negatives), it was assumed that their management had been optimised as a result of obtaining the correct diagnosis. However, two retrospective case series reported poorer outcomes and worse treatment responses in infants with infantile spasms misdiagnosed as GORD (false positive test results) compared with infants with no treatment lag. Two systematic reviews comparing medical treatment with anti-reflux surgery reported that surgery was more effective than medical management at treating GORD symptoms, at least in the short to medium term.Two randomised controlled trials (RCTs) have been published since the high-quality Wileman et al. (2010) review was published. After 5?years laparoscopic fundoplication continued to provide better relief of GORD symptoms than medical management. Economic and financial considerationsTwo economic models were constructed to determine: the cost-effectiveness of catheter-free pH monitoring vs no monitoring (empirical treatment) in an Australian population who cannot tolerate catheter-based monitoring; and the cost-effectiveness (or not) of catheter-free monitoring vs catheter-based monitoring should use of the proposed listing ‘leak’ to include patients who are not intolerant of catheter-based monitoring.Characteristics of the cost–utility models, which assume a health system perspective from public and private healthcare providers and defined patient contributions are outlined in REF _Ref379483368 \h Table ES 1.Table ES 1Summary of the economic evaluation (applies to both models)Time horizonBase-case analysis of 15 yearsOutcomesQuality-adjusted life yearsMethods used to generate resultsMarkov model with half-cycle correctionCycle length1 yearDiscount rate5% for both costs and outcomesSoftware packages usedTreeAge Pro and Excel (hybrid)Key structural assumptions were: that a positive pH test result provided patients the option of surgery to treat GORD symptoms; and that a negative result would prompt investigation for other diagnoses and reduce the use of ongoing high-dose PPIs. When modelling, it was considered that inclusion of the accuracy of wireless pH monitoring when measured against catheter-based monitoring—an imperfect reference standard—would distort the results; therefore, the base-case assumes wireless pH monitoring, catheter-based monitoring and a trial of empirical treatment (high-dose PPIs) to be equally accurate. Sensitivity analyses explore alternative test accuracy values.The base-case analysis found that wireless pH monitoring vs no pH monitoring had an incremental cost-effectiveness ratio of $14,457 per quality-adjusted life year (QALY) gained. However, when compared against catheter-based monitoring, wireless monitoring was dominated—it had a higher cost and was less effective, with the lesser effectiveness due to an increased technical failure rate. Thus, if catheter-free monitoring were to be MBS listed, leakage of use into patients who could otherwise tolerate catheter-based monitoring may substantially reduce the assumed cost-effectiveness. The overall cost-effectiveness of an MBS listing is dependent on the predicted extent of leakage, with 30% leakage into cohorts of patients who are able to tolerate, or do not fail, catheter-based monitoring increasing the overall incremental cost-effectiveness ratio (ICER) to $58,429/QALY.Other key areas of uncertainty in the cost–utility models relate to: the assumed accuracy of the test—where imperfect sensitivity and specificity values are incorporated, sensitivity analyses showed that wireless monitoring was dominated, with sensitivity values ≤90%; and the assumption that, in the absence of a pH test (which incorporates a follow-up assessment of results), some patients will be trialled on high-dose PPIs and inappropriately remain on this treatment indefinitely. That this occurs is supported by the literature and expert opinion, but quantification is highly uncertain. If the assumption is removed altogether, wireless pH monitoring is dominated by an empirical trial of high-dose medication. The base-case assumes that inappropriate ongoing high-dose PPI use occurs in 1 in 10 patients diagnosed with non-erosive reflux disease (NERD)-like symptoms but who actually have a non-acid related condition.It is estimated that the ‘true’ catheter-intolerant patient population who would benefit from wireless monitoring would be approximately 400 patients per year (2015–16 estimate = 404), increasing by 4%–8% per year, based on the current extent and growth of catheter-based pH monitoring MBS claims. This estimate would result in MBS costs of approximately $369,000 directly associated with the new item number, and a further $67,000 in associated MBS-funded anaesthesia items, per year (with annual growth). There are no MBS cost offsets in this patient population. Of this expenditure of $436,000, patients are expected to pay approximately $100,000.The overall financial impact of the proposed listing is also highly dependent on the extent of predicted use beyond the intended catheter-intolerant population, and it is noted that the proposed fee, in including an ‘equipment depreciation’ component, provides an incentive that encourages increased servicing.If 90% (an extreme upper plausible limit) of patients who are tolerant to catheter-based monitoring ‘switched’ to wireless monitoring, the net MBS impacts, including cost offsets of ‘unused’ catheter-based monitoring, would exceed $3.5?million per year, of which approximately $880,000 would be paid through patient contributions.Other non-MBS costs incurred are private hospital costs, which may range from $275,000 to $2.5?million across the population, depending on leakage.Other relevant considerations / discussionThe catheter-free monitoring test is seen as more convenient and has less impact on daily activities than catheter-based monitoring. It can be difficult to determine who is ‘unable’ to tolerate a catheter. Physicians might therefore be inclined to give more patients catheter-free monitoring than catheter-based monitoring to avoid discomfort and embarrassment. Thus, it is possible that the population using catheter-free monitoring may expand beyond the population currently being considered for eligibility for the device, and this ‘leakage’ could lead to extra costs (see ‘Economic and financial considerations’).The validity of catheter-based monitoring as a reference standard to determine the diagnostic accuracy of catheter-free monitoring is questionable. First, catheter-free monitoring is able to monitor acid reflux for 48?hours instead of the 24?hours used with catheter-based monitoring; this leads to increased diagnostic yield. Second, many of the short reflux events that are measured by catheter-based monitoring and not by catheter-free monitoring could be artefacts that are not related to GORD. It is possible that catheter-free monitoring is more accurate than catheter-based monitoring.There are other limitations with the reported test accuracy data. There was considerable variation and a lack of consensus across the studies in the evidence-base with regard to diagnostic thresholds (cut-off points), defining a positive test result (worst day analysis, positive value on both days, reflux symptom correlation) and determining the optimal position of the capsule in the oesophagus. There is therefore a considerable lack of certainty with regard to the reported test accuracy results. Glossary and abbreviations TermDescriptionAHTAAdelaide Health Technology AssessmentARTGAustralian Register of Therapeutic Goodscatheter-based monitoringcatheter-based pH monitoringcatheter-free monitoringcatheter-free (wireless) pH monitoringCBPMcatheter-based pH monitoringCFPMcatheter-free (wireless) pH monitoringCIconfidence intervalDAPdecision analytic protocolFHfunctional heartburnGOJgastro-oesophageal junctionGORDgastro-oesophageal reflux diseaseH. pyloriHelicobacter pyloriH2histamine 2 (receptor)HESPHealth Expert Standing PanelHOhypersensitive oesophagusICERincremental cost-effectiveness ratioLOSlower oesophageal sphincterLR+likelihood ratio positiveLR–likelihood ratio negativeMBSMedicare Benefits ScheduleMIImultichannel intraluminal impedanceMSACMedical Services Advisory CommitteeNERDnon-erosive reflux diseaseNHMRCNational Health and Medical Research CouncilNPVnegative predictive valueNSnot significantOeOoesinophilic oeosphagitisPASCProtocol Advisory Sub-Committee (of MSAC)PBSPharmaceutical Benefits SchemePPIsproton pump inhibitorsPPVpositive predictive valueQALYquality-adjusted life yearQoLquality of lifeRCTrandomised controlled trialSCJsquamo-columnar junctionVASvisual analogue scaleIntroductionThis assessment report is intended for the Medical Services Advisory Committee (MSAC). MSAC evaluates new and existing health technologies and procedures for which funding is sought under the Medicare Benefits Schedule (MBS) in terms of their safety, effectiveness and cost-effectiveness, while taking into account other issues such as access and equity. MSAC adopts an evidence-based approach to its assessments, based on reviews of the scientific literature and other information sources, including clinical expertise.Adelaide Health Technology Assessment (AHTA), School of Population Health, University of Adelaide, has been commissioned by the Australian Government Department of Health to conduct a systematic literature review and economic evaluation of the use of catheter-free (wireless) oesophageal pH monitoring in the diagnosis of gastro-oesophageal reflux disease (GORD). This evaluation has been undertaken in order to inform MSAC’s decision-making regarding public funding of the intervention. The proposed use of catheter-free (wireless) oesophageal pH monitoring in Australian clinical practice was outlined in a decision analytical protocol (DAP) that guided the evaluation undertaken by AHTA. The DAP was released for public comment on 28 May 2012 and closed for comments on 5 July 2012. No public consultation responses were received. The DAP was finalised as a result of PASC deliberation on 16–17 August 2012.Rationale for assessmentGiven Imaging Pty Ltd (the applicant) submitted an application to the Department of Health in January 2012, requesting an MBS listing for catheter-free (wireless) ambulatory oesophageal pH monitoring for the diagnosis of GORD. Its use is proposed in patients who have previously failed catheter-based monitoring or in whom the use of the latter is anatomically inappropriate. BackgroundGastro-oesophageal reflux disease (GORD)Gastric acid reflux in the oesophagus is a normal physiological event and it usually occurs after the consumption of a meal. GORD occurs when acid reflux impairs a person’s quality of life or when it leads to a risk of physical complications such as oesophagitis, Barrett’s oesophagus or oesophageal adenocarcinoma ADDIN EN.CITE <EndNote><Cite><Year>2011</Year><RecNum>14</RecNum><DisplayText>(Gastroenterological Society of Australia 2011)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">14</key></foreign-keys><ref-type name="Pamphlet">24</ref-type><contributors><authors><author>Gastroenterological Society of Australia,</author></authors><secondary-authors><author>Gastroenterological Society of Australia</author></secondary-authors></contributors><titles><title>Gastro-oesophageal Reflux Disease in Adults (5th ed)</title></titles><dates><year>2011</year></dates><publisher>Gastroenterological Society of Australia, Digestive Health Foundation</publisher><urls></urls></record></Cite></EndNote>(Gastroenterological Society of Australia 2011). Although there is no clear internationally applied definition for GORD, it is defined by consensus PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EZW50PC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EZW50PC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA (Dent et al. 2005; Katz, Gerson & Vela 2012). The current definition of the disorder being used by the International Foundation of Functional Gastrointestinal Disorders (IFFGD) and the American Gastroenterological Association is: ‘a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications’ PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5JRkZHRDwvQXV0aG9yPjxSZWNOdW0+NTg2PC9SZWNOdW0+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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5JRkZHRDwvQXV0aG9yPjxSZWNOdW0+NTg2PC9SZWNOdW0+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 EN.CITE.DATA (IFFGD 2014; Kahrilas 2008; Kahrilas, Shaheen & Vaezi 2008). Reflux is considered to impact on quality of life when symptoms are present on two or more days a week. The definition used by the Gastroenterological Society of Australia (2013) is ‘persistent reflux that occurs more than twice a week’. Oesophagitis, which is present in about one-third of GORD patients, occurs when excessive reflux of acid and pepsin results in necrosis of surface layers of the oesophageal mucosa, causing erosions and ulcers. Although the absolute risk of oesophageal cancer in an individual with GORD is small ADDIN EN.CITE <EndNote><Cite><Year>2011</Year><RecNum>14</RecNum><DisplayText>(Gastroenterological Society of Australia 2011)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">14</key></foreign-keys><ref-type name="Pamphlet">24</ref-type><contributors><authors><author>Gastroenterological Society of Australia,</author></authors><secondary-authors><author>Gastroenterological Society of Australia</author></secondary-authors></contributors><titles><title>Gastro-oesophageal Reflux Disease in Adults (5th ed)</title></titles><dates><year>2011</year></dates><publisher>Gastroenterological Society of Australia, Digestive Health Foundation</publisher><urls></urls></record></Cite></EndNote>(Gastroenterological Society of Australia 2011), oesophageal adenocarcinoma is epidemiologically linked to GORD and the incidence of both is increasing PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+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ADDIN EN.CITE.DATA (Kahrilas 2008; Lagergren et al. 1999). Up to 15% of patients with chronic reflux disease undergoing endoscopy may be shown to develop Barrett’s oesophagus. This condition involves the development of columnar metaplasia in place of the normal squamous epithelium, and is a risk factor for the development of oesophageal adenocarcinoma PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoZWVuPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGFoZWVuPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48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ADDIN EN.CITE.DATA (Shaheen & Richter 2009). Several factors can predispose patients to GORD, such as a hiatus hernia, lower oesophageal sphincter (LOS) hypotension, loss of oesophageal peristaltic function, obesity, increased compliance of the hiatal canal, gastric hypersecretory states, delayed gastric emptying, overeating and alcohol consumption. Often, multiple risk factors are present PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs
YXlUZXh0PihHYXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkgb2YgQXVzdHJhbGlhIDIwMTE7IEth
aHJpbGFzIDIwMDgpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE0PC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNWRlZGZkc3RsZHR3dGxlMDVh
aHB3ZjBjdjI1emUwZWYyZTV2Ij4xNDwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1l
PSJQYW1waGxldCI+MjQ8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5H
YXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkgb2YgQXVzdHJhbGlhLDwvYXV0aG9yPjwvYXV0aG9y
cz48c2Vjb25kYXJ5LWF1dGhvcnM+PGF1dGhvcj5HYXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkg
b2YgQXVzdHJhbGlhPC9hdXRob3I+PC9zZWNvbmRhcnktYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48
dGl0bGVzPjx0aXRsZT5HYXN0cm8tb2Vzb3BoYWdlYWwgUmVmbHV4IERpc2Vhc2UgaW4gQWR1bHRz
ICg1dGggZWQpPC90aXRsZT48L3RpdGxlcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48L2RhdGVz
PjxwdWJsaXNoZXI+R2FzdHJvZW50ZXJvbG9naWNhbCBTb2NpZXR5IG9mIEF1c3RyYWxpYSwgRGln
ZXN0aXZlIEhlYWx0aCBGb3VuZGF0aW9uPC9wdWJsaXNoZXI+PHVybHM+PC91cmxzPjwvcmVjb3Jk
PjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPkthaHJpbGFzPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48
UmVjTnVtPjU4NzwvUmVjTnVtPjxJRFRleHQ+MTcwMC03PC9JRFRleHQ+PHJlY29yZD48cmVjLW51
bWJlcj41ODc8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4
enc1ZWZkZmxkZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjU4Nzwva2V5PjwvZm9yZWlnbi1r
ZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJp
YnV0b3JzPjxhdXRob3JzPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRob3Jz
PjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9n
eSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBDaGljYWdvIElMIDYwNjExLTI5NTEsIFVT
QS4gcC1rYWhyaWxhc0Bub3J0aHdlc3Rlcm4uZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0
bGU+Q2xpbmljYWwgcHJhY3RpY2UuIEdhc3Ryb2Vzb3BoYWdlYWwgcmVmbHV4IGRpc2Vhc2U8L3Rp
dGxlPjxzZWNvbmRhcnktdGl0bGU+TiBFbmdsIEogTWVkPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10
aXRsZT5UaGUgTmV3IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWx0LXRpdGxlPjwvdGl0
bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk4gRW5nbCBKIE1lZDwvZnVsbC10aXRsZT48YWJi
ci0xPlRoZSBOZXcgRW5nbGFuZCBqb3VybmFsIG9mIG1lZGljaW5lPC9hYmJyLTE+PC9wZXJpb2Rp
Y2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OIEVuZ2wgSiBNZWQ8L2Z1bGwtdGl0bGU+
PGFiYnItMT5UaGUgTmV3IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWJici0xPjwvYWx0
LXBlcmlvZGljYWw+PHBhZ2VzPjE3MDAtNzwvcGFnZXM+PHZvbHVtZT4zNTk8L3ZvbHVtZT48bnVt
YmVyPjE2PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPkVzb3BoYWd1cy9wYXRob2xvZ3k8L2tl
eXdvcmQ+PGtleXdvcmQ+KkZ1bmRvcGxpY2F0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vz
b3BoYWdlYWwgUmVmbHV4L2NvbXBsaWNhdGlvbnMvZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3b3Jk
PjxrZXl3b3JkPkhpc3RhbWluZSBBbnRhZ29uaXN0cy90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+
PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+
TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+UHJhY3RpY2UgR3VpZGVsaW5lcyBhcyBUb3Bp
Yzwva2V5d29yZD48a2V5d29yZD5Qcm90b24gUHVtcCBJbmhpYml0b3JzLyp0aGVyYXBldXRpYyB1
c2U8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwODwveWVhcj48cHViLWRhdGVz
PjxkYXRlPk9jdCAxNjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1MzMtNDQwNiAo
RWxlY3Ryb25pYykmI3hEOzAwMjgtNDc5MyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+
MTg5MjMxNzI8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93
d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTg5MjMxNzI8L3VybD48L3JlbGF0ZWQtdXJscz48
L3VybHM+PGN1c3RvbTI+MzA1ODU5MTwvY3VzdG9tMj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+
MTAuMTA1Ni9ORUpNY3AwODA0Njg0PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48
L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs
YXlUZXh0PihHYXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkgb2YgQXVzdHJhbGlhIDIwMTE7IEth
aHJpbGFzIDIwMDgpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE0PC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNWRlZGZkc3RsZHR3dGxlMDVh
aHB3ZjBjdjI1emUwZWYyZTV2Ij4xNDwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1l
PSJQYW1waGxldCI+MjQ8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5H
YXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkgb2YgQXVzdHJhbGlhLDwvYXV0aG9yPjwvYXV0aG9y
cz48c2Vjb25kYXJ5LWF1dGhvcnM+PGF1dGhvcj5HYXN0cm9lbnRlcm9sb2dpY2FsIFNvY2lldHkg
b2YgQXVzdHJhbGlhPC9hdXRob3I+PC9zZWNvbmRhcnktYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48
dGl0bGVzPjx0aXRsZT5HYXN0cm8tb2Vzb3BoYWdlYWwgUmVmbHV4IERpc2Vhc2UgaW4gQWR1bHRz
ICg1dGggZWQpPC90aXRsZT48L3RpdGxlcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48L2RhdGVz
PjxwdWJsaXNoZXI+R2FzdHJvZW50ZXJvbG9naWNhbCBTb2NpZXR5IG9mIEF1c3RyYWxpYSwgRGln
ZXN0aXZlIEhlYWx0aCBGb3VuZGF0aW9uPC9wdWJsaXNoZXI+PHVybHM+PC91cmxzPjwvcmVjb3Jk
PjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPkthaHJpbGFzPC9BdXRob3I+PFllYXI+MjAwODwvWWVhcj48
UmVjTnVtPjU4NzwvUmVjTnVtPjxJRFRleHQ+MTcwMC03PC9JRFRleHQ+PHJlY29yZD48cmVjLW51
bWJlcj41ODc8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4
enc1ZWZkZmxkZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjU4Nzwva2V5PjwvZm9yZWlnbi1r
ZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJp
YnV0b3JzPjxhdXRob3JzPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRob3Jz
PjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9n
eSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBDaGljYWdvIElMIDYwNjExLTI5NTEsIFVT
QS4gcC1rYWhyaWxhc0Bub3J0aHdlc3Rlcm4uZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0
bGU+Q2xpbmljYWwgcHJhY3RpY2UuIEdhc3Ryb2Vzb3BoYWdlYWwgcmVmbHV4IGRpc2Vhc2U8L3Rp
dGxlPjxzZWNvbmRhcnktdGl0bGU+TiBFbmdsIEogTWVkPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10
aXRsZT5UaGUgTmV3IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWx0LXRpdGxlPjwvdGl0
bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk4gRW5nbCBKIE1lZDwvZnVsbC10aXRsZT48YWJi
ci0xPlRoZSBOZXcgRW5nbGFuZCBqb3VybmFsIG9mIG1lZGljaW5lPC9hYmJyLTE+PC9wZXJpb2Rp
Y2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OIEVuZ2wgSiBNZWQ8L2Z1bGwtdGl0bGU+
PGFiYnItMT5UaGUgTmV3IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWJici0xPjwvYWx0
LXBlcmlvZGljYWw+PHBhZ2VzPjE3MDAtNzwvcGFnZXM+PHZvbHVtZT4zNTk8L3ZvbHVtZT48bnVt
YmVyPjE2PC9udW1iZXI+PGtleXdvcmRzPjxrZXl3b3JkPkVzb3BoYWd1cy9wYXRob2xvZ3k8L2tl
eXdvcmQ+PGtleXdvcmQ+KkZ1bmRvcGxpY2F0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vz
b3BoYWdlYWwgUmVmbHV4L2NvbXBsaWNhdGlvbnMvZGlhZ25vc2lzLyp0aGVyYXB5PC9rZXl3b3Jk
PjxrZXl3b3JkPkhpc3RhbWluZSBBbnRhZ29uaXN0cy90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+
PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+
TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+UHJhY3RpY2UgR3VpZGVsaW5lcyBhcyBUb3Bp
Yzwva2V5d29yZD48a2V5d29yZD5Qcm90b24gUHVtcCBJbmhpYml0b3JzLyp0aGVyYXBldXRpYyB1
c2U8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwODwveWVhcj48cHViLWRhdGVz
PjxkYXRlPk9jdCAxNjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1MzMtNDQwNiAo
RWxlY3Ryb25pYykmI3hEOzAwMjgtNDc5MyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+
MTg5MjMxNzI8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93
d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTg5MjMxNzI8L3VybD48L3JlbGF0ZWQtdXJscz48
L3VybHM+PGN1c3RvbTI+MzA1ODU5MTwvY3VzdG9tMj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+
MTAuMTA1Ni9ORUpNY3AwODA0Njg0PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48
L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE.DATA (Gastroenterological Society of Australia 2011; Kahrilas 2008). Also, the following specific patient groups are at higher risk of GORD and its complications ADDIN EN.CITE <EndNote><Cite><Year>2011</Year><RecNum>14</RecNum><DisplayText>(Gastroenterological Society of Australia 2011)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">14</key></foreign-keys><ref-type name="Pamphlet">24</ref-type><contributors><authors><author>Gastroenterological Society of Australia,</author></authors><secondary-authors><author>Gastroenterological Society of Australia</author></secondary-authors></contributors><titles><title>Gastro-oesophageal Reflux Disease in Adults (5th ed)</title></titles><dates><year>2011</year></dates><publisher>Gastroenterological Society of Australia, Digestive Health Foundation</publisher><urls></urls></record></Cite></EndNote>(Gastroenterological Society of Australia 2011): patients with connective tissue diseases such as sclerodermapatients with chronic respiratory diseases such as asthma and cystic fibrosispeople who are institutionalised and/or intellectually handicappedpatients nursed in a supine position for prolonged periods. Most GORD patients experience a burning feeling rising up from the stomach or lower chest towards the neck, known as heartburn. However, the symptoms of GORD, ulcer disease, irritable bowel syndrome (IBS) and dyspepsia are often similar. When a patient exhibits typical GORD symptoms and responds to therapy, no additional diagnostic tests are necessary. Diagnostic testing is usually done to avert misdiagnosis, identify complications of GORD and evaluate treatment failures. Other diagnoses that could be considered when GORD treatment fails include coronary heart disease; gallbladder disease; gastric or oesophageal cancer; peptic ulcer disease; oesophageal motility disorders; and oesinophilic, infectious or pill oesophagitis ADDIN EN.CITE <EndNote><Cite><Author>Kahrilas</Author><Year>2008</Year><RecNum>587</RecNum><IDText>1700-7</IDText><DisplayText>(Kahrilas 2008)</DisplayText><record><rec-number>587</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">587</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kahrilas, P. J.</author></authors></contributors><auth-address>Division of Gastroenterology, Feinberg School of Medicine, Chicago IL 60611-2951, USA. p-kahrilas@northwestern.edu</auth-address><titles><title>Clinical practice. Gastroesophageal reflux disease</title><secondary-title>N Engl J Med</secondary-title><alt-title>The New England journal of medicine</alt-title></titles><periodical><full-title>N Engl J Med</full-title><abbr-1>The New England journal of medicine</abbr-1></periodical><alt-periodical><full-title>N Engl J Med</full-title><abbr-1>The New England journal of medicine</abbr-1></alt-periodical><pages>1700-7</pages><volume>359</volume><number>16</number><keywords><keyword>Esophagus/pathology</keyword><keyword>*Fundoplication</keyword><keyword>Gastroesophageal Reflux/complications/diagnosis/*therapy</keyword><keyword>Histamine Antagonists/therapeutic use</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Practice Guidelines as Topic</keyword><keyword>Proton Pump Inhibitors/*therapeutic use</keyword></keywords><dates><year>2008</year><pub-dates><date>Oct 16</date></pub-dates></dates><isbn>1533-4406 (Electronic)
0028-4793 (Linking)</isbn><accession-num>18923172</accession-num><urls><related-urls><url>;(Kahrilas 2008). When the patient’s symptoms are resistant to acid suppression therapy, endoscopy is the primary test to exclude reflux disease and to diagnose other causes. However, the yield of endoscopy is low because of the poor correlation between symptoms of GORD and oesophagitis, the likelihood that oesophagitis may already have been resolved with previous therapy, and its poor sensitivity at detecting motility disorders. If the endoscopy result is negative, other physiological testing can be considered, such as oesophageal manometry to detect motility disorders, ambulatory pH monitoring to demonstrate abnormal exposure to acid (see below), or impedance monitoring to identify reflux events regardless of acidic content PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs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ADDIN EN.CITE.DATA (Gastroenterological Society of Australia 2011; Kahrilas 2008). Treatments for GORD depend on symptom severity and include lifestyle modification, pharmacologic therapy [proton pump inhibitors (PPIs), H2 (histamine 2) antagonists] and surgical intervention. PPIs and H2 antagonists both reduce gastric acid production, although PPIs seem to be more effective than H2 antagonists PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Fcmlrc3NvbjwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Fcmlrc3NvbjwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+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ADDIN EN.CITE.DATA (Eriksson et al. 1995). Reflux disease patients with severe oesophagitis may be treated with a standard dose of PPIs on an ongoing basis. A surgical intervention, usually laparoscopic fundoplication, is indicated in patients whose GORD symptoms cannot be controlled using medical therapy, or who wish to avoid being medicated over the long term and accept the risks associated with a surgical procedure. pH monitoringOesophageal pH monitoring is widely used to monitor GORD after a negative endoscopy result. It provides additional information by monitoring acid reflux over a period of time rather than, in the case of endoscopy, at one point in time. It is useful when the relationship between symptoms and reflux aetiology remains unclear. A pH-monitoring study may reveal PPI failure and associated ongoing acid reflux, which may require dose escalation of therapy, adequate acid control or no reflux. When the pH study in refractory GORD patients is negative, those with heartburn may be classified as having ‘functional heartburn’; and in those with other ongoing, atypical symptoms, other diagnoses may be considered ADDIN EN.CITE <EndNote><Cite><Author>Katz</Author><Year>2012</Year><RecNum>239</RecNum><DisplayText>(Katz, Gerson & Vela 2012)</DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Katz, P. O.</author><author>Gerson, L. B.</author><author>Vela, M. F.</author></authors></contributors><auth-address>Division of Gastroenterology, Einstein Medical Center, Philadelphia, Pennsylvania, USA.</auth-address><titles><title>Guidelines for the diagnosis and management of gastroesophageal reflux disease</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>308-28</pages><volume>108</volume><number>3</number><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1572-0241 (Electronic)
0002-9270 (Linking)</isbn><accession-num>23419381</accession-num><urls><related-urls><url>;(Katz, Gerson & Vela 2012). The current MBS-approved pH-monitoring test for GORD: catheter-based ambulatory oesophageal pH monitoring (MBS item 11810)Currently, the 24-hour catheter-based pH-monitoring system is commonly used to objectively diagnose GORD PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZWJlcjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZWJlcjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Weber, Davis & Fisichella 2011). Before the measurement starts, a pH-measuring sensor with a catheter is passed transnasally and placed with manometric guidance. This is often a cause of discomfort for the patient. The catheter is then taped to the patient’s nose, and the patient returns to the hospital or rooms of the specialist 24?hours later to have the catheter removed and the data analysed.Although catheter-based monitoring quantifies the time the oesophagus is exposed to acid and measures the association between symptoms and reflux events, it does have some disadvantages. It is claimed that poor patient tolerance is the main drawback, as it leads to patient discomfort, social embarrassment, and alteration of daily activities and eating habits during the monitoring period ( REF _Ref379455158 \h Figure 1). Other claimed disadvantages include variable test accuracy and a limited observation period that leads to less-reproducible results. It is very important that the sensors are correctly placed in order for the results to be valid PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA (Lee 2012; Weber, Davis & Fisichella 2011). The information from the sensor is used to guide or reassess treatment strategies for patients.Figure 1Catheter-based pH monitoring Source: [accessed August 2013]Catheter-free (wireless) ambulatory oesophageal pH monitoringCatheter-free (wireless) ambulatory oesophageal pH monitoring for use in the confirmatory diagnosis of GORD is a system that consists of a small capsule (which is usually delivered transorally during an oesophagoscopy or sometimes transnasally during manometry) plus a wireless receiver that the patient wears on his or her belt. The radiotelemetry pH-monitoring capsule is temporarily attached to the oesophagus wall to measure and transmit pH information every 6?seconds for at least 48?hours, sending it to the receiver and thereby circumventing the need for an oesophageal catheter PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZWJlcjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZWJlcjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Maerten et al. 2007; Weber, Davis & Fisichella 2011). The wireless capsule is invisible, so the patient should be better able to carry out his/her normal daily activities, which should lead to more reliable and accurate results. The procedureFirst, the capsule is calibrated by submersion in pH buffer solutions, and is then placed through the mouth, and sometimes the nose, into the oesophagus via endoscopic guidance. The distal end of the capsule is placed approximately 6?cm above the squamo-columnar junction (SCJ) or 5?cm above the proximal border of the LOS via manometric guidance. The LOS is usually localised before capsule placement PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OdXNyYXQ8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OdXNyYXQ8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Nusrat, Roy & Bielefeldt 2012). The capsule itself measures 6?x?5.5?x?25?mm and contains a 3.5?mm-deep well that is connected to an external vacuum unit. When the capsule is being placed, suction is applied through the suction channel, causing the adjacent mucosa to be drawn into the well of the capsule. At this point a spring-loaded mechanism puts a little stainless steel pin through the well of the capsule, securing the mucosa in the well and attaching the capsule to the oesophageal wall. The delivery system is then removed PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWVydGVuPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWVydGVuPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE.DATA (Maerten et al. 2007; Pandolfino et al. 2003). The single-use capsule makes catheter-free monitoring more expensive than the traditional catheter-based monitoring, which usually uses a reusable catheter, although single-use catheters are also available. During the pH recording days, patients keep a diary where they record food intake, symptoms and activities, including changes in their position. After 48?hours the patient returns to the hospital or specialist’s rooms, and the information on the receiver is uploaded to a computer and interpreted by a physician. AccuView is the software used to review and analyse the test results. Recent versions of the software are compatible with both the Bravo pH (catheter-free) and Digitrapper pH-Z (catheter-based) monitoring systems, eliminating the need to learn and maintain separate systems. The information in the diary is used to interpret the pH data. The capsule usually spontaneously dislodges from the oesophageal mucosa within 15?days. However, in some cases it does not spontaneously detach and needs to be endoscopically removed PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwMzwvWWVh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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwMzwvWWVh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 EN.CITE.DATA (Pandolfino et al. 2003). Intended purpose Between 5% and 10% of patients eligible for pH monitoring are intolerant of the intubation required for the transnasal catheter or they fail to complete 24-hour catheter-based monitoring PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Sweis et al. 2009). Early referral for pH monitoring, and pH monitoring of patients who fail catheter-based monitoring, may avoid lengthy periods of unnecessary medical therapy ADDIN EN.CITE <EndNote><Cite><Author>Kleiman</Author><Year>2012</Year><RecNum>10</RecNum><DisplayText>(Kleiman et al. 2012)</DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kleiman, D. A.</author><author>Sporn, M. J.</author><author>Beninato, T.</author><author>Metz, Y.</author><author>Crawford, C.</author><author>Fahey, T. J., 3rd</author><author>Zarnegar, R.</author></authors></contributors><auth-address>Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, 525 East 68th Street, F-2024, New York, NY, 10065, USA, dak2011@.</auth-address><titles><title>Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications</title><secondary-title>Surg Endosc</secondary-title><alt-title>Surgical endoscopy</alt-title></titles><periodical><full-title>Surg Endosc</full-title><abbr-1>Surgical endoscopy</abbr-1></periodical><alt-periodical><full-title>Surg Endosc</full-title><abbr-1>Surgical endoscopy</abbr-1></alt-periodical><dates><year>2012</year><pub-dates><date>Dec 12</date></pub-dates></dates><isbn>1432-2218 (Electronic)
0930-2794 (Linking)</isbn><accession-num>23232999</accession-num><urls><related-urls><url>;(Kleiman et al. 2012). The expectation is that pH monitoring will change management in patients suspected of GORD in approximately 50% of cases, although such changes are not always maintained, and this may lead to an increased quality of life for this patient group PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FY2thcmR0PC9BdXRob3I+PFllYXI+MTk5OTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FY2thcmR0PC9BdXRob3I+PFllYXI+MTk5OTwvWWVhcj48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ADDIN EN.CITE.DATA (Eckardt, Dilling & Bernhard 1999; Hirano, Richter & Practice Parameters Committee of the American College of 2007; Netzer et al. 1999).IndicationsThe American College of Gastroenterology documented the usefulness of pH monitoring in GORD patients and its impact on patient management PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFyPjxS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 EN.CITE.DATA (Hirano, Richter & Practice Parameters Committee of the American College of 2007; Katz, Gerson & Vela 2012). They determined that pH monitoring is useful to:quantify reflux and assess the relationship between reflux episodes and the patient’s symptomsdocument abnormal oesophageal acid exposure in endoscopy-negative individuals being considered for a surgical anti-reflux procedureevaluate endoscopy-negative patients with typical or atypical reflux symptoms that are refractory to PPI therapy document the adequacy of PPI therapy in oesophageal acid control in patients with complications of GORD that include Barrett’s oesophagus.Of these patients, catheter-free monitoring would be indicated for those in whom catheter-based monitoring has failed or is anatomically inappropriate.Contraindications for catheter-free (wireless) ambulatory oesophageal pH monitoring include the following (Maerten et al. 2007):haemorrhagic diathesisoesophageal varicessevere oesophagitisoesophageal strictures or diverticulahaving a pacemaker or defibrillatorpregnancy.Clinical need Reflux disease is common. Knox et al. (2008) estimated the prevalence of GP-diagnosed GORD in Australia to be around 10.4% of patients. The prevalence in the Australian population was estimated at 9.2%, which equates to approximately 2?million Australians with GORD. Knox et al. reported on the percentage of patients who were currently under clinical management, which means that this study probably underestimated the total GORD prevalence. Other studies report higher prevalence rates, ranging between 14% and 25% of adults experiencing symptoms of reflux at least once a week PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PFllYXI+MjAxMTwvWWVhcj48UmVjTnVtPjE0PC9SZWNOdW0+PERpc3Bs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ADDIN EN.CITE.DATA (Gastroenterological Society of Australia 2011; Kahrilas 2008; Miller & Pan 2009). The lower prevalence recorded from GP-encounter data compared with community-based studies may indicate that there is a significant level of unmet need for management of this disease in the Australian community.There is a lack of epidemiological data on GORD in infants and children. However, one American study reported that at least one episode of regurgitation a day occurs in approximately half of infants aged 0–3?months, and heartburn and regurgitation were reported on a weekly basis in about 2% of 3–9 year old children and 5%–8% of 10–17 year old children ADDIN EN.CITE <EndNote><Cite><Author>Nelson</Author><Year>2000</Year><RecNum>607</RecNum><IDText>150-4</IDText><DisplayText>(Nelson et al. 2000)</DisplayText><record><rec-number>607</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">607</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nelson, S. P.</author><author>Chen, E. H.</author><author>Syniar, G. M.</author><author>Christoffel, K. K.</author></authors></contributors><auth-address>Division of Gastroenterology, Northwestern University Medical School and Children's Memorial Medical Center, Chicago, IL 60614, USA. snelson@nwu.edu</auth-address><titles><title>Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group</title><secondary-title>Arch Pediatr Adolesc Med</secondary-title><alt-title>Archives of pediatrics & adolescent medicine</alt-title></titles><periodical><full-title>Arch Pediatr Adolesc Med</full-title><abbr-1>Archives of pediatrics & adolescent medicine</abbr-1></periodical><alt-periodical><full-title>Arch Pediatr Adolesc Med</full-title><abbr-1>Archives of pediatrics & adolescent medicine</abbr-1></alt-periodical><pages>150-4</pages><volume>154</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Chicago/epidemiology</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Female</keyword><keyword>Gastroesophageal Reflux/*epidemiology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Prevalence</keyword></keywords><dates><year>2000</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1072-4710 (Print)
1072-4710 (Linking)</isbn><accession-num>10665601</accession-num><urls><related-urls><url>;(Nelson et al. 2000). GORD occurs more often in developed countries and may be associated with reduction of Helicobacter pylori (H. pylori) colonisation of the gastric mucosa due to better hygiene, a greater use of antibiotics, and the increasing frequency of obesity in the community ADDIN EN.CITE <EndNote><Cite><Author>Knox</Author><Year>2008</Year><RecNum>36</RecNum><DisplayText>(Knox et al. 2008)</DisplayText><record><rec-number>36</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">36</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knox, S. A.</author><author>Harrison, C. M.</author><author>Britt, H. C.</author><author>Henderson, J. V.</author></authors></contributors><auth-address>Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW, Australia.</auth-address><titles><title>Estimating prevalence of common chronic morbidities in Australia</title><secondary-title>Med J Aust</secondary-title><alt-title>The Medical journal of Australia</alt-title></titles><periodical><full-title>Med J Aust</full-title><abbr-1>The Medical journal of Australia</abbr-1></periodical><alt-periodical><full-title>Med J Aust</full-title><abbr-1>The Medical journal of Australia</abbr-1></alt-periodical><pages>66-70</pages><volume>189</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Australia/epidemiology</keyword><keyword>Cardiovascular Diseases/epidemiology</keyword><keyword>Chronic Disease/*epidemiology</keyword><keyword>Female</keyword><keyword>Gastroesophageal Reflux/epidemiology</keyword><keyword>Health Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Morbidity</keyword><keyword>Prevalence</keyword><keyword>Pulmonary Disease, Chronic Obstructive/epidemiology</keyword></keywords><dates><year>2008</year><pub-dates><date>Jul 21</date></pub-dates></dates><isbn>0025-729X (Print)
0025-729X (Linking)</isbn><accession-num>18637769</accession-num><urls><related-urls><url>;(Knox et al. 2008). However, the relationship between H. pylori infection and GORD is still controversial ADDIN EN.CITE <EndNote><Cite><Author>Katz</Author><Year>2012</Year><RecNum>239</RecNum><DisplayText>(Katz, Gerson & Vela 2012)</DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Katz, P. O.</author><author>Gerson, L. B.</author><author>Vela, M. F.</author></authors></contributors><auth-address>Division of Gastroenterology, Einstein Medical Center, Philadelphia, Pennsylvania, USA.</auth-address><titles><title>Guidelines for the diagnosis and management of gastroesophageal reflux disease</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>308-28</pages><volume>108</volume><number>3</number><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1572-0241 (Electronic)
0002-9270 (Linking)</isbn><accession-num>23419381</accession-num><urls><related-urls><url>;(Katz, Gerson & Vela 2012). It is known that GORD patients with daily or weekly symptoms are more likely to have time off work, a decrease in work productivity, lower quality sleep and a decrease in physical functioning. Nocturnal GORD has an even greater impact on quality of life compared with daytime symptoms ADDIN EN.CITE <EndNote><Cite><Author>Katz</Author><Year>2012</Year><RecNum>239</RecNum><DisplayText>(Katz, Gerson & Vela 2012)</DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Katz, P. O.</author><author>Gerson, L. B.</author><author>Vela, M. F.</author></authors></contributors><auth-address>Division of Gastroenterology, Einstein Medical Center, Philadelphia, Pennsylvania, USA.</auth-address><titles><title>Guidelines for the diagnosis and management of gastroesophageal reflux disease</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>308-28</pages><volume>108</volume><number>3</number><dates><year>2012</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1572-0241 (Electronic)
0002-9270 (Linking)</isbn><accession-num>23419381</accession-num><urls><related-urls><url>;(Katz, Gerson & Vela 2012). Other existing tests for GORDOesophageal impedance testingIn 1991 multichannel intraluminal impedance (MII) was first described. It is a technology that is able to detect refluxate moving from the stomach into the oesophagus, independent of the content. With this method it is possible to determine the composition, distribution and clearance of gastro-oesophageal reflux, differentiating between the refluxate of liquid, gas, and combined liquid and gas. Impedance depends on the conductivity of material through which current travels; this means that MII measures the electrical conductivity across a pair of electrodes in the oesophageal lumen, and changes in conductivity as a result of intraoesophageal materials moving will be recorded. It can detect movement in both the retrograde (reflux) and the anterograde (swallow) direction. This test uses a catheter and can be combined with catheter-based monitoring. Therefore, it could be an important tool to identify reflux of all types, independent of their acid content PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Hirano 2006; Tutuian 2008; Weber, Davis & Fisichella 2011; Wilson & Vela 2008).Marketing status of device/technologyAll therapeutic products marketed in Australia require listing on the Australian Register of Therapeutic Goods (ARTG). The device for catheter-free monitoring is listed on the ARTG under the item shown in REF _Ref364240778 \h \* MERGEFORMAT Table 1. It is stated that ‘the Bravo pH-monitoring system is intended to be used for gastro-oesophageal pH measurement and monitoring of gastric reflux’. Table 1Catheter-free monitoring device listed on the ARTGARTG no.Product no.Product descriptionProduct categorySponsor20579558357Gastrointestinal telemetric monitoring systemMedical Device Class IIaGiven Imaging Pty LimitedSource: Therapeutic Goods Administration, [accessed 14 August 2013]Current reimbursement arrangementsCurrently, there is no listing on the MBS for catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD. As a result, its use in Australia is limited: only 27, 22 and 46 capsules were sold to Australian sites in 2011, 2012 and 2013, respectively.The diagnostic test for GORD currently listed on the MBS—24-hour ambulatory catheter-based pH monitoring—is shown in REF _Ref350151252 \h \* MERGEFORMAT Table 2. Table 2Relevant MBS item for the currently reimbursed test for GORDCategory 2 – Diagnostic procedures and interventionsMBS 11810CLINICAL ASSESSMENT of GASTRO-OESOPHAGEAL REFLUX DISEASE involving 24 hour pH monitoring, including analysis, interpretation and report and including any associated consultation Fee: $174.45 Benefit: 75% = $130.85 85% = $148.30Although GORD is relatively common, there is fairly low usage of the current MBS item for pH monitoring; there were only 3,590 claims for catheter-based monitoring from July 2012 until June 2013 ( REF _Ref379455256 \h \* MERGEFORMAT Figure 2). It is claimed that part of the low usage for the current test could reflect the discomfort and inconvenience of having a catheter in place for 24?hours, so that use of pH-monitoring devices might increase if catheter-free monitoring is publicly funded on the MBS.Figure 2Usage of catheter-based pH monitoring, July 2012 – June 2013 Source: Medicare (2013)Surgical treatments for GORD are listed under five different MBS item numbers: 43951, 43954, 31464, 30527 and 30530. A total of 1,834 anti-reflux procedures were claimed from July 2012 to June 2013 ADDIN EN.CITE <EndNote><Cite><Author>Medicare</Author><Year>2013</Year><RecNum>240</RecNum><DisplayText>(Medicare 2013)</DisplayText><record><rec-number>240</rec-number><foreign-keys><key app="EN" db-id="5dedfdstldtwtle05ahpwf0cv25ze0ef2e5v">240</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Medicare</author></authors></contributors><titles><title>Medicare Item Reports</title></titles><dates><year>2013</year></dates><pub-location>Canberra</pub-location><publisher>Australian Government</publisher><urls></urls></record></Cite></EndNote>(Medicare 2013). For the description and usage of each individual item number, see REF _Ref375317101 \h \* MERGEFORMAT Appendix I. Proposal for public fundingThe proposed MBS item is summarised in REF _Ref373485347 \h \* MERGEFORMAT Table 3. The fee was suggested by the applicant. It includes a $350 fee for professional time for performing the test, $430.40 for the capsule itself and $133.25 for the reader system. The proposed item descriptor makes it clear that it is a requirement that all individuals undergoing catheter-free monitoring have previously failed catheter-based monitoring or are anatomically inappropriate for a catheter-based system. Furthermore, the test should only be performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy.Table 3Proposed MBS item descriptorCategory 2 – Diagnostic procedures and interventionsCLINICAL ASSESSMENT of GASTRO-OESOPHAGEAL REFLUX DISEASE that involves 48 hour catheter-free wireless ambulatory oesophageal pH monitoring including administration of the device and any endoscopy associated with this, analysis and interpretation of the data and all attendances providing the service, ifThe service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; andThe patient has previously failed (rather than intolerant of) a catheter-based ambulatory oesophageal pH-monitoring or is anatomically inappropriate for a catheter-based-systemFee: $913.64Consumer impact statementPASC received one response from the public when the DAP was put out for public consultation—from the professional body, the Gastroenterological Society of Australia (GESA). Approach to assessment The purpose of a DAP is to describe in detail a limited set of decision option(s) associated with the possible public funding of a proposed medical service. A DAP also accurately captures current clinical practice, reflects likely future practice with the proposed?medical service, and describes all potentially affected healthcare resources. A DAP was developed prior to the commencement of this assessment, and was approved by the PASC of MSAC. The guiding framework of the DAP was used throughout this assessment.ObjectiveTo determine whether there is sufficient evidence, in relation to safety, effectiveness and cost-effectiveness, to have catheter-free monitoring for GORD listed on the MBS for patients who have previously failed a catheter-based test or for whom catheter-based monitoring is anatomically inappropriate.Clinical pathwayA flowchart can help define the place of a new intervention in the clinical management of a patient. The solid lines in REF _Ref379455005 \h \* MERGEFORMAT Figure 3 indicate the current clinical management pathway, whereas the dashed lines show the proposed change in management if catheter-free monitoring becomes available. The tests prior to pH monitoring are also shown in the pathway, and the relevant population being targeted by catheter-free monitoring can be found in the shaded box.The proposed pathway indicates that there would be more diagnostic options for patients who have either failed a catheter-based pH test or in whom it is anatomically inappropriate to use the currently available test (i.e. as an alternative to no pH monitoring). Instead of no further testing and continuation of potentially ineffective PPI treatment, patients are able to undergo a pH-monitoring test that would lead to other treatment options such as surgery or different medication. Figure SEQ Figure \* ARABIC 3Clinical management algorithm for the proposed new interventionComparatorComparators are usually selected by determining the diagnostic test that is most likely to be replaced, or added to, by the technology submitted for a new MBS item number. As catheter-free monitoring (the index test) is indicated for people that currently have no monitoring due to a failed catheter-based test or people for whom a catheter-based test is anatomically inappropriate, the appropriate comparator is ‘no pH monitoring’ and empirical therapy. However, for catheter-free monitoring to be implemented in this group, PASC determined that it should be demonstrated that the diagnostic sensitivity, specificity and safety of the proposed new test is at least equivalent to catheter-based monitoring. Thus, to establish diagnostic accuracy and safety, the selected comparator was catheter-based monitoring.The reference standard Oesophageal pH monitoring is used to diagnose GORD. In this assessment the accuracy of catheter-free monitoring in diagnosing GORD was benchmarked against the evidentiary standard as agreed to by PASC in August 2012—catheter-based pH monitoring. Patients usually have a GORD diagnosis if they respond to anti-reflux medication therapy, i.e. symptoms disappear completely or decrease by at least 50%. Clinical diagnosis based on response to treatment (which is the ‘gold standard’ in diagnosing GORD) has therefore also been used as a secondary reference standard. Research questionsIn the event that direct evidence was available to assess the safety, effectiveness and cost-effectiveness of catheter-free monitoring, the following research question was to be addressed by this evaluation:What is the safety, effectiveness and cost-effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD, compared with no pH monitoring, in patients who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?In the event that linked evidence (see ‘ REF _Ref375553651 \h \* MERGEFORMAT Diagnostic assessment framework’ on page 40) was the only evidence available to assess the safety, effectiveness and cost-effectiveness of catheter-free monitoring, the following research questions were also to be addressed:Safety:Is catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD as safe as, or safer than, no pH monitoring?Is catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD as safe as, or safer than, catheter-based oesophageal pH monitoring?Accuracy:What is the diagnostic accuracy of catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD compared with catheter-based oesophageal pH monitoring?Effectiveness / patient management:Compared with no pH monitoring, does catheter-free (wireless) ambulatory oesophageal pH monitoring change the clinical management or treatment options available for patients with suspected GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?Effectiveness / health outcomes, in case of a change in management:Do alterations in clinical management and treatment options have an impact on the health outcomes of patients with suspected GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?Do alterations in clinical management and treatment options have an impact on the health outcomes of patients with GORD (true positives)?Do alterations in clinical management and treatment options have an impact on the health outcomes of patients who were initially suspected of GORD but who received an incorrect diagnosis after catheter-free monitoring (false positives and false negatives)?Cost-effectiveness:What is the cost-effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring compared with no pH monitoring for patients with suspected GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?What is the cost-effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring compared with catheter-based oesophageal pH monitoring in patients with symptoms of GORD?Diagnostic assessment frameworkThis assessment uses the theoretical framework outlined in the MSAC Guidelines for the assessment of diagnostic technologies ADDIN EN.CITE <EndNote><Cite><Author>MSAC</Author><Year>2005</Year><RecNum>42</RecNum><DisplayText>(MSAC 2005b)</DisplayText><record><rec-number>42</rec-number><ref-type name="Electronic Source">12</ref-type><contributors><authors><author>MSAC</author></authors></contributors><titles><title>Guidelines for the assessment of diagnostic technologies</title></titles><pages>1-93</pages><dates><year>2005</year><pub-dates><date>August 2005</date></pub-dates></dates><pub-location>Canberra, ACT</pub-location><publisher>Medical Services Advisory Committee, Commonwealth of Australia</publisher><work-type>Internet</work-type><urls><related-urls><url>.au</url></related-urls></urls></record></Cite></EndNote>(MSAC 2005b).This means that evidence of the clinical effectiveness of catheter-free monitoring requires either the first or, if not available, the second of the following: evidence of the effectiveness of catheter-free monitoring from high-quality comparative studies evaluating its use and subsequent treatment compared with no monitoring and treatment (direct evidence); randomised controlled trials (RCTs) provide the highest quality evidence for this comparison. evidence of treatment effectiveness from high-quality comparative studies evaluating the treatment for GORD, linked with applicable and high-quality evidence of the accuracy of catheter-free monitoring to diagnose GORD compared with catheter-based monitoring or no monitoring; this is called ‘linked evidence’. There was limited, low-quality direct evidence available that assessed the impact of catheter-free monitoring, so in this assessment the available direct evidence was supplemented with a linked evidence approach. This means that evidence from studies that report on diagnostic test performance (diagnostic accuracy), the impact on clinical decision-making and the impact of the treatment of diagnosed patients on health outcomes was narratively linked in order to infer the effect of the diagnostic test on patient health outcomes. For the last step of the linked analysis, to answer the questions, two separate searches were conducted ( REF _Ref371687271 \h \* MERGEFORMAT Table 6): Evidence-based guidelines and/or systematic reviews providing evidence on treatment effectiveness in patients with GORD was collated, as this provides data on the health outcomes of those who are correctly diagnosed (i.e. true positives). For people initially suspected of GORD but who are eventually given an alternative diagnosis, it was assumed that their management/treatment would be optimised as a consequence of obtaining the correct diagnosis. To address the implications associated with either inappropriately treating people who are incorrectly diagnosed with GORD (i.e. false positives) or not properly treating people who are incorrectly given an alternative diagnosis to GORD (i.e. false negatives), a second separate literature search was conducted.Review of literature Literature sources and search strategiesThe medical literature was searched to identify relevant studies and reviews for the period between 2001 and September 2013, as catheter-free monitoring became available in 2001. Searches were conducted via the databases described in REF _Ref363131254 \h \* MERGEFORMAT Table 4. Search terms are described in REF _Ref379483486 \h Table 5 and REF _Ref371687785 \h \* MERGEFORMAT Table 6. REF _Ref371687785 \h \* MERGEFORMAT Table 6 contains the search terms for the last step of the linked analysis.Table 4Electronic databases searchedElectronic databasePeriod coveredCochrane Library – including, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials (CENTRAL), the Health Technology Assessment Database, the NHS Economic Evaluation Database2001 – 9/2013Current Contents 2001 – 9/2013Embase 2001 – 9/2013PubMed2001 – 9/2013Web of Science – Science Citation Index Expanded2001 – 9/2013Cinahl2001 – 9/2013Econlit2001 – 9/2013Scopus2001 – 9/2013Table 5Search terms usedElement of clinical questionSearch termsPopulationGastroesophageal reflux [MeSH] OR Gastric Acid [MeSH] OR heartburn [MeSH] OR (GORD OR GERD OR Heartburn OR gastro oesophageal reflux disease OR gastro esophageal reflux disease OR gastroesophageal reflux diseaseIntervention((hydrogen-ion concentration [MeSH]) OR hydrogen-ion concentration OR pH) AND(Esophageal pH monitoring [MeSH] OR Gastric Acidity Determination /instrumentation [MeSH] OR “catheter free” OR catheterless OR wireless OR tubeless OR telemetry [MeSH] OR telemetry OR (radio transmit*) OR (radio transmis*) OR radiotransmit* OR radiotransmis* OR bravo)Comparator (if applicable)N/AOutcomes (if applicable)N/ALimits2001–2013MeSH = Medical Subject Heading, based on a Medline/PubMed platformTable SEQ Table \* ARABIC 6Search terms used to identify studies for the last step of the linked analysis (health outcomes)Element of clinical questionTrue positivesFalse negatives and false positivesPopulationGastroesophageal reflux [MeSH] OR Gastric Acid [MeSH] OR heartburn [MeSH] OR (GORD OR GERD OR heartburn OR "gastro oesophageal reflux disease" OR "gastro esophageal reflux disease" OR "gastroesophageal reflux disease")(Gastroesophageal reflux [MeSH] OR Gastric Acid [MeSH] OR heartburn [MeSH] OR (GORD OR GERD OR heartburn OR "gastro oesophageal reflux disease" OR "gastro esophageal reflux disease" OR "gastroesophageal reflux disease") Intervention(Omeprazole OR lansoprazole OR dexlansoprazole OR esomeprazole OR pantoprazole OR rabeprazole OR ilaprazole OR “proton pump inhibitor” OR PPI OR “proton pump inhibitors”) OR (cimetidine OR rantidine OR famotidine OR nizatidine OR (H2 receptor antagonist*) OR (H2 antagonist*)) (untreated OR "not treated" OR "no treatment" OR "delayed treatment" OR "non-optimal treatment" OR "inappropriate treatment") OR (“wrong diagnosis” OR “missed diagnosis” OR misdiagnosis) OR “false negative” OR “false negatives” OR “false reassurance” OR “false positive” OR “false positives” OR “false alarm” OR "Diagnostic Errors"[Mesh]Comparator (if applicable)--Outcomes (if applicable)--“Systematic review” OR guideline OR guidelines-MeSH = Medical Subject Heading, based on a Medline/PubMed platformSelection criteriaIn general, studies were excluded (Figures 4, 5 and 6) if they: did not provide information on the pre-specified target populationdid not address one of the pre-specified outcomes and/or provided inadequate data on these outcomeswere in a language other than English and were of a lower level of evidence than the studies in Englishdid not have an eligible study designused impedance monitoring as a comparatorincluded a non-Bravo wireless pH-monitoring device as the index test.If the same data were duplicated in multiple articles, only results from the most comprehensive or most recent article were included. Search resultsPRISMA flowchartFigure 4Summary of the process used to identify and select studies for the review (in first search)Figure 5Summary of the process used to identify and select studies for the review (in search 'true positives')Figure 6Summary of the process used to identify and select studies for the review (in search 'false negatives and false positives')Data extraction and analysisA profile of key characteristics was developed for each included study (see REF _Ref364237249 \h \* MERGEFORMAT Appendix C). Each study profile described the level of evidence, design and quality of the study, authors, publication year, location, criteria for including/excluding patients, study population characteristics, type of intervention, comparator intervention and/or reference standard (where relevant), and outcomes assessed. Studies that could not be retrieved or that met the inclusion criteria but contained insufficient or inadequate data for inclusion are listed in REF _Ref364237293 \h \* MERGEFORMAT Appendix D. Definitions of all technical terms and abbreviations are provided in the Glossary (page PAGEREF _Ref363826811 \h 23). Descriptive statistics were extracted or calculated for all safety and effectiveness outcomes in the individual studies.Assessing diagnostic accuracyTo assess the diagnostic accuracy of catheter-free monitoring, where possible the sensitivity, specificity, negative and positive predictive values (NPV, PPV) and likelihood ratios of the tests were calculated with corresponding 95% confidence intervals (CIs). Data were extracted into a classic 2? 2 table, in which the results of the index diagnostic test were cross-classified (Table 7) against the results of the reference standard ADDIN EN.CITE <EndNote><Cite><Author>Armitage</Author><Year>2002</Year><RecNum>83</RecNum><DisplayText>(Armitage, Berry & Matthews 2002; Deeks 2001)</DisplayText><record><rec-number>83</rec-number><ref-type name="Book">6</ref-type><contributors><authors><author>Armitage, P.</author><author>Berry,G.</author><author>Matthews, J.N.S</author></authors></contributors><titles><title>Statistical methods in medical research</title></titles><edition>Fourth Edition</edition><dates><year>2002</year></dates><pub-location>Oxford</pub-location><publisher>Blackwell Science</publisher><urls></urls><custom1>yes</custom1></record></Cite><Cite><Author>Deeks</Author><Year>2001</Year><RecNum>84</RecNum><record><rec-number>84</rec-number><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Deeks, J.J.</author></authors></contributors><titles><title>Systematic reviews of evaluations of diagnostic and screening tests</title><secondary-title>British Medical Journal</secondary-title><alt-title>British Medical Journal (Education and Debate)</alt-title></titles><pages>157-162</pages><volume>323</volume><number>21 July</number><keywords><keyword>Review literature</keyword><keyword>Meta-analysis</keyword><keyword>Mass-screening</keyword><keyword>Diagnostic techniques</keyword><keyword>Sensitivity-and-Specificity</keyword><keyword>Predictive-Value-of-Tests</keyword><keyword>ROC-Curve</keyword></keywords><dates><year>2001</year></dates><label>Methodology; SR; diagnostic test; screening;SR</label><urls></urls></record></Cite></EndNote>(Armitage, Berry & Matthews 2002; Deeks 2001), and Bayes’ Theorem was applied:Table 7Diagnostic accuracy data extraction for GORDReference standard(catheter-based oesophageal pH monitoring or clinical diagnosis)Disease +Disease –Index test(catheter-free [wireless] ambulatory oesophageal pH monitoring)Test +true positivefalse positiveTotal test positiveTest –false negativetrue negativeTotal test negativeTotal with GORDTotal without GORDPrimary measuresTest sensitivity was calculated as the proportion of people with GORD, as determined by catheter-based monitoring or clinical diagnosis, who had a positive test result on catheter-free monitoring:Sensitivity (true positive rate) = number with true positive result / total with GORDTest specificity was calculated as the proportion of people without GORD, as determined by catheter-based monitoring or clinical diagnosis, who had a normal test result on catheter-free monitoring:Specificity (true negative rate) = number with true negative result / total without GORDWhere possible, the PPV and NPV were also provided. A PPV is the proportion of positive test results that are true positives, and the NPV is the proportion of negative test results that are true negatives. They reflect the probability that a positive (or negative) test result corresponds with having (or not having) GORD. However, the values depend on the prevalence of GORD.PPV = number true positive / total test positiveNPV = number true negative / total test negativeWhen a 95%CI was not provided, it was calculated by exact binomial methods.Summary measuresPositive and negative likelihood ratios (LRs) were reported if available. These ratios measure the probability of the test result in patients with GORD compared with those without GORD. LR+ = sensitivity / 1–specificityLR– = 1–sensitivity / specificityA likelihood ratio of 1 means that the test does not provide any useful diagnostic information, whereas LR+ >5 and LR– <0.2 can suggest strong diagnostic ability ADDIN EN.CITE <EndNote><Cite><Author>MSAC</Author><Year>2005</Year><RecNum>260</RecNum><DisplayText>(MSAC 2005a)</DisplayText><record><rec-number>260</rec-number><foreign-keys><key app="EN" db-id="5fztv099mfwwx7e0pse5vxeozd5aa2d59rpz">260</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>MSAC,</author></authors></contributors><titles><title>Gruidelines for the Assessment of Diagnostic Technologies</title></titles><dates><year>2005</year></dates><pub-location>Canberra</pub-location><publisher>Commonwealth of Australia</publisher><urls></urls></record></Cite></EndNote>(MSAC 2005a). The summary receiver–operator characteristic curve plots the estimated sensitivity versus 1–specificity from different studies to produce a global measure of test accuracy.All statistical calculations were undertaken using the biostatistical computer package Stata version 12.0.Meta-analysis of diagnostic accuracy results was not conducted owing to the heterogeneous nature of the available evidence-base assessing the test performance of GORD; specifically, different thresholds for diagnosis were used and there were not enough studies reporting data within each threshold to stratify and meta-analyse the results by cut-point. Meta-analysis of technical failure data was conducted using the metan command in Stata version 12.0 and specifying a random-effects model. Subgroup analyses were not performed.A narrative meta-synthesis of the data was undertaken where meta-analysis could not be performed.Appraisal of the evidenceAppraisal of the evidence was conducted in three stages:Stage 1: Appraisal of the applicability and quality of individual studies included in the review (strength of the evidence).Stage 2: Appraisal of the precision, size of effect and clinical importance of the results for primary outcomes in individual studies—used to determine the safety and effectiveness of the intervention. Stage 3: Integration of this evidence for conclusions about the net clinical benefit of the intervention in the context of Australian clinical practice. The evidence presented in the selected studies was assessed and classified using the dimensions of evidence defined by the National Health and Medical Research Council (NHMRC 2000). These dimensions ( REF _Ref206478845 \h \* MERGEFORMAT Table 8) consider important aspects of the evidence supporting a particular intervention and include three main domains: strength of the evidence, size of the effect and relevance of the evidence. The first domain is derived directly from the literature identified as informing a particular intervention; the last two each requires expert clinical input as part of its determination.Table SEQ Table \* ARABIC 8Evidence dimensionsType of evidenceDefinitionStrength of the evidence:LevelQualityStatistical precisionThe study design used, as an indicator of the degree to which bias has been eliminated by design.aThe methods used by investigators to minimise bias within a study design.The p-value or, alternatively, the precision of the estimate of the effect. It reflects the degree of certainty about the existence of a true effect.Size of effectThe distance of the study estimate from the ‘null’ value and the inclusion of only clinically important effects in the confidence interval.Relevance of evidenceThe usefulness of the evidence in clinical practice, particularly the appropriateness of the outcome measures used.aSee REF _Ref206478826 \h \* MERGEFORMAT Table 9Stage 1: strength of the evidenceThe three sub-domains—level, quality and statistical precision—are collectively a measure of the strength of the evidence. The ‘level’ of evidence reflects the effectiveness of a study design to answer a particular research question. Effectiveness is based on the probability that the design of the study has reduced or eliminated the impact of bias on the results. The NHMRC evidence hierarchy provides a ranking of various study designs (‘levels of evidence’) by the type of research question being addressed ( REF _Ref206478826 \h \* MERGEFORMAT Table 9).Table SEQ Table \* ARABIC 9Designations of levels of evidence according to type of research question (including table notes) LevelIntervention aDiagnostic accuracy bI cA systematic review of level II studiesA systematic review of level II studiesIIA randomised controlled trialA study of test accuracy with: an independent, blinded comparison with a valid reference standard,d among consecutive persons with a defined clinical presentation eIII-1A pseudo-randomised controlled trial(i.e. alternate allocation or some other method)A study of test accuracy with: an independent, blinded comparison with a valid reference standard,d among non-consecutive persons with a defined clinical presentation eIII-2A comparative study with concurrent controls:? non-randomised, experimental trial f? cohort study? case-control study? interrupted time series with a control groupA comparison with reference standard that does not meet the criteria required for level II and III-1 evidenceIII-3A comparative study without concurrent controls:? historical control study? two or more single arm studies g ? interrupted time series without a parallel control groupDiagnostic case-control study eIVCase series with either post-test or pre-test/post-test outcomesStudy of diagnostic yield (no reference standard) hSources: Merlin et al. (2009); hierarchies adapted and modified from: NHMRC 1999; Bandolier 1999; Lijmer et al. 1999; Phillips et al. 2001Explanatory notes:a Definitions of these study designs are provided in NHMRC (2000; pp. 7–8) and in the Glossary accompanying Merlin et al. (2009).b These levels of evidence apply only to studies assessing the accuracy of diagnostic or screening tests. To assess the overall effectiveness of a diagnostic test there also needs to be a consideration of the impact of the test on patient management and health outcomes (MSAC 2005; Sackett & Haynes 2002). The evidence hierarchy given in the ‘Intervention’ column should be used when assessing the impact of a diagnostic test on health outcomes relative to an existing method of diagnosis or comparator test(s). The evidence hierarchy given in the ‘Screening’ column should be used when assessing the impact of a screening test on health outcomes relative to no screening or alternative screening methods.c A systematic review will only be assigned a level of evidence as high as the studies it contains, excepting where those studies are of level II evidence. Systematic reviews of level II evidence provide more data than the individual studies and any meta-analyses will increase the precision of the overall results, reducing the likelihood that the results are affected by chance. Systematic reviews of lower level evidence present results of likely poor internal validity and thus are rated on the likelihood that the results have been affected by bias, rather than whether the systematic review itself is of good quality. Systematic review quality should be assessed separately. A systematic review should consist of at least two studies. In systematic reviews that include different study designs, the overall level of evidence should relate to each individual outcome/result, as different studies and study designs might contribute to each different outcome.d The validity of the reference standard should be determined in the context of the disease under review. Criteria for determining the validity of the reference standard should be pre-specified. This can include the choice of the reference standard(s) and its timing in relation to the index test. The validity of the reference standard can be determined through quality appraisal of the study (Whiting et al. 2003).e Well-designed population-based case-control studies (e.g. screening studies where test accuracy is assessed on all cases, with a random sample of controls) do capture a population with a representative spectrum of disease and thus fulfil the requirements for a valid assembly of patients. However, in some cases the population assembled is not representative of the use of the test in practice. In diagnostic case-control studies a selected sample of patients already known to have the disease is compared with a separate group of normal/healthy people known to be free of the disease. In this situation patients with borderline or mild expressions of the disease, and conditions mimicking the disease, are excluded, which can lead to exaggeration of both sensitivity and specificity. This is called spectrum bias or spectrum effect because the spectrum of study participants will not be representative of patients seen in practice (Mulherin & Miller 2002).f This also includes controlled before-and-after (pre-test/post-test) studies as well as adjusted indirect comparisons, i.e. utilising A vs B and B vs C to determine A vs C, with statistical adjustment for B.gComparing single arm studies, i.e. case series from two studies. This would also include unadjusted indirect comparisons, i.e. utilising A vs B and B vs C to determine A vs C, but where there is no statistical adjustment for B.hStudies of diagnostic yield provide the yield of diagnosed patients, as determined by an index test, without confirmation of the accuracy of this diagnosis by a reference standard. These may be the only alternative when there is no reliable reference standard.Note A: Assessment of comparative harms/safety should occur according to the hierarchy presented for each of the research questions, with the proviso that this assessment occurs within the context of the topic being assessed. Some harms (and other outcomes) are rare and cannot feasibly be captured within randomised controlled trials, in which case lower levels of evidence may be the only type of evidence that is practically achievable; both physical and psychological harms may need to be addressed by different study designs; harms from diagnostic testing include the likelihood of false positive and false negative results; harms from screening include the likelihood of false alarms and false reassurance results.Note B: When a level of evidence is attributed in the text of a document, it should also be framed according to its corresponding research question, e.g. level II intervention evidence; level IV diagnostic evidence; level III-2 prognostic evidence.Note C: Each individual study that is attributed a ‘level of evidence’ should be rigorously appraised using validated or commonly used checklists or appraisal tools to ensure that factors other than study design have not affected the validity of the results.Individual studies assessing diagnostic effectiveness were graded according to pre-specified quality and applicability criteria (MSAC 2005), as shown in REF _Ref206477516 \h \* MERGEFORMAT Table 10.Table SEQ Table \* ARABIC 10Grading system used to rank included studiesValidity criteriaDescriptionGrading systemAppropriate comparisonDid the study evaluate a direct comparison of the index test strategy versus the comparator test strategy?C1 direct comparison CX other comparison Applicable populationDid the study evaluate the index test in a population that is representative of the subject characteristics (age and sex) and clinical setting (disease prevalence, disease severity, referral filter and sequence of tests) for the clinical indication of interest?P1 applicable P2 limited P3 different population Quality of studyWas the study designed to avoid bias?High quality = no potential for bias based on pre-defined key quality criteria Medium quality = some potential for bias in areas other than those pre-specified as key criteriaPoor quality = poor reference standard and/or potential for bias based on key pre-specified criteriaQ1 high quality Q2 medium Q3 poor reference standardpoor quality or insufficient informationThe appraisal of intervention studies pertaining to treatment safety and effectiveness was undertaken using the Downs and Black (1998) checklist, which was used for trials and cohort studies. Uncontrolled before-and-after case series are a poorer level of evidence with which to assess effectiveness. The quality of this type of study design was assessed according to a checklist developed by the UK National Health Service (NHS) Centre for Reviews and Dissemination ADDIN EN.CITE <EndNote><Cite><Author>Khan</Author><Year>2001</Year><RecNum>27</RecNum><DisplayText>(Khan et al. 2001)</DisplayText><record><rec-number>27</rec-number><ref-type name="Report">27</ref-type><contributors><authors><author>Khan, K.S.</author><author>Ter Riet, G.</author><author>Glanville, J.M.</author><author>Sowden, A.J.</author><author>Kleijnen, J.</author></authors></contributors><titles><title>Undertaking systematic reviews of research on effectiveness. CRD's guidance for those carrying out or commissioning reviews</title></titles><dates><year>2001</year><pub-dates><date>2001 (second edition)</date></pub-dates></dates><pub-location>York</pub-location><publisher>NHS Centre for Reviews and Dissemination, University of York</publisher><isbn>CRD Report Number 4 (second edition)</isbn><call-num>TRACY</call-num><label>evidence ; sr ; health information ; research ; LR</label><work-type>CRD Report</work-type><urls></urls></record></Cite></EndNote>(Khan et al. 2001). Studies of diagnostic accuracy were assessed using the QUADAS-2 quality assessment tool ADDIN EN.CITE <EndNote><Cite><Author>Whiting</Author><Year>2011</Year><RecNum>18735</RecNum><IDText>529-36</IDText><DisplayText>(Whiting, Rutjes, Westwood, Mallett, Deeks, Reitsma, Leeflang, Sterne, Bossuyt, et al. 2011)</DisplayText><record><rec-number>18735</rec-number><foreign-keys><key app="EN" db-id="5exd9tre4x0dwoefarq5epd0f5vx52s59paf">18735</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Whiting, P. F.</author><author>Rutjes, A. W.</author><author>Westwood, M. E.</author><author>Mallett, S.</author><author>Deeks, J. J.</author><author>Reitsma, J. B.</author><author>Leeflang, M. M.</author><author>Sterne, J. A.</author><author>Bossuyt, P. M.</author><author>Quadas- Group</author></authors></contributors><auth-address>University of Bristol, United Kingdom. penny.whiting@bristol.ac.uk</auth-address><titles><title>QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><periodical><full-title>Ann Intern Med</full-title></periodical><alt-periodical><full-title>Annals of Internal Medicine</full-title></alt-periodical><pages>529-36</pages><volume>155</volume><number>8</number><keywords><keyword>Bias (Epidemiology)</keyword><keyword>*Diagnosis</keyword><keyword>Evidence-Based Medicine</keyword><keyword>Humans</keyword><keyword>Patient Selection</keyword><keyword>Quality Control</keyword><keyword>*Questionnaires</keyword><keyword>Reference Standards</keyword><keyword>*Review Literature as Topic</keyword><keyword>Time Factors</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct 18</date></pub-dates></dates><isbn>1539-3704 (Electronic)
0003-4819 (Linking)</isbn><accession-num>22007046</accession-num><urls><related-urls><url>;(Whiting et al. 2011), whereas systematic reviews included in the last step of the linked analysis were assessed with the PRISMA checklist ADDIN EN.CITE <EndNote><Cite><Author>Liberati</Author><Year>2009</Year><RecNum>616</RecNum><IDText>b2700</IDText><DisplayText>(Liberati et al. 2009)</DisplayText><record><rec-number>616</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">616</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liberati, A.</author><author>Altman, D. G.</author><author>Tetzlaff, J.</author><author>Mulrow, C.</author><author>Gotzsche, P. C.</author><author>Ioannidis, J. P.</author><author>Clarke, M.</author><author>Devereaux, P. J.</author><author>Kleijnen, J.</author><author>Moher, D.</author></authors></contributors><auth-address>Universita di Modena e Reggio Emilia, Modena, Italy.</auth-address><titles><title>The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration</title><secondary-title>BMJ</secondary-title><alt-title>Bmj</alt-title></titles><periodical><full-title>BMJ</full-title><abbr-1>Bmj</abbr-1></periodical><alt-periodical><full-title>BMJ</full-title><abbr-1>Bmj</abbr-1></alt-periodical><pages>b2700</pages><volume>339</volume><keywords><keyword>Evidence-Based Medicine/standards</keyword><keyword>Humans</keyword><keyword>*Meta-Analysis as Topic</keyword><keyword>Publishing/*standards</keyword><keyword>Quality Control</keyword><keyword>*Review Literature as Topic</keyword><keyword>Terminology as Topic</keyword></keywords><dates><year>2009</year></dates><isbn>1756-1833 (Electronic)
0959-535X (Linking)</isbn><accession-num>19622552</accession-num><urls><related-urls><url>;(Liberati et al. 2009).Stage 2: precision, size of effect and clinical importance Statistical precision was determined using statistical principles. Small CIs and p-values give an indication as to the probability that the reported effect is real and not attributable to chance ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2000</Year><RecNum>25</RecNum><DisplayText>(NHMRC 2000)</DisplayText><record><rec-number>25</rec-number><ref-type name="Report">27</ref-type><contributors><authors><author>NHMRC,</author></authors></contributors><titles><title>How to use the evidence: assessment and application of scientific evidence</title></titles><pages>84</pages><keywords><keyword>Practice guidelines</keyword><keyword>Review literature</keyword><keyword>Australia</keyword><keyword>Evidence-Based Medicine</keyword></keywords><dates><year>2000</year><pub-dates><date>February 2000</date></pub-dates></dates><pub-location>Canberra</pub-location><publisher>National Health and Medical Research Council</publisher><call-num>SHELF 7</call-num><label>evidence ; treatment path ; clinical decisions ; guidelines; methodology; health technology;</label><work-type>Handbook series on preparing clinical practice guidelines</work-type><urls></urls></record></Cite></EndNote>(NHMRC 2000). Studies need to be appropriately powered to ensure that a real difference between groups will be detected in the statistical analysis.For intervention studies it was important to assess whether statistically significant differences between patients receiving catheter-free monitoring and those receiving no pH monitoring or catheter-based monitoring were also clinically important. The size of the effect needed to be determined, as well as whether the 95%CI included only clinically important effects. The outcomes being measured in this report were assessed as to whether they were appropriate and clinically relevant ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2000</Year><RecNum>25</RecNum><DisplayText>(NHMRC 2000)</DisplayText><record><rec-number>25</rec-number><ref-type name="Report">27</ref-type><contributors><authors><author>NHMRC,</author></authors></contributors><titles><title>How to use the evidence: assessment and application of scientific evidence</title></titles><pages>84</pages><keywords><keyword>Practice guidelines</keyword><keyword>Review literature</keyword><keyword>Australia</keyword><keyword>Evidence-Based Medicine</keyword></keywords><dates><year>2000</year><pub-dates><date>February 2000</date></pub-dates></dates><pub-location>Canberra</pub-location><publisher>National Health and Medical Research Council</publisher><call-num>SHELF 7</call-num><label>evidence ; treatment path ; clinical decisions ; guidelines; methodology; health technology;</label><work-type>Handbook series on preparing clinical practice guidelines</work-type><urls></urls></record></Cite></EndNote>(NHMRC 2000). Stage 3: Assessment of the body of evidenceAppraisal of the body of evidence was conducted along the lines suggested by the NHMRC in their guidance on clinical practice guideline development ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2008</Year><RecNum>132</RecNum><DisplayText>(NHMRC 2008)</DisplayText><record><rec-number>132</rec-number><ref-type name="Electronic Source">12</ref-type><contributors><authors><author>NHMRC</author></authors></contributors><titles><title>NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation.</title></titles><number>11/03/08</number><dates><year>2008</year></dates><publisher>National Health and Medical Research Council, Australian Government</publisher><work-type>Internet</work-type><urls><related-urls><url>.au/consult/index.htm</url></related-urls></urls></record></Cite></EndNote>(NHMRC 2008). Five components are considered essential by the NHMRC when judging the body of evidence: the evidence-base—which includes the number of studies sorted by their methodological quality and relevance to patients;the consistency of the study results—whether the better quality studies had results of a similar magnitude and in the same direction, i.e. homogeneous or heterogeneous findings;the potential clinical impact—appraisal of the precision, size and clinical importance or relevance of the primary outcomes used to determine the safety and effectiveness of the test;the generalisability of the evidence to the target population; andthe applicability of the evidence—integration of this evidence for conclusions about the net clinical benefit of the intervention in the context of Australian clinical practice.A matrix for assessing the body of evidence for each research question, according to the components above, was used for this assessment ( REF _Ref362269843 \h \* MERGEFORMAT Table 11).Table 11Body of evidence matrix ComponentABCD-ExcellentGoodSatisfactoryPoorEvidence-base aOne or more level I studies with a low risk of bias or several level II studies with a low risk of biasOne or two level II studies with a low risk of bias or an SR or several level III studies with a low risk of biasOne or two level III studies with a low risk of bias, or level I or II studies with a moderate risk of biasLevel IV studies, or level I to III studies/SRs with a high risk of biasConsistency bAll studies consistentMost studies consistent and inconsistency may be explainedSome inconsistency reflecting genuine uncertainty around clinical questionEvidence is inconsistentClinical impactVery largeSubstantialModerateSlight or restrictedGeneralisabilityPopulation(s) studied in body of evidence are the same as target population Population(s) studied in body of evidence are similar to target population Population(s) studied in body of evidence differ from target population for guideline but it is clinically sensible to apply this evidence to target population cPopulation(s) studied in body of evidence differ from target population and it is hard to judge whether it is sensible to generalise to target populationApplicabilityDirectly applicable to Australian healthcare contextApplicable to Australian healthcare context with few caveatsProbably applicable to Australian healthcare context with some caveatsNot applicable to Australian healthcare contextSource: adapted from ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2008</Year><RecNum>132</RecNum><DisplayText>(NHMRC 2008)</DisplayText><record><rec-number>132</rec-number><ref-type name="Electronic Source">12</ref-type><contributors><authors><author>NHMRC</author></authors></contributors><titles><title>NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation.</title></titles><number>11/03/08</number><dates><year>2008</year></dates><publisher>National Health and Medical Research Council, Australian Government</publisher><work-type>Internet</work-type><urls><related-urls><url>.au/consult/index.htm</url></related-urls></urls></record></Cite></EndNote>NHMRC (2008)aLevel of evidence determined from the NHMRC evidence hierarchy (Table 9) bIf there is only one study, rank this component as ‘not applicable’. cFor example, results in adults that are clinically sensible to apply to children OR psychosocial outcomes for one cancer that may be applicable to patients with another cancerSR = systematic review; several = more than two studiesExpert advice: Health Expert Standing Panel (HESP) The Health Expert Standing Panel (HESP) has been established as a panel of the MSAC and is a pool of experts collated from various medical fields who are nominated by their associated professional body or by applicants. HESP members are engaged to provide practical, professional advice to evaluators that directly relates to each application and the service being proposed for the MBS. HESP members are not members of either MSAC or its subcommittees. Their role is limited to providing input and guidance to the assessment groups to ensure that the pathway is clinically relevant and takes into account consumer interests. HESP members’ advice is used to inform the deliberations that MSAC presents to the Federal Minister for Health.Results of assessment Is it safe? Summary—Is catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD as safe as, or safer than, no pH monitoring?Only one study was identified that assessed the safety of catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD compared with no pH monitoring. This RCT found that chest pain was more likely to occur in those undergoing catheter-free monitoring (66%) than those undergoing no monitoring (28%) (RR=2.33, 95%CI 0.81, 6.76). Chest pain is likely to be attributed to the placement of the capsule.Summary—Is catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD as safe as, or safer than, catheter-based oesophageal pH monitoring?Twelve comparative studies were identified that reported on complications of catheter-free monitoring compared with catheter-based monitoring. Included were four RCTs, one pseudo-RCT, three cohort studies, two non-randomised controlled trials and two case-control studies.No deaths or life-threatening events caused by pH monitoring were reported in the comparative studies. Chest pain was significantly more prevalent in patients undergoing catheter-free monitoring compared with catheter-based monitoring, as reported in four out of seven studies. In a high-quality RCT by Andrews et al. (2012), the median chest pain score during the pH test was 29?±?4?mm on a 100-point VAS in the catheter-free monitoring group, compared with only 14?±?3?mm in the catheter-based monitoring group (p=0.001). The difference is likely to be clinically meaningful. On the other hand, other adverse events such as nose and throat pain, dysphagia, eating and drinking difficulties, and headache were significantly more prevalent in catheter-based monitoring compared with catheter-free monitoring. Catheter-based monitoring tends to produce more overall discomfort than catheter-free monitoring and is more likely to have a negative impact on normal daily activities and work attendance. In addition to the comparative studies, 29 non-comparative level IV studies were included to determine other complications and/or adverse events caused by catheter-free monitoring. The most common reported adverse events were chest pain and foreign-body sensation. Other complications included diminished appetite, extreme gagging, nausea, epistaxis, pharyngeal irritation, retrosternal discomfort on swallowing, throat pain, back pain, rash, mucosal abrasion with (minor) haemorrhage, capsule dislodgement, capsule detachment failure, laryngospasm, vasovagal reaction, poor capsule tolerance with vomiting, and a dizzy spell during insertion.In children, two oesophageal tears were reported, at least one due to a capsule release failure. Less-severe adverse events in children were overall discomfort, mild chest discomfort, coughing and dysphagia.Finally, seven case reports were identified that reported some additional (rare) complications resulting from catheter-free monitoring, such as capsule dislodgment and/or aspiration, retention of the capsule in a colonic diverticulum and oesophageal perforation.In conclusion, most complications reported were mild and did not require medical therapy. However, some (rare) complications can become severe when left untreated.Studies were included to assess the safety of catheter-free (wireless) oesophageal pH monitoring according to criteria outlined a priori in REF _Ref360536329 \h \* MERGEFORMAT Box 1.Box 1Inclusion criteria for studies assessing the safety of catheter-free (wireless) oesophageal pH monitoringSelection criteriaInclusion criteriaPopulationPatients with symptoms of GORD for whom pH monitoring is indicatedPatients with symptoms of GORD in whom catheter-based pH monitoring has failed or in whom it is anatomically inappropriate Subgroups: adults versus childrenInterventionCatheter-free (wireless) ambulatory oesophageal pH monitoringComparatorsNo pH monitoringCatheter-based oesophageal pH monitoringOutcomesAny adverse events arising from monitoring including:oesophageal injurychest painlate detachmentstricturenaso-pharyngeal discomfortnauseaAny adverse events arising from (incorrect) treatment (as a result of no monitoring), such as:worsening of or no decrease in reflux complaintsBarrett’s oesophagus / oesophageal adenocarcinomaPublication typeRandomised or non-randomised controlled trials, cohort studies, registers, case series, case reports or systematic reviews of these study designsSearch period2001 – 5/2013LanguageNon-English language articles were excluded unless they provided a higher level of evidence than the English language articles identifiedThere were 48 studies that met the selection criteria that reported on the safety of catheter-free monitoring. There was 1 comparative study on the safety of (proximal) catheter-free monitoring compared with no monitoring, and 12 studies compared catheter-based monitoring with catheter-free monitoring in terms of safety. The remaining studies were case series or case reports. There were no deaths or life-threatening events reported as a direct result of either catheter-free or catheter-based monitoring. Safety of catheter-free (wireless) pH monitoring Safety results have been divided into the commonly reported outcomes of chest pain, foreign-body sensation, nose and throat pain, dysphagia, eating and drinking difficulties, impact on daily life, overall discomfort and satisfaction, and ‘other’. Within each table of results per outcome, studies are listed in order of methodological quality and sample size. For the complete overview of safety data extracted per study, including non-significant results, see REF _Ref364237359 \h \* MERGEFORMAT Appendix E (page PAGEREF _Ref366248166 \h 231). Chest pain One randomised blinded controlled trial ADDIN EN.CITE <EndNote><Cite><Author>Francis</Author><Year>2012</Year><RecNum>236</RecNum><IDText>91-97</IDText><DisplayText>(Francis, DO et al. 2012)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francis, D. O.</author><author>Sumner, E.</author><author>Goutte, M.</author><author>Slaughter, J. C.</author><author>Garrett, C. G.</author><author>Hagaman, D.</author><author>Vaezi, M. F.</author></authors></contributors><titles><title>Feasibility of Dual Wireless Esophageal pH Monitoring: Randomized Blinded Sham-Controlled Trial</title><secondary-title>Otolaryngology-Head and Neck Surgery</secondary-title></titles><periodical><full-title>Otolaryngology-Head and Neck Surgery</full-title></periodical><pages>91-97</pages><volume>147</volume><number>1</number><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0194-5998</isbn><accession-num>CCC:000314267600016</accession-num><urls><related-urls><url><Go to ISI>://CCC:000314267600016</url><url>;(Francis et al. 2012) reported on chest discomfort during proximal (16?cm above the SCJ) catheter-free pH monitoring compared with no proximal monitoring (Table 12). All patients had a wireless pH-monitoring capsule positioned 6?cm proximal to the gastro-oesophageal junction (GOJ), and 48?hours later they were randomised into proximal capsule placement (i.e. another capsule placed 16?cm above the SCJ) or sham capsule placement. Patients were blinded regarding whether the second capsule was deployed and there were 11 patients in each group. In the intervention group 66% reported chest pain scores of 3 or greater on a 10-point VAS where higher scores indicate more pain, compared with only 28% in the control group (RR=2.33, 95%CI 0.81, 6.76). For higher levels of chest discomfort, 32% reported a chest pain score of ≥7 in the intervention group, compared with 8% in the sham group. Multivariate analysis showed an increased odds of severe chest pain in the intervention group when comparing subjects with the same chest pain score during the first monitoring period (adjusted OR=8.44; 95%CI 1.35, 52.6). Four (three level II and one level III-2) intervention studies reported significantly more chest pain or oesophageal discomfort with catheter-free monitoring than with catheter-based monitoring in adults. In a high-quality RCT by Andrews et al. (2012), the median chest pain score during the pH test was 29?±?4?mm on a 100-point VAS in the catheter-free monitoring group, compared with only 14?±?3?mm in the catheter-based monitoring group (p=0.001) This difference is likely to be clinical meaningful. An RCT by Wong et al. (2005) reported 9/25 patients (36%) with chest discomfort with catheter-free monitoring, compared with only 2/25 patients (8%) in the catheter-based monitoring group (RR=4.5, 95%CI 1.08, 18.77, p=0.037, p=0.037). More chest discomfort (RR=1.95, 95%CI 1.47, 2.60) and chest pain (RR=1.76, 95%CI 1.2, 2.57) in the catheter-free monitoring group, relative to the catheter-based monitoring group, was also reported in a cohort study by Bradley et al. (2011). In one average-quality case-control study (Pandolfino et al. 2003) 34% of the patients undergoing catheter-free monitoring had oesophageal discomfort, compared with only 17% of those undergoing catheter-based monitoring. Three studies (Schneider et al. 2007; Grigolon et al. 2007; Wenner, Johnsson et al. 2007) did not report significant differences in chest pain or oesophageal discomfort.Table 12Chest discomfort or chest pain resulting from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI] (p-value)Wenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median 10 cm VAS (IQR) Chest symptoms: 2.4 (0.3–5.9)Patients’ experience, median 10 cm VAS (IQR) Chest symptoms: 1.1 (0.3 – 2.9)(0.084)aAndrews et al. (2012)Level IIQuality: 19/26Dual centre, randomised, non-blinded trial43 participants, catheter group43 participants, wireless grouppH placement discomfort (100 mm VAS ± SE)Chest: 14 ± 3pH-test discomfort (mm VAS ± SE)Chest: 29 ± 4pH placement discomfort (100 mm VAS ± SE)Chest: 13 ± 3pH-test discomfort (mm VAS ± SE)Chest: 14 ± 3(0.968)b(0.001)bWong et al. (2005)Level IIQuality: 16.5/26Randomised controlled trial25 participants, catheter group25 participants, wireless groupChest discomfort: 9/25 (36%)Chest discomfort: 2/25 (8%)4.5 [1.08, 18.77] (0.037)Grigolon et al. (2007)Level III-1Quality: 13.5/26Pseudo-randomised controlled trial78 participants, catheter group55 participants, wireless groupChest discomfort: 17/55 (30.9%)Not stated-Bradley et al. (2011)Level III-2Quality: 15/26Cohort study106 participants, catheter group234 participants, wireless groupChest discomfort: 54/106 (51%)Chest pain: 35/106 (33%)Chest discomfort: 61/234 (26%)Chest pain: 44/234 (19%)1.95 [1.47, 2.60](<0.001)1.76 [1.2, 2.57](0.009)Pandolfino et al. (2003)Level III-2Quality: 11.5/26Case-control study30 participants, catheter group29 participants, wireless groupOesophageal discomfort: 10/29 (34.5%)Severe discomfort leading to capsule removal: 2/29 (6.9%)Moderate chest pain: 4/29 (13.8%)Oesophageal discomfort: 5/30 (16.7%)2.07 [0.80, 5.32](<0.05)Schneider et al. (2007)Level III-2Quality: 9/26Non-randomised controlled trial78 participants, wireless group55 participants, catheter groupOesophagus discomfort: 14/78 (17.9%)Oesophagus discomfort: 18/55 (32.7%)0.55, [0.30, 1.01](NS)NS = not significantaAnalysis was done using the Mann-Whitney U-test.bAnalysis was done using the Student t-test.Chest pain was reported in 21/31 non-comparative studies and was the most reported adverse event resulting from catheter-free monitoring. In the studies that reported chest pain or discomfort as an adverse event, rates varied between 0.27% and 45%, with a median of 17.19%. Severe or intolerable chest pain was reported in 6 of the 21 studies and occurred in 0.52% to 5.13% of cases, with a median of 1.44% (see REF _Ref383766707 \h \* MERGEFORMAT Table 75 in REF _Ref364237359 \h \* MERGEFORMAT Appendix E).Children had six times more chest pain undergoing catheter-free monitoring (39%) compared with catheter-based monitoring (6%; p=0.02) (Croffie et al. 2007). Of the four non-comparative studies on complications of catheter-free monitoring in children, one study (Gunnarsdottir, Stenstrom & Arnbjornsson 2007, 2008) reported a case of mild chest discomfort ( REF _Ref366833236 \h \* MERGEFORMAT Table 13 and REF _Ref375124857 \h \* MERGEFORMAT Table 14). Table 13Chest pain or chest discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI] (p-value)Croffie et al. (2007)Level IIQuality: 14.5/25Randomised controlled trial16 participants, catheter group18 participants, wireless groupChest pain 7/18 (39%)Chest pain 1/16 (6%)6.22 [0.86, 45.25](0.02)Table 14Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in childrenStudyLevel and qualityPopulation Complications per procedureGunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008)Level IVQ1Case series58 children 1/58 procedures1 mild chest discomfortForeign-body sensationA foreign-body sensation during monitoring was reported in one comparative study and nine non-comparative studies. Bradley et al. (2011) reported significantly more chest foreign-body sensation in patients with catheter-free monitoring compared with catheter-based monitoring ( REF _Ref361063962 \h \* MERGEFORMAT Table 15).In a large case series by Crowell et al. (2009) the foreign-body sensation rate was as high as 50% (147/294) ( REF _Ref379483586 \h Table 16). Other smaller studies reported a lower rate of globus sensation (i.e. feeling a lump or foreign body in their throat): the proportion of procedures associated with this sensation ranged from 0.22% to 22.97%, with a median of 5.9%.Table 15A foreign-body sensation resulting from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI] (p-value)Bradley et al. (2011)Level III-2Quality: 15/26Cohort study106 participants, catheter group234 participants, wireless groupForeign body chest: 66/106 (62)%Foreign body throat: 22/106 (21%)Foreign body chest: 80/234 (34% )Foreign body throat: 51/234 (22%)1.82 [1.44, 2.30](<0.001)0.95 [0.61, 1.48](0.887)Table 16A foreign-body sensation resulting from catheter-free (wireless) oesophageal pH monitoring in adultsStudyLevel and qualityPopulation Chest discomfort / complications per procedureCrowell et al. (2008)Level IVQ1Case series294 patients147/294 procedures147 foreign-body sensationTseng et al. (2005)Level IVQ1Retrospective case series190 procedures, 186 patientsMost patients noted a foreign-body sensationRemes-Troche et al. (2005)Level IVQ1Prospective case series77 patients11/77 procedures11 foreign-body sensationPrakash et al. (2006)Level IVQ2Retrospective case series452 patients1/452 procedures (but this only gives the major side effects of the patients who requested removal of the capsule)1 severe foreign-body sensationDomingues, Moraes-Filho & Domingues (2011)Level IVQ2Retrospective case series74 patients17/74 procedures17 mild foreign-body sensationGarrean et al. (2008)Level IVQ2Post-test case series60 patients1/60 procedures1 globus sensationBelafsky et al. (2004)Level IVQ2Prospective case series46 patients4/46 procedures4 foreign-body sensationPandolfino et al. (2006)aLevel IVQ2Case-control study10 control subjects and 10 patients with GORD7/20 7 mild chest discomfort or foreign-body sensationaThis study is not a case series but is still included as level IV safety evidence because it does not report a(n) (appropriate) comparison regarding complications or adverse events. Nose and throat painIn contrast to the findings for chest pain and discomfort, other complications and discomforts from pH monitoring were more common with catheter-based monitoring compared with catheter-free monitoring. Five studies reported on nose and/or throat pain or discomfort, and in all studies this was significantly more severe in patients receiving catheter-based monitoring ( REF _Ref361044607 \h \* MERGEFORMAT Table 17). Wenner, Johnsson et al. (2007) reported a median score of 0.2?cm on a 10?cm VAS scale for nose/throat symptoms in patients undergoing catheter-free monitoring, compared with a score of 6.5?cm for patients in the catheter-based monitoring group (p<0.0001)—a clinically significant difference. Andrews et al. (2012) noted a greater difference in nasal discomfort than throat discomfort between the two pH-monitoring technologies, with results favouring catheter-free monitoring. Nasal pain was halved in patients receiving catheter-free monitoring compared with catheter-based monitoring in Wong et al. (2005). The differences in throat pain and discomfort between the two pH tests in Wong et al. (2005), Pandolfino et al. (2003) and Schneider et al. (2007) was much greater than in Andrews et al. (2012), with relative risk reductions favouring catheter-free monitoring that ranged from 67% to 96%. Croffie et al. (2007) reported that throat pain in children was also significantly more common during catheter-based monitoring ( REF _Ref379483635 \h Table 18).Table 17 Nose and throat pain or discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI] (p-value)Wenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median cm VAS (IQR) Nose/throat symptoms: 0.2 (0.0–1.9)Patients’ experience, median cm VAS (IQR) Nose/throat symptoms: 6.5 (1.5–8.0)(<0.0001) aAndrews et al. (2012)Level IIQuality: 19/26Dual centre, randomised, non-blinded trial43 participants, catheter group43 participants, wireless grouppH placement discomfort (mm VAS ± SE)Nasal: 6 ± 2Throat: 32 ± 4pH-test discomfort (mm VAS ± SE)Nasal: 10 ± 3Throat: 19 ± 4pH placement discomfort (mm VAS ± SE)Nasal: 36 ± 4Throat: 37 ± 3pH-test discomfort (mm VAS ± SE)Nasal: 39 ± 3Throat: 43 ± 4(<0.001) b(0.317) b(<0.001) b(<0.001) bWong et al. (2005)Level IIQuality: 16.5/26Randomised controlled trial25 participants, catheter group25 participants, wireless groupNose pain: 8/25 (32%)Runny nose: 13/25 (52%)Nose bleeding: 1/25 (4%)Throat pain: 4/25 (16%)Throat discomfort: 12/25 (48%)Nose pain: 15/25 (60%)Runny nose: 24/25 (96%)Nose bleeding: 0/25 (0%)Throat pain: 12/25 (48%)Throat discomfort: 23/25 (92%)0.53 [0.28, 1.03] (0.047)0.54 [0.37, 0.8] (0.001)(1.0)0.33 [0.12, 0.89] (0.032) 0.52 [0.34, 0.8] (0.001)Pandolfino et al. (2003)Level III-2Quality: 11.5/26Case-control study30 participants, catheter group29 participants, wireless groupThroat discomfort: 4/29 (13.8%)Throat discomfort: 22/30 (73.3%)0.19 [0.07, 0.48] (<0.001)Schneider et al. (2007)Level III-2Quality: 9/26Non-randomised controlled trial55 participants, catheter group78 participants, wireless groupThroat discomfort: 3/78 (3.8%)Throat discomfort: 52/55 (94.5%) 0.04 [0.01, 0.12] (0.001)aAnalysis was done using the Mann-Whitney U-test.bAnalysis was done using the Student t-test.Table 18Nose and throat pain or discomfort resulting from catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI](p-value)Croffie et al. (2007)Level IIQuality: 14.5/25Randomised controlled trial16 participants, catheter group18 participants, wireless group Throat pain 8/18 (44%)Throat pain 15/16 (94%) 0.47 [0.28, 0.81] (0.001)Three case series reported throat pain during catheter-free monitoring ( REF _Ref361045484 \h \* MERGEFORMAT Table 19). Throat pain was reported in 9.3% of cases in the study by Karamanolis et al. (2012), 5.0% of cases by Garrean et al. (2008) and 32.8% of patients by Sofi et al. (2011). No case series mentioned nose pain or discomfort as a side effect from catheter-free monitoring; however, some cases of epistaxis were reported ( REF _Ref361045484 \h \* MERGEFORMAT Table 19).Table 19Throat pain and epistaxis resulting from catheter-free (wireless) oesophageal pH monitoring in adultsStudyLevel and qualityPopulation Throat pain per procedureKaramanolis et al. (2012)Level IVQ1Post-test case series32 patients3/32 procedures3 throat painGarrean et al. (2008)Level IVQ2Post-test case series60 patients3/60 procedures3 throat painSofi et al. (2011)Level IVQ3Retrospective case series58 patients19/58 procedures19 sore throatdes Varannes et al. (2005)aLevel IVQ1In-subject simultaneous recording study40 patients1/40 procedures1 epistaxisMarchese et al. (2006)Level IVQ1Prospective case series39 patients2/39 procedures2 mild epistaxisBelafsky et al. (2004)Level IVQ2Prospective case series46 patients2/46 procedures2 epistaxisaThis study is not a case series but is still included as level IV safety evidence because it does not report a(n) (appropriate) comparison regarding complications or adverse events. DysphagiaDysphagia (difficulty swallowing) was also mentioned as a common adverse effect from pH monitoring. Francis et al. (2012) compared proximal wireless pH monitoring with no proximal pH monitoring (48?hours after the start of distal wireless pH monitoring) during a blinded RCT. They reported increased odds of dysphagia (adjusted OR=14.3; 95%CI 2.12, 96.6; p=0.006) and odynophagia (painful swallowing) (adjusted OR=49.5; 95%CI 4.70, 520; p=0.001) in the intervention group, i.e. those receiving catheter-free monitoring. Wenner, Johnsson et al. (2007) compared swallow-induced symptoms in patients receiving catheter-free and catheter-based monitoring, and reported a median score of 5.2 on a 10?cm VAS scale (IQR=2.1–6.7) in the catheter-based monitoring group, compared with a score of only 2.1 (IQR=0.5–5.0) in the catheter-free monitoring group (p=0.033). Swallowing difficulties were a lot more common in patients undergoing catheter-based, as opposed to catheter-free, monitoring and were approximately halved in a cohort study by Bradley et al. (2011). This study also reported a significant difference in painful swallowing ( REF _Ref379466243 \h \* MERGEFORMAT Table 20). In children the results were similar, with one high-quality case series by Gunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008) reporting that 3 out of 58 (5.2%) children undergoing catheter-free monitoring had dysphagia (see REF _Ref364237359 \h \* MERGEFORMAT Appendix E).Table 20Dysphagia resulting from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNDysphagia, wireless pH monitoringDysphagia, catheter-based pH monitoringRR [95%CI](p-value)Wenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median cm VAS (IQR) Swallow-induced symptoms: 2.1 (0.5–5.0)Patients’ experience, median cm VAS (IQR) Swallow-induced symptoms: 5.2 (2.1–6.7)0.033 aBradley et al. (2011)Level III-2Quality: 15/26Cohort study106 participants, catheter group234 participants, wireless groupDifficulty swallowing: 98/234 (42%)Painful swallowing: 103/234 (44%)Difficulty swallowing: 96/106 (91%)Painful swallowing: 66/106 (62%)0.46 [0.39, 0.54](<0.001)0.71 [0.57, 0.87](0.002)aAnalysis was done using the Mann-Whitney U-test.Eating and drinking difficultiesSix studies reported that pH monitoring affects diet or appetite ( REF _Ref361059257 \h \* MERGEFORMAT Table 21 and REF _Ref379483689 \h \* MERGEFORMAT Table 22). Andrews et al. (2012) reported that patients in the catheter-free monitoring group were more likely to be able to eat and drink without difficulties than those undergoing catheter-based monitoring, with scores of 75?±?5 and 51?±?4 on a VAS-scale, respectively (p<0.001). Catheter-based monitoring affected the diet of 47% of patients in the study by Pandolfino et al. (2003). In comparison, only 3% of the patients receiving catheter-free monitoring in the same study had their diet affected (p<0.001). Wenner, Johnsson et al. (2007) reported a median food intake interference of 1.4 with the catheter-free (wireless) test and 4.0 with the catheter-based test (on a 10-point VAS, where 0 was defined as no interference at all and 10 the worst possible interference). Although a difference of this size would likely be considered clinically significant, the sample was too small for this to be so. Bradley et al. (2011) also did not report any significant differences regarding early fullness or diminished appetite comparing the two pH tests. In children the results were again consistent, with patients undergoing catheter-free monitoring shown to have more appetite than those undergoing catheter-based monitoring (Croffie et al. 2007; REF _Ref379483689 \h \* MERGEFORMAT Table 22).One non-comparative study, a large case series, addressed eating and drinking during catheter-free monitoring, and reported that 82/294 (27.9%) of the patients had a diminished appetite (Crowell et al. 2008; see REF _Ref364237359 \h \* MERGEFORMAT Appendix E). Table 21Eating and drinking difficulties resulting from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI](p-value)Wenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median cm VAS (IQR) Interference food intake: 1.4 (0.2–4.9)Patients’ experience, median cm VAS (IQR) Interference food intake: 4.0 (1.8–7.0)(0.056) aAndrews et al. (2012)Level IIQuality: 19/26Dual centre, randomised, non-blinded trial43 participants, catheter group43 participants, wireless grouppH-test discomfort (mm VAS ± SE)Eating/drinking: 75 ± 5 pH-test discomfort (mm VAS ± SE)Eating/drinking: 51 ± 4(<0.001) bGrigolon et al. (2007)Level III-1Quality: 13.5/26Pseudo-randomised controlled trial78 participants, catheter group55 participants, wireless groupLimitation of food intake (score 0–3)0.4 ± 0.1Limitation of food intake (score range 0–3)0.9 ± 0.1(<0.05)b Bradley et al. (2011)Level III-2Quality: 15/26Cohort study106 participants, catheter group234 participants, wireless groupEarly fullness: 68/234 (29%)Diminished appetite: 56/234 (24%)Early fullness: 23/106 (22%)Diminished appetite: 34/106 (32%)1.33 [0.89, 2.02](0.188)0.75 [0.52, 1.07](0.144) Pandolfino et al. (2003)Level III-2Quality: 11.5/26Case-control study30 participants, catheter group29 participants, wireless groupAffected diet: 1/29 (3%)Affected diet: 14/30 (47%)0.07 [0.01, 0.53](<0.001)aAnalysis was done using the Mann-Whitney U-test, 10?cm VAS.bAnalysis was done using the Student t-test, 100?mm VAS.Table 22Eating and drinking difficulties resulting from catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringp-valueCroffie et al. (2007)Level IIQuality: 14.5/25Randomised controlled trial16 participants, catheter group18 participants, wireless groupAppetite on scale of 1–5: mean 3.54Appetite on scale of 1–5: mean 2.720.029a aAnalysis was done using the Student t-test.Impact on daily life Oesophageal pH monitoring can have an impact on daily activities. All seven studies reported a significant difference in interference in daily activities when comparing the two different tests, favouring catheter-free monitoring ( REF _Ref366245099 \h \* MERGEFORMAT Table 23 and REF _Ref366244904 \h \* MERGEFORMAT Table 24). On a scale of 0– 10—where 0 means no interference, and 10 means maximum interference, with physical activities—Wenner, Johnsson et al. (2007) reported a median score of 0.6 (IQR=0.2–2.7) with catheter-free monitoring, compared with a score of 5.0 (IQR=2.6–8.5) in the catheter-based monitoring group (Mann-Whitney U test p<0.0001). Interference with normal daily life was also assessed in this study and similar results were obtained. Andrews et al. (2012) assessed whether patients with wireless monitoring were better able to maintain their usual activities than patients with a catheter inserted, and found this was the case. Grigolon et al. (2007), Pandolfino et al. (2003) and Schneider et al. (2007) reported similar results ( REF _Ref366245099 \h \* MERGEFORMAT Table 23). Gillies et al. (2005) reported that catheter-based monitoring seemed to affect work attendance significantly more than wireless monitoring: 82% of patients in the catheter-based group did not attend work, compared with only 14% in the catheter-free group (p<0.0001); and interference with work activities was also significantly less with catheter-free monitoring than with catheter-based monitoring in the study by Wenner, Johnsson et al. (2007).Table 23Impact on daily life from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI](p-value)Wenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median cm VAS (IQR) Interference work activities: 0.3 (0.0–1.4)Interference physical activities: 0.6 (0.2–2.7)Interference normal daily life: 0.7 (0.2–3.4)Patients’ experience, median cm VAS (IQR) Interference work activities: 6.8 (1.7–9.0)Interference physical activities: 5.0 (2.6–8.5)Interference normal daily life: 5.7 (2.3–8.0)(0.005) a(<0.0001) a(<0.0001) aAndrews et al. (2012)Level IIQuality: 19/26Dual centre, randomised, non-blinded trial43 participants, catheter group43 participants, wireless grouppH-test discomfort (mm VAS ± SE)Ability usual activities:92 ± 2pH-test discomfort (mm VAS ± SE)Ability usual activities: 75 ± 5(<0.001) bGrigolon et al. (2007)Level III-1Quality: 13.5/26Pseudo-randomised controlled trial78 participants, catheter group55 participants, wireless groupLimitation of daily activities (score 0–3, mean ± SEM)0.2 ± 0.1Limitation of daily activities (score 0–3, mean ± SEM)1.2 ± 0.1(<0.001) bGillies et al. (2007)Level III-2Quality: 13.5/26Non-randomised controlled trial 100 participants, catheter group 85 participants, wireless group (but 100 studies)Impact on work attendance: 14/100 (14%) Impact on work attendance: 82/100 (82%) 0.17[0.10, 0.28](<0.0001)Pandolfino et al. (2003)Level III-2Quality: 11.5/26Case-control study30 participants catheter group,29 participants, wireless groupChange daily routine: 0/29 (0%)Affected activity: 0%Change daily routine: 11/30 (37%)Affected activity: 60%(<0.001)Schneider et al. (2007)Level III-2Quality: 9/26Non-randomised controlled trial55 participants, catheter group78 participants, wireless groupReduced activities: 5/78 (6.4%)Reduced activities: 55/55 (100%)0.12[0.05, 0.29](0.0001)aAnalysis was done using the Mann-Whitney U-test.bAnalysis was done using the Student t-test.In children the results were similar to those described in adults ( REF _Ref366244904 \h \* MERGEFORMAT Table 24).Table 24Impact on daily life from catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringp-valueCroffie et al. (2007)Level IIQuality: 14.5/25Randomised controlled trial16 participants catheter group18 participants wireless group Mean activity on scale of 1–5: 3.66 Mean activity on scale of 1–5: 2.330.001 aaAnalysis was done using the Student t-test.Overall discomfort and satisfactionOverall placement discomfort was not significantly different between the two pH monitoring tests, when Andrews et al. (2012) and Grigolon et al. (2007) reported on this outcome. Overall discomfort during the period of monitoring was higher when a catheter was used. Overall discomfort scores on a VAS—where 0 means no discomfort and 100 means worst possible discomfort—ranged from 21 to 29 in patients undergoing catheter-free monitoring and from 33 to 51 in those undergoing catheter-based monitoring (Wenner, Johnsson et al. 2007; Andrews et al. 2012; Grigolon et al. 2007; p-values ≤0.012). Gilles et al. (2007) reported that 27% of the patients undergoing catheter-free monitoring experienced no overall discomfort, compared with only 3% undergoing catheter-based monitoring (p<0.0001). In the same patient population 23% in the catheter-free group and 45% in the catheter-based group reported discomfort scores >5 on a scale of 0–10. This difference was not considered statistically significant. Overall satisfaction scores were higher in patients who underwent catheter-free monitoring than catheter-based monitoring (Pandolfino et al. 2003; Sweis et al. 2009; REF _Ref361134190 \h \* MERGEFORMAT Table 25). Table 25Overall discomfort and satisfaction from catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringRR [95%CI]p-valueWenner, Johnsson et al. (2007) Level IIQuality: 20/26Randomised crossover trial31 participants, catheter group31 participants, wireless groupPatients’ experience, median cm VAS (IQR) All adverse symptoms: 2.1 (0.5–4.6)Patients’ experience, median cm VAS (IQR) All adverse symptoms: 5.1 (2.0–6.6)(<0.001) aAndrews et al. (2012)Level IIQuality: 19/26Dual centre, randomised, non-blinded trial43 participants, catheter group43 participants, wireless grouppH placement discomfort (mm VAS ± SE)Overall: 29 ± 4pH-test discomfort (mm VAS ± SE)Overall: 26 ± 4pH placement discomfort (mm VAS ± SE)Overall: 33 ± 4pH-test discomfort (mm VAS ± SE)Overall: 39 ± 4(0.406) b(0.012) bGrigolon et al. (2007)Level III-1Quality: 13.5/26Pseudo-randomised controlled trial78 participants, catheter group55 participants, wireless groupMean placement discomfort (mm VAS ± SE) 29 ± 4Discomfort during whole test (mm VAS ± SE)22 ± 3None to mild discomfort: 41/55 (74.5%)Mean placement discomfort (mm VAS ± SE) 32 ± 3Discomfort during whole test (mm VAS ± SE)37 ± 3None to mild discomfort: 40/78 (51.3%)NS(<0.001) b(<0.05) bSweis et al. (2009)Level III-2Quality: 15/26Cohort study110 participants, catheter group134 participants, wireless groupOverall satisfaction: 4.4/5Overall satisfaction: 3.5/5(<0.001) bGillies et al. (2007)Level III-2Quality: 13.5/26Non-randomised controlled trial 100 participants, catheter group 85 participants, wireless group (but 100 studies)73/100 (73%) overall discomfortMedian discomfort: 3Discomfort score >5: 23/100 (23%)97/100 (97%) overall discomfortMedian discomfort: 5Discomfort score >5: 45/100 (45%)0.85 [0.68, 1.07](<0.0001) a0.60 [0.39, 0.94]Pandolfino et al. (2003)Level III-2Quality: 11.5/26Case-control study30 participants, catheter group29 participants, wireless groupSatisfaction (the lower the better): 0.8 ± 0.1Satisfaction (the lower the better): 1.9 ± 0.2(<0.001) bNS = not significantaAnalysis was done using the Mann-Whitney U-test.bAnalysis was done using the Student t-test.In children the results were similar to those found in adults ( REF _Ref361134205 \h \* MERGEFORMAT Table 26).Table 26Overall discomfort and satisfaction from catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringp-valueCroffie et al. (2007)Level IIQuality: 14.5/25Randomised controlled trial16 participants, catheter group18 participants, wireless group Overall satisfaction on scale of 1–5: 4.31Overall satisfaction on scale of 1–5: 3.110.003 aaAnalysis was done using the Student t-test.Other reported side effects and complicationsWong et al. (2005) reported other fairly prevalent side effects such as coughing (20% in catheter-free and 28% in catheter-based monitoring) and headaches (20% in catheter-free and 56% in catheter-based monitoring, p=0.009). Furthermore, 19% experienced abdominal pain and 18% nausea, and 6% had to vomit during the wireless test, compared with 14%, 20% and 6%, respectively, in the catheter group in the study by Bradley et al. (2011); but these results were not significantly different. In the study by Pandolfino et al. (2003) 9% of patients undergoing catheter-free monitoring reported disrupted sleep, compared with 30% undergoing catheter-based monitoring; this difference was not considered statistically significant (see REF _Ref364237359 \h \* MERGEFORMAT Appendix E).In the non-comparative studies, other adverse events or complications resulting from wireless pH monitoring were extreme gagging (1/190); coughing (6/58); nausea (5/77); pharyngeal irritation (3/39); back pain (5.0% to 6.3%); rash (1/203); mucosal abrasion with minor haemorrhage (1/30); capsule dislodgement in the mouth, pyriform sinus or stomach (3/76); detachment failure of the capsule (1/66); laryngospasm (2/46); vasovagal reaction (1/46); poor tolerance with vomiting (2/40); and dizzy spell during insertion (1/40).Four case series reported adverse events of catheter-free monitoring in children. There were two oesophageal tears reported, at least one due to a capsule release failure. A less severe adverse event reported was coughing (1/58). Case reports were also included but provided less information than case series because it was impossible to determine the denominator, i.e. how many patients received the test and were at risk of harm but did not have any adverse effects. Case reports only provide descriptive information as to the possible types of adverse events and can be useful for describing rare complications. The case reports’ results are shown in REF _Ref364237359 \h \* MERGEFORMAT Appendix E. Serious complications of catheter-free monitoring mentioned in these case reports and not anywhere else were: a retention of the capsule in a colonic diverticulum for over 2?years, a capsule aspiration followed by decreased oxygen saturation, an oesophageal perforation, and different capsule dislodgements—one in the left pyriform sinus and one in the mainstem bronchus. Capsule aspirations and dislodgements can lead to pain, breathing difficulties and choking, depending on where the capsules dislodge, and can therefore become a severe complication. Oesophageal perforations can lead to further complications such as permanent damage to the oesophagus, abscess formation, infection in and around the lungs, and can progress to shock and even death if remain untreated. Is it effective? Direct evidence of diagnostic effectivenessDoes catheter-free monitoring improve health outcomes?Summary—What is the effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD in patients who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate? Does catheter-free monitoring improve health outcomes?No studies were identified that assessed the direct health impact of catheter-free monitoring versus no monitoring in the selected study population. However, one matched-pairs study found that just slightly more patients who were monitored by the wireless system had an improvement or disappearance of the principal symptom, compared with those monitored by the catheter-based system (73% in the wireless group versus 69% in the catheter-based group (n=51 in each group)). A before-and-after study reported that out of 26 patients who received medical therapy or conservative advice after a catheter-free monitoring test, 9 patients had a good or moderate improvement in symptoms.In a meta-analysis, catheter-free monitoring in adults was found to have over three times the risk (RR=3.3, 95%CI 1.63, 6.81) of having technical problems compared with catheter-based monitoring. A similar comparative risk of technical problems was seen in a trial of pH monitoring in adults and children combined (RR=2.87, 95%CI 1.47, 5.62). Most studies (15/20) reported only minimal day-to-day variability in oesophageal acid exposure across the 2?days of monitoring, suggesting that catheter-free monitoring is a reliable means of monitoring pH levels. Studies were included to assess the effectiveness of catheter-free (wireless) oesophageal pH monitoring according to the criteria outlined a priori in REF _Ref360542369 \h \* MERGEFORMAT Box 2.Box 2Eligibility criteria for identification of studies relevant to an assessment of effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoringSelection criteriaInclusion criteriaPopulationPatients with symptoms of GORD in whom catheter-based pH monitoring has failed or in whom it is anatomically inappropriate InterventionCatheter-free (wireless) ambulatory oesophageal pH monitoringComparatorsNo pH monitoringOutcomesPatient relevant outcomes: quality of life, reduction in progression to Barrett’s oesophagus and/or oesophageal cancer, symptom resolution or symptom reductionPublication typeRandomised or non-randomised controlled trials, cohort studies or systematic reviews of these study designsSearch period2001 – 5/2013LanguageNon-English language articles were excluded unless they provided a higher level of evidence than the English language articles identifiedNo studies were identified that assessed the direct health impact of catheter-free monitoring versus no monitoring in the selected study population. Two studies reported on the reduction in GORD symptoms after catheter-free monitoring. However, these studies did not include patients who had either failed a catheter-based test or in whom catheter-based monitoring was anatomically inappropriate. Furthermore, they did not have ‘no pH monitoring’ as a comparator, and therefore did not meet the inclusion criteria specified a priori. However, in the absence of more relevant data, results from these studies are presented. A matched-pairs retrospective cohort study by Grigolon et al. (2011) evaluated the usefulness of a 96-hour catheter-free monitoring test in patients’ clinical management, comparing outcomes of 51 patients studied with the wireless technique and 51 patients studied with the traditional catheter-based 24-hour test. The percentage of patients with an improvement in or disappearance of the principal GORD symptom was 73% in the catheter-free group and 69% in the catheter-based group. The average satisfaction score was 7.0 in the catheter-free group compared with 6.5 in the catheter-based group, on a scale of 0 to 10; as expected, the average score for satisfaction increased progressively (p<0.001) in the two groups as their symptoms improved.Sweis et al. (2011) assessed the clinical impact of prolonged, 96-hour catheter-free pH monitoring at clinical follow-up (6–36?months) in patients with negative 24-hour catheter-based monitoring referred for a second opinion due to ongoing symptoms suggestive of GORD. Follow-up data from at least 6?months after initiation of therapy were available for 33 out of 38 patients (87%). Twenty-six of these patients received medical therapy or conservative advice, with median follow-up at 24?months. Nine of these patients had a moderate or good improvement in symptoms and 17 had a poor outcome or were lost to follow-up. In these groups all 9 (100%) in the improvement group and 9 out of the 17 (53%) in the poor-outcome group had a GORD diagnosis on the basis of pathologic acid exposure or a positive association with GORD symptoms during catheter-free monitoring (p=0.361).Technical efficacy Studies were included to assess the technical efficacy of catheter-free (wireless) oesophageal pH monitoring according to the criteria outlined in REF _Ref360615021 \h \* MERGEFORMAT Box 3.Box 3Eligibility criteria for identification of studies relevant to an assessment of the technical efficacy of catheter-free (wireless) ambulatory oesophageal pH monitoringSelection criteriaInclusion criteriaPopulationPatients with symptoms of GORD in whom catheter-based pH monitoring has failed or in whom it is anatomically inappropriate Patients with symptoms of GORD for whom pH monitoring is indicated InterventionCatheter-free (wireless) ambulatory oesophageal pH monitoringComparatorsNo pH monitoringCatheter-based oesophageal pH monitoring OutcomesTechnical efficacy: operative success and early detachment or hardware malfunctionsPublication typeRandomised or non-randomised controlled trials, cohort studies, registers, case series, case reports or systematic reviews of these study designs Search period2001 – 5/2013LanguageNon-English language articles were excluded unless they provided a higher level of evidence than the English language articles identifiedCatheter-free monitoring versus catheter-based monitoringNine studies were included that reported not only the technical efficacy of catheter-free monitoring, but also catheter-based monitoring failure rates. There were no statistically significant differences in failure rates or recording efficacy when the two pH-measuring systems were compared. However, all eight studies conducted in adults reported a higher percentage of technical problems with the new catheter-free system compared with the traditional catheter-based system ( REF _Ref361145268 \h \* MERGEFORMAT Table 27). No differences were found between the two systems when used in children (Croffie et al. 2007). A meta-analysis was conducted to determine the overall risk of technical failures of both systems when used in adults ( REF _Ref361236783 \h \* MERGEFORMAT Figure 7). The risk of having technical problems with catheter-free monitoring was over three times higher than with catheter-based monitoring (RRp=3.3; 95%CI 1.63, 6.81; I2=0%, p=0.906; k = 8 studies). Results of studies included in this meta-analysis were fairly consistent.Other (non-comparative) technical efficacy results of catheter-free monitoring have been divided and described per outcome; for the complete overview of non-comparative technical efficacy data extracted by each study, see REF _Ref379483855 \h \* MERGEFORMAT Appendix F . Studies are listed in order of level of evidence, quality and sample size.Table 27Failure rates / recording efficacy of catheter-free monitoring compared with catheter-based monitoring StudyLevel and qualityNCatheter-free monitoring Catheter-based monitoring RR[95%CI]des Varannes et al. (2005)Level: II Quality: 20/26In-subject simultaneous recording study40 patientsAdults7/40 procedures (17.5%)1 dysfunction of the capsule2 insertion intolerances1 detachment failure from the delivery system1 recording failure 2 early detachments1/40 procedures (2.5%)1 recording failure7.00[0.90, 54.32]Wenner, Johnsson et al. (2007)Level: IIQuality: 20/26Randomised crossover trial35 patientsAdults2/35 procedures (5.7%)2 technical problems0/35 procedures (0%)5.00[0.25, 100.53]Andrews et al. (2012)Level: IIQuality: 19/26Dual centre, randomised, non-blinded trial43 patients in the wireless group 43 patients in the catheter groupAdults5/43 procedures (12%)2 failed capsule calibrations2 early detachments1 insertion intolerance3/43 procedures (7%)1 equipment malfunction after the patient dropped the recorder2 catheter intolerances with early probe removal1.67 [0.42, 6.54]Azzam et al. (2012)Level: II Quality: 17/26In-subject simultaneous recording study25 patientsAdults1/25 procedures (4.0%)1 early detachment0/25 procedures (0%)3.00[0.13, 70.30]Wong et al. (2005)Level: IIQuality: 16.5/26Randomised controlled trial25 patients in the wireless group 25 patients in the catheter groupAdults2/25 procedures (8.0%)2 failures of transnasal insertion1/25 procedures (4.0%)1 catheter intolerance2.00 [0.19, 20.67]Grigolon et al. (2007)Level: III-1Quality: 13.5/26Pseudo-randomised controlled trial55 patients in the wireless group 78 patients in the catheter groupAdults1/55 procedures (1.8%)1 early detachment95.5% (91.5–97) recording time0/78 procedures (0%)98% (94–99) recording time4.23[0.18, 102.00]Bradley et al. (2011)Level: III-2Quality: 15/26Cohort study234 patients in the wireless group 106 patients in the catheter groupAdults5/234 procedures (2.1%)2 early detachments3 endoscopic removals due to severe discomfort1/106 procedures (0.9%)1 catheter intolerance 2.26 [0.27, 19.15]Hakanson et al. (2009)Level: III-2Quality: 14/26Case-control study with in-subject simultaneous recording53 volunteers and 55 patientsAdults13/108 procedures (12.0%)5 attachment failures4 early detachments3 immediate detachments1 recording failure2/108 procedures (1.9%)1 sensor displacement in the stomach1 catheter intolerance6.50[1.5, 28.12]Croffie et al. (2007)Level: IIQuality:14.5/26Randomised controlled trial30 patients in wireless + catheter group, 18 patients in wireless group and 18 in catheter groupChildren2/48 procedures (4.2%)1 recording failure1 early detachment2/48 procedures (4.2%)1 recording failure1 catheter intolerance1.00[0.15, 6.81]Figure 7Meta-analysis of technical efficacy of catheter-free monitoring compared with catheter-based monitoringInsertion and placement of the catheter-free (wireless) systemSix studies reported on the rate of problems associated with the insertion and placement of both the catheter-free and catheter-based monitoring systems ( REF _Ref361145268 \h \* MERGEFORMAT Table 27). On average, problems occurred more often during insertion or placement of the catheter-free (median 7.5% procedures, range 0%–12%) than the catheter-based monitoring system (median 0.9% procedures, range 0%–4%) ( REF _Ref361145268 \h \* MERGEFORMAT Table 27). Reported insertion and placement problems with the catheter-based system were catheter intolerance or sensor displacement. REF _Ref379483855 \h Appendix F outlines the errors during insertion and placement of the wireless system, which were reported in 24 studies for a total of 1,933 patients. The most common errors during insertion and placement of the wireless system were:an error in placement: either in the cardia or in the wrong place on the oesophagus wall (63–73 times).attachment failure: the capsule does not attach (properly) to the oesophageal mucosa (28–38 times).4detachment failure: the capsule fails to deploy from the delivery system (6–10 times).insertion failure: the inability to insert the system, either due to intolerance or anatomical abnormalities (9 times).immediate detachment: detachment of the capsule from the oesophageal wall immediately after insertion, sometimes followed by aspiration of the capsule (4 times).failed capsule calibration or device malfunction: inability to correctly calibrate the capsule before the monitoring period, or malfunction of the device when inserting (2 and 2 times, respectively).Most insertion and placement errors that occur with wireless monitoring are bothersome and inconvenient for the patient, since they have to return for another try or have the catheter inserted twice in the same sitting. However, insertion failures due to intolerance or anatomical abnormalities would occur in both catheter-free and catheter-based monitoring situations, because both systems are inserted using a catheter. The only difference would be that the catheter could be inserted transnasally or transorally in catheter-free monitoring, whereas it has to be inserted transnasally in catheter-based monitoring.Technical failures during data recordingThe only complications reported in catheter-based monitoring in comparative studies during data recording were recording failures (recorded once in a child and once in an adult) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Dcm9mZmllPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Dcm9mZmllPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE.DATA (Croffie et al. 2007; des Varannes et al. 2005). Technical failures during the (usually 48-hour) catheter-free monitoring period in adults were reported in 36 comparative and non-comparative studies with a total of 3,629 patients. The most commonly reported complication influencing technical efficacy was early capsule detachment (reported 133 times). When the capsule detaches from the oesophageal mucosa early, it passes through the stomach, which leads to unreliable data. The commonly reported errors leading to incomplete data were:early capsule detachment (133 times)incomplete data capture (58 times) recording failure or receiver malfunction (11 times)transmission failure (7 times)errors in data retrieval (4 times)poor data reception (3 times).Furthermore, ‘technical failures’ were reported in 7 cases and the capsule malfunctioned in 2 patients. One patient lost his/her data recorder and therefore no analysis was possible (see REF _Ref361145268 \h \* MERGEFORMAT Table 27 and REF _Ref379483855 \h Appendix F ).In children technical errors occurring during monitoring were similar to those with adults. Incomplete data capture was reported in 21/289 children by Cabrera et al. (2011). Furthermore, early detachment occurred in 5 children PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWJyZXJhPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYWJyZXJhPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48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=
ADDIN EN.CITE.DATA (Cabrera et al. 2011; Croffie et al. 2007), and there were 4 shorter monitoring periods of unknown cause, 2 recording failures and 1 transmission failure during the wireless monitoring period (see REF _Ref361145268 \h \* MERGEFORMAT Table 27 and REF _Ref379483855 \h Appendix F ).Day-to-day variability in oesophageal acid exposureWith catheter-free monitoring it is possible to monitor pH for more than 24?hours: in most cases there is a 48-hour monitoring period. There is a concern that sedation used during insertion of the system may influence the results of the first 24?hours of monitoring, and oesophageal acid exposure has been reported to exhibit day-to-day variability ADDIN EN.CITE <EndNote><Cite><Author>Wiener</Author><Year>1988</Year><RecNum>609</RecNum><IDText>1127-33</IDText><DisplayText>(Wiener et al. 1988)</DisplayText><record><rec-number>609</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">609</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiener, G. J.</author><author>Morgan, T. M.</author><author>Copper, J. B.</author><author>Wu, W. C.</author><author>Castell, D. O.</author><author>Sinclair, J. W.</author><author>Richter, J. E.</author></authors></contributors><auth-address>Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27103.</auth-address><titles><title>Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters</title><secondary-title>Dig Dis Sci</secondary-title><alt-title>Digestive diseases and sciences</alt-title></titles><periodical><full-title>Dig Dis Sci</full-title><abbr-1>Digestive diseases and sciences</abbr-1></periodical><alt-periodical><full-title>Dig Dis Sci</full-title><abbr-1>Digestive diseases and sciences</abbr-1></alt-periodical><pages>1127-33</pages><volume>33</volume><number>9</number><keywords><keyword>Adult</keyword><keyword>Ambulatory Care</keyword><keyword>Female</keyword><keyword>*Gastric Acidity Determination</keyword><keyword>Gastroesophageal Reflux/*diagnosis/physiopathology</keyword><keyword>Humans</keyword><keyword>Hydrogen-Ion Concentration</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Monitoring, Physiologic</keyword><keyword>Prospective Studies</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>1988</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0163-2116 (Print)
0163-2116 (Linking)</isbn><accession-num>3044715</accession-num><urls><related-urls><url>;(Wiener et al. 1988). If this is the case, monitoring for 48 hours instead of 24?hours, as with traditional catheter-based monitoring, would give truer and more-accurate results, and this may have clinical advantages. Twenty studies reported on the day-to-day variability in oesophageal acid exposure with catheter-free monitoring in adults (see Table 78 in Appendix G).Two large case series of 124 and 77 patients reported significantly more reflux episodes on the second day of monitoring PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaGFuZGVyPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DaGFuZGVyPC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48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ADDIN EN.CITE.DATA (Chander et al. 2012; Remes-Troche et al. 2005). Three other quality case series of 203, 148 and 26 patients reported more reflux on day 1 PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWNodG9sZDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+
PFJlY051bT4xOTc8L1JlY051bT48SURUZXh0PjQwOTEtNTwvSURUZXh0PjxEaXNwbGF5VGV4dD4o
QmVjaHRvbGQgZXQgYWwuIDIwMDc7IEJoYXQsIE1jR3JhdGggJmFtcDsgQmllbGVmZWxkdCAyMDA2
OyBUdXJuZXIgZXQgYWwuIDIwMDcpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE5
NzwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6dzVlZmRm
bGRkejVhZTJ4MDM1cnAyZnoyMnNld3J2cjB3ciI+MTk3PC9rZXk+PC9mb3JlaWduLWtleXM+PHJl
Zi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+
PGF1dGhvcnM+PGF1dGhvcj5CZWNodG9sZCwgTS4gTC48L2F1dGhvcj48YXV0aG9yPkhvbGx5LCBK
LiBTLjwvYXV0aG9yPjxhdXRob3I+VGhhbGVyLCBLLjwvYXV0aG9yPjxhdXRob3I+TWFyc2hhbGws
IEouIEIuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2
aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSBVbml2ZXJzaXR5IG9mIE1pc3NvdXJpIFNjaG9vbCBv
ZiBNZWRpY2luZSwgT25lIEhvc3BpdGFsIERyaXZlLCBDb2x1bWJpYSwgTU8gNjUyMTIsIFVTQS48
L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5CcmF2byAod2lyZWxlc3MpIGFtYnVsYXRvcnkg
ZXNvcGhhZ2VhbCBwSCBtb25pdG9yaW5nOiBob3cgZG8gZGF5IDEgYW5kIGRheSAyIHJlc3VsdHMg
Y29tcGFyZT88L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+V29ybGQgSiBHYXN0cm9lbnRlcm9sPC9z
ZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Xb3JsZCBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xv
Z3kgOiBXSkc8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5Xb3Js
ZCBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5Xb3JsZCBqb3VybmFsIG9mIGdh
c3Ryb2VudGVyb2xvZ3kgOiBXSkc8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2Fs
PjxmdWxsLXRpdGxlPldvcmxkIEogR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0xPldv
cmxkIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neSA6IFdKRzwvYWJici0xPjwvYWx0LXBlcmlv
ZGljYWw+PHBhZ2VzPjQwOTEtNTwvcGFnZXM+PHZvbHVtZT4xMzwvdm9sdW1lPjxudW1iZXI+MzA8
L251bWJlcj48ZWRpdGlvbj4yMDA3LzA4LzE5PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5B
ZG9sZXNjZW50PC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8
L2tleXdvcmQ+PGtleXdvcmQ+Q29uc2Npb3VzIFNlZGF0aW9uL2FkdmVyc2UgZWZmZWN0czwva2V5
d29yZD48a2V5d29yZD5Fc29waGFnZWFsIHBIIE1vbml0b3JpbmcvIGluc3RydW1lbnRhdGlvbjwv
a2V5d29yZD48a2V5d29yZD5Fc29waGFndXMvIHBoeXNpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+
RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vzb3BoYWdlYWwgUmVmbHV4L2RpYWdub3Np
cy8gcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5
d29yZD5IeWRyb2dlbi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r
ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlJldHJvc3BlY3Rp
dmUgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5UaW1lIEZhY3RvcnM8L2tleXdvcmQ+PC9rZXl3
b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkF1ZyAxNDwvZGF0
ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEwMDctOTMyNyAoUHJpbnQpJiN4RDsxMDA3LTkz
MjcgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE3Njk2MjI3PC9hY2Nlc3Npb24tbnVt
Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3LndqZ25ldC5jb20vMTAwNy05MzI3
LzEzLzQwOTEucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxyZW1vdGUtZGF0YWJhc2Ut
cHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFu
Z3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFyPjIw
MDY8L1llYXI+PFJlY051bT4yMDE8L1JlY051bT48SURUZXh0PjExNi0yMTwvSURUZXh0PjxyZWNv
cmQ+PHJlYy1udW1iZXI+MjAxPC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVO
IiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4yMDE8L2tleT48
L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5
cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJoYXQsIFkuIE0uPC9hdXRob3I+PGF1
dGhvcj5NY0dyYXRoLCBLLiBNLjwvYXV0aG9yPjxhdXRob3I+QmllbGVmZWxkdCwgSy48L2F1dGhv
cj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIEdh
c3Ryb2VudGVyb2xvZ3ksIEhlcGF0b2xvZ3kgYW5kIE51dHJpdGlvbiwgVW5pdmVyc2l0eSBvZiBQ
aXR0c2J1cmdoIFNjaG9vbCBvZiBNZWRpY2luZSwgUGl0dHNidXJnaCwgUEEgMTUyMTMsIFVTQS4g
YmhhdHltQHVwbWMuZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+V2lyZWxlc3MgZXNv
cGhhZ2VhbCBwSCBtb25pdG9yaW5nOiBuZXcgdGVjaG5pcXVlIG1lYW5zIG5ldyBxdWVzdGlvbnM8
L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+SiBDbGluIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10
aXRsZT48YWx0LXRpdGxlPkpvdXJuYWwgb2YgY2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neTwvYWx0
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQ2xpbiBHYXN0cm9lbnRl
cm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiBjbGluaWNhbCBnYXN0cm9lbnRlcm9s
b2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KIENs
aW4gR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0xPkpvdXJuYWwgb2YgY2xpbmljYWwg
Z2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PHBhZ2VzPjExNi0yMTwv
cGFnZXM+PHZvbHVtZT40MDwvdm9sdW1lPjxudW1iZXI+MjwvbnVtYmVyPjxlZGl0aW9uPjIwMDYv
MDEvMDY8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3Jk
PkVzb3BoYWd1cy8gcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5
d29yZD48a2V5d29yZD5HYXN0cmljIEFjaWRpdHkgRGV0ZXJtaW5hdGlvbi9pbnN0cnVtZW50YXRp
b248L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIHBoeXNpb3BhdGhv
bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4t
SW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29y
ZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5LyBp
bnN0cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+UHJvc3BlY3RpdmUgU3R1ZGllczwva2V5
d29yZD48a2V5d29yZD5SZWdpc3RyaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlN0YXRpc3RpY3MsIE5v
bnBhcmFtZXRyaWM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNjwveWVhcj48
cHViLWRhdGVzPjxkYXRlPkZlYjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAxOTIt
MDc5MCAoUHJpbnQpJiN4RDswMTkyLTA3OTAgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVt
PjE2Mzk0ODcxPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8v
Z3JhcGhpY3MudHgub3ZpZC5jb20vb3ZmdHBkZnMvRlBERE5DRkJGQkVQSUcwMC9mczA0Ny9vdmZ0
L2xpdmUvZ3YwMjQvMDAwMDQ4MzYvMDAwMDQ4MzYtMjAwNjAyMDAwLTAwMDA2LnBkZjwvdXJsPjwv
cmVsYXRlZC11cmxzPjwvdXJscz48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3Rl
LWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0
ZT48Q2l0ZT48QXV0aG9yPlR1cm5lcjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051bT41
MzY8L1JlY051bT48SURUZXh0PjczNy03NDE8L0lEVGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjUz
NjwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6dzVlZmRm
bGRkejVhZTJ4MDM1cnAyZnoyMnNld3J2cjB3ciI+NTM2PC9rZXk+PC9mb3JlaWduLWtleXM+PHJl
Zi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+
PGF1dGhvcnM+PGF1dGhvcj5UdXJuZXIsIEIuIEcuPC9hdXRob3I+PGF1dGhvcj5TYWx0em1hbiwg
Si4gUi48L2F1dGhvcj48YXV0aG9yPkh1YSwgTC48L2F1dGhvcj48YXV0aG9yPk1hdXJlciwgUi48
L2F1dGhvcj48YXV0aG9yPkZlbGRtYW4sIE4uPC9hdXRob3I+PGF1dGhvcj5DYXJyLUxvY2tlLCBE
LiBMLjwvYXV0aG9yPjxhdXRob3I+QnVyYWtvZmYsIFIuPC9hdXRob3I+PGF1dGhvcj5MaXUsIEou
IEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjx0aXRsZXM+PHRpdGxlPkVuZG9z
Y29waWMgcEggbW9uaXRvcmluZyBmb3IgcGF0aWVudHMgd2l0aCBzdXNwZWN0ZWQgb3IgcmVmcmFj
dG9yeSBnYXN0cm9lc29waGFnZWFsIHJlZmx1eCBkaXNlYXNlPC90aXRsZT48c2Vjb25kYXJ5LXRp
dGxlPkNhbmFkaWFuIEpvdXJuYWwgb2YgR2FzdHJvZW50ZXJvbG9neTwvc2Vjb25kYXJ5LXRpdGxl
PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNhbmFkaWFuIEpvdXJuYWwgb2YgR2Fz
dHJvZW50ZXJvbG9neTwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjczNy03NDE8L3Bh
Z2VzPjx2b2x1bWU+MjE8L3ZvbHVtZT48bnVtYmVyPjExPC9udW1iZXI+PGRhdGVzPjx5ZWFyPjIw
MDc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48
aXNibj4wODM1LTc5MDA8L2lzYm4+PGFjY2Vzc2lvbi1udW0+Q0NDOjAwMDI1MTQ4MTAwMDAwODwv
YWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+Jmx0O0dvIHRvIElTSSZndDs6
Ly9DQ0M6MDAwMjUxNDgxMDAwMDA4PC91cmw+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5n
b3YvcG1jL2FydGljbGVzL1BNQzI2NTg1ODkvcGRmL2NqZzIxNzM3LnBkZjwvdXJsPjwvcmVsYXRl
ZC11cmxzPjwvdXJscz48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWNodG9sZDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+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ADDIN EN.CITE.DATA (Bechtold et al. 2007; Bhat, McGrath & Bielefeldt 2006; Turner et al. 2007). The remaining 14 studies did not report a significant difference in oesophageal acid exposure when comparing the first day with the second day of monitoring. In children one out of three studies (n=44) reporting on day-to-day variability noted significantly more reflux on day 1 of monitoring PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2NobWFuPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2NobWFuPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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=
ADDIN EN.CITE.DATA (Hochman & Favaloro-Sabatier 2005). However, in the higher quality RCT and the case series with 27 and 58 included children, respectively, there were no significant differences in reflux reported when comparing the first 24 to the second 24?hours PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdW5uYXJzZG90dGlyPC9BdXRob3I+PFllYXI+MjAwNzwv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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdW5uYXJzZG90dGlyPC9BdXRob3I+PFllYXI+MjAwNzwv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=
ADDIN EN.CITE.DATA (Croffie et al. 2007; Gunnarsdottir, Stenstrom & Arnbjornsson 2007). See REF _Ref361820725 \h \* MERGEFORMAT Table 79 in REF _Ref379480322 \h Appendix G for the full results.Linked evidenceIs it accurate?Summary—What is the diagnostic accuracy of catheter-free (wireless) ambulatory oesophageal pH monitoring for GORD compared with catheter-based oesophageal pH monitoring?There was no consensus in the literature regarding what cut-offs should be used when pH monitoring is used to diagnose GORD. In the highest quality study available, a diagnosis of GORD was given if patients had a pH <4 for more than, or equal to, 4.4% of the time. Using these criteria, the catheter-free monitoring test had reasonable sensitivity (86.4%) and specificity (77.8%) when catheter-based monitoring was used as a reference standard. The two other studies that used this reference standard reported similar accuracy results, with slightly lower sensitivity and slightly higher specificity (variable cut-off points). Five diagnostic case-control studies used clinical diagnosis as the reference standard. The study with the largest patient population reported test sensitivity between 59% and 88% and test specificity between 75% and 96%, depending on which cut-off value was used (between 1.9% and 4.4% of the time that patients had pH <4). The remaining studies used thresholds between 4.4% and 5.3% for ‘proximal’ oesophageal pH monitoring. The sensitivity and specificity in these studies varied from 67% to 100% and from 66% to 100%, respectively. No studies compared the accuracy of both catheter-free and catheter-based monitoring against the reference standard of clinical diagnosis. Nine studies of adults reported on the time that the oesophagus was exposed to acid, rather than using a diagnostic cut-off, during pH monitoring. In four of the studies both tests were conducted in the same patient population, and therefore variations in results can be attributed with more certainty to the pH-monitoring method, rather than being associated with the use of two different samples of patients. However, the results were mixed, with two studies reporting that catheter-based monitoring detected more acid exposure time and one study reporting that catheter-free monitoring detected more acid exposure PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Azzam et al. 2012). The remaining five studies reported no significant differences between the two measurement methods. One study reported on oesophageal acid exposure in children, finding significantly more reflux with wireless monitoring compared with catheter-based monitoring (p=0.01). Four studies reported not only on acid exposure time concordance, but also on variation in the number of reflux events. Three of the four studies—two level II and one level III-2—reported significantly more reflux events with the catheter-based monitoring system.Two comparative diagnostic yield studies reported that significantly more patients were diagnosed with catheter-free monitoring compared with catheter-based monitoring (p<0.001). One reported advantage of catheter-free monitoring is that it allows a longer monitoring period than catheter-based monitoring, i.e. 48 rather than 24?hours. Six studies reported that the additional day of monitoring increased diagnosed yield with a median of 7.8%.Studies were included to assess the accuracy of catheter-free (wireless) oesophageal pH monitoring according to criteria outlined in REF _Ref361041769 \h \* MERGEFORMAT Box 4.Box 4Inclusion criteria for identification of studies relevant to an assessment of the accuracy of catheter-free (wireless) ambulatory oesophageal pH monitoringSelection criteriaInclusion criteriaPopulationPatients with symptoms of GORD for whom pH monitoring is indicatedInterventionCatheter-free (wireless) ambulatory oesophageal pH monitoringReference standard (1)Catheter-based oesophageal pH monitoringReference standard (2)Clinical diagnosisOutcomesSensitivitySpecificityPositive/negative predictive valueLevel of agreement (concordance of data)Diagnostic yield Publication typeAll study designs listed in the ‘Diagnostic accuracy’ column of REF _Ref206478826 \h \* MERGEFORMAT Table 9Search period2001 – 5/2013LanguageNon-English language articles were excluded unless they provided a higher level of evidence than the English language articles identifiedOnly eight studies met the inclusion criteria for assessing the accuracy of catheter-free monitoring and provided sufficient data to determine its sensitivity and specificity. In three studies the reference standard used was catheter-based monitoring. Among them, two level II studies (a randomised crossover trial and an in-subject simultaneous recording study) and one level III-3 diagnostic accuracy study (a case-control study with in-subject simultaneous recording) were identified. All three studies with catheter-based monitoring as a reference standard scored high on flow and timing—the flow of patients through the study, and the timing of the index test(s) and reference standard—mostly because the index test and reference standard were performed almost simultaneously. Patient selection had an unknown to high risk of bias, depending on how patients enrolled and if there was the possibility of bias. The risk of bias regarding the index test and the reference standard varied depending on how the results were interpreted. The results of these studies are presented in REF _Ref361833867 \h \* MERGEFORMAT Table 28. All three studies included patients who were suspected of GORD and in whom pH monitoring was indicated, although one study PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYWthbnNvbjwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYWthbnNvbjwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+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ADDIN EN.CITE.DATA (Hakanson et al. 2009) also included 45 volunteers—people without a history of GORD or any other pathology of the upper gastrointestinal tract. The highest quality study available (level II diagnostic evidence) indicated that a catheter-free monitoring test with a cut-off point of 4.4% of the time that pH <4 had good sensitivity and specificity (86.4% and 77.8%, respectively). The accuracy of the two other studies was in the same range, although their sensitivity was slightly lower and their specificity slightly higher. There is no consensus on which cut-off value should be used, so the cut-off values for diagnosing GORD in both catheter-free and catheter-based monitoring are different in all studies, making it difficult to interpret the accuracy data.Five studies used clinical diagnosis as a reference standard ( REF _Ref361907349 \h \* MERGEFORMAT Table 29). These were all diagnostic case-control studies (level III-3). This means that most of those included in the patient groups were GORD patients who had responded to therapy, because response to PPI therapy is a clear indication of having GORD and is widely used to diagnose the disease. Furthermore, the control groups consisted of patients who did not have GORD symptoms, so the applicability of the results based on these populations is questionable, since they do not match the target population, i.e. patients suspected of GORD who do not respond to PPIs. Most of these studies had a high risk of bias for patient selection when quality was assessed using the QUADAS-2 tool, and a medium to high risk of bias for flow and timing of the studies. Different cut-off values were used for diagnosis, varying from 1.9% to 10.6% of the time that oesophageal pH <4. Wenner, Johansson et al. (2007) and Wenner et al. (2008) used multiple cut-off values (from 1.9% to 4.4%) to determine the optimal value for diagnosis, and Bansal et al. (2009) used two different cut-off values for catheter-free monitoring: 4.4% for pH monitoring more proximal in the oesophagus and 10.6% for more distal pH monitoring (1?cm above the GOJ). Since every study used different cut-off values, they were considered too heterogeneous in their methods to meta-analyse.The study with the largest sample PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZW5uZXI8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XZW5uZXI8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Wenner, Johansson et al. 2007; Wenner et al. 2008) reported sensitivity values between 59% and 88% and specificity values between 75% and 96%, depending on which cut-off value was used. The remaining studies used cut-off values between 4.4% and 5.3% for ‘proximal’ oesophageal pH monitoring, i.e. with the capsule placed approximately 5?cm above the LOS or 6?cm above the SCJ, respectively. The sensitivity and specificity in these studies varied from 67% to 100% and from 66% to 100%, respectively. Whereas most studies use the ‘total time that pH <4 in the oesophagus’ to establish a positive or negative test result, some studies also use a ‘worst day analysis’—they only take the data from the day with the most gastro-oesophageal reflux PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwMzwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwMzwvWWVh
cj48UmVjTnVtPjI5NTwvUmVjTnVtPjxJRFRleHQ+NzQwLTk8L0lEVGV4dD48RGlzcGxheVRleHQ+
KFBhbmRvbGZpbm8gZXQgYWwuIDIwMDM7IFNjYXJwdWxsYSBldCBhbC4gMjAwNzsgU3dlaXMgZXQg
YWwuIDIwMTEpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjI5NTwvcmVjLW51bWJl
cj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6dzVlZmRmbGRkejVhZTJ4MDM1
cnAyZnoyMnNld3J2cjB3ciI+Mjk1PC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9
IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1
dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+UmljaHRlciwgSi4gRS48L2F1
dGhvcj48YXV0aG9yPk91cnMsIFQuPC9hdXRob3I+PGF1dGhvcj5HdWFyZGlubywgSi4gTS48L2F1
dGhvcj48YXV0aG9yPkNoYXBtYW4sIEouPC9hdXRob3I+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48
L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5Ob3J0aHdlc3Rl
cm4gVW5pdmVyc2l0eSBGZWluYmVyZyBTY2hvb2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlu
b2lzIDYwNjExLTMwMDgsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5BbWJ1bGF0
b3J5IGVzb3BoYWdlYWwgcEggbW9uaXRvcmluZyB1c2luZyBhIHdpcmVsZXNzIHN5c3RlbTwvdGl0
bGU+PHNlY29uZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48
YWx0LXRpdGxlPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10
aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8
L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9s
b2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBK
IEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBv
ZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NzQwLTk8
L3BhZ2VzPjx2b2x1bWU+OTg8L3ZvbHVtZT48bnVtYmVyPjQ8L251bWJlcj48ZWRpdGlvbj4yMDAz
LzA1LzEwPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29y
ZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkNhcHN1bGVzL2FkdmVyc2UgZWZmZWN0czwva2V5d29y
ZD48a2V5d29yZD5FcXVpcG1lbnQgRGVzaWduPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy8g
cGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29y
ZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC8gcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3
b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5IeWRyb2dlbi1Jb24gQ29uY2VudHJhdGlvbjwv
a2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3
b3JkPjxrZXl3b3JkPk1vbml0b3JpbmcsIEFtYnVsYXRvcnkvYWR2ZXJzZSBlZmZlY3RzLyBpbnN0
cnVtZW50YXRpb24vIG1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UmVwcm9kdWNpYmlsaXR5IG9m
IFJlc3VsdHM8L2tleXdvcmQ+PGtleXdvcmQ+U2Vuc2l0aXZpdHkgYW5kIFNwZWNpZmljaXR5PC9r
ZXl3b3JkPjxrZXl3b3JkPlRlbGVtZXRyeS9hZHZlcnNlIGVmZmVjdHMvaW5zdHJ1bWVudGF0aW9u
L21ldGhvZHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwMzwveWVhcj48cHVi
LWRhdGVzPjxkYXRlPkFwcjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAwMDItOTI3
MCAoUHJpbnQpJiN4RDswMDAyLTkyNzAgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjEy
NzM4NDUwPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3
Lm5hdHVyZS5jb20vYWpnL2pvdXJuYWwvdjk4L240L3BkZi9hamcyMDAzMTg0YS5wZGY8L3VybD48
L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvai4x
NTcyLTAyNDEuMjAwMy4wNzM5OC54PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRh
dGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5l
bmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPlNjYXJwdWxsYTwvQXV0
aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051bT4zMDc8L1JlY051bT48SURUZXh0PjI2NDItNzwv
SURUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MzA3PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+
PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdy
Ij4zMDc8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xl
Ij4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNjYXJwdWxsYSwg
Ry48L2F1dGhvcj48YXV0aG9yPkNhbWlsbGVyaSwgUy48L2F1dGhvcj48YXV0aG9yPkdhbGFudGUs
IFAuPC9hdXRob3I+PGF1dGhvcj5NYW5nYW5hcm8sIE0uPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0u
PC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+R2FzdHJvZW50
ZXJvbG9neSBEaXZpc2lvbiwgTS4gUmFpbW9uZGkgSG9zcGl0YWwsIFNhbiBDYXRhbGRvIChDTCks
IEl0YWx5LjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlRoZSBpbXBhY3Qgb2YgcHJvbG9u
Z2VkIHBIIG1lYXN1cmVtZW50cyBvbiB0aGUgZGlhZ25vc2lzIG9mIGdhc3Ryb2Vzb3BoYWdlYWwg
cmVmbHV4IGRpc2Vhc2U6IDQtZGF5IHdpcmVsZXNzIHBIIHN0dWRpZXM8L3RpdGxlPjxzZWNvbmRh
cnktdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5U
aGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hbHQtdGl0bGU+PC90aXRs
ZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxl
PjxhYmJyLTE+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWJici0x
PjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QW0gSiBHYXN0cm9lbnRl
cm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50
ZXJvbG9neTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PHBhZ2VzPjI2NDItNzwvcGFnZXM+PHZv
bHVtZT4xMDI8L3ZvbHVtZT48bnVtYmVyPjEyPC9udW1iZXI+PGVkaXRpb24+MjAwNy8wOS8xNDwv
ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5d29yZD5B
ZHVsdDwva2V5d29yZD48a2V5d29yZD5BbmFseXNpcyBvZiBWYXJpYW5jZTwva2V5d29yZD48a2V5
d29yZD5Fc29waGFnZWFsIHBIIE1vbml0b3JpbmcvIGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48
a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgv
IGRpYWdub3Npcy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3
b3JkPjxrZXl3b3JkPkh5ZHJvZ2VuLUlvbiBDb25jZW50cmF0aW9uPC9rZXl3b3JkPjxrZXl3b3Jk
Pk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+UmVw
cm9kdWNpYmlsaXR5IG9mIFJlc3VsdHM8L2tleXdvcmQ+PGtleXdvcmQ+U2Vuc2l0aXZpdHkgYW5k
IFNwZWNpZmljaXR5PC9rZXl3b3JkPjxrZXl3b3JkPlRpbWUgRmFjdG9yczwva2V5d29yZD48L2tl
eXdvcmRzPjxkYXRlcz48eWVhcj4yMDA3PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RGVjPC9kYXRl
PjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MDAwMi05MjcwIChQcmludCkmI3hEOzAwMDItOTI3
MCAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTc4NTA0MTI8L2FjY2Vzc2lvbi1udW0+
PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmF0dXJlLmNvbS9hamcvam91cm5h
bC92MTAyL24xMi9wZGYvYWpnMjAwNzUyMGEucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxz
PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL2ouMTU3Mi0wMjQxLjIwMDcuMDE0NjEu
eDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08
L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29y
ZD48L0NpdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl
Y051bT4zMTg8L1JlY051bT48SURUZXh0PjQxOS0yNjwvSURUZXh0PjxyZWNvcmQ+PHJlYy1udW1i
ZXI+MzE4PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3
NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4zMTg8L2tleT48L2ZvcmVpZ24ta2V5
cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1
dG9ycz48YXV0aG9ycz48YXV0aG9yPlN3ZWlzLCBSLjwvYXV0aG9yPjxhdXRob3I+Rm94LCBNLjwv
YXV0aG9yPjxhdXRob3I+QW5nZ2lhbnNhaCwgQS48L2F1dGhvcj48YXV0aG9yPldvbmcsIFQuPC9h
dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+R3V5JmFwb3M7cyBh
bmQgU3QgVGhvbWFzJmFwb3M7IEhvc3BpdGFscywgTG9uZG9uLCBVSy48L2F1dGgtYWRkcmVzcz48
dGl0bGVzPjx0aXRsZT5Qcm9sb25nZWQsIHdpcmVsZXNzIHBILXN0dWRpZXMgaGF2ZSBhIGhpZ2gg
ZGlhZ25vc3RpYyB5aWVsZCBpbiBwYXRpZW50cyB3aXRoIHJlZmx1eCBzeW1wdG9tcyBhbmQgbmVn
YXRpdmUgMjQtaCBjYXRoZXRlci1iYXNlZCBwSC1zdHVkaWVzPC90aXRsZT48c2Vjb25kYXJ5LXRp
dGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+
TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs
IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10
aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wg
TW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGls
aXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGlu
YWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+
PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+
TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs
IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnIt
MT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz40MTktMjY8L3BhZ2VzPjx2b2x1bWU+MjM8L3ZvbHVt
ZT48bnVtYmVyPjU8L251bWJlcj48ZWRpdGlvbj4yMDExLzAxLzE4PC9lZGl0aW9uPjxrZXl3b3Jk
cz48a2V5d29yZD5BZG9sZXNjZW50PC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxr
ZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2F0aGV0ZXJzPC9rZXl3b3JkPjxrZXl3b3Jk
PkVzb3BoYWdlYWwgcEggTW9uaXRvcmluZzwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdv
cmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npcy8gcGh5c2lvcGF0
aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5IeWRyb2dl
bi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3
b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tl
eXdvcmQ+PGtleXdvcmQ+UXVlc3Rpb25uYWlyZXM8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50
IE91dGNvbWU8L2tleXdvcmQ+PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jk
cz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heTwvZGF0ZT48L3B1
Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNjUtMjk4MiAoRWxlY3Ryb25pYykmI3hEOzEzNTAtMTky
NSAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjEyMzU2ODU8L2FjY2Vzc2lvbi1udW0+
PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly9vbmxpbmVsaWJyYXJ5LndpbGV5LmNvbS9z
dG9yZS8xMC4xMTExL2ouMTM2NS0yOTgyLjIwMTAuMDE2NjMueC9hc3NldC9qLjEzNjUtMjk4Mi4y
MDEwLjAxNjYzLngucGRmP3Y9MSZhbXA7dD1oaDlxMGZtZyZhbXA7cz0zZWE3YTVjZTAzMGY2ZGQ3
OTMwNTI3ODUyYzE3YTFjZDEzNDc4MjBkPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVj
dHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL2ouMTM2NS0yOTgyLjIwMTAuMDE2NjMueDwvZWxl
Y3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90
ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0Np
dGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA (Pandolfino et al. 2003; Scarpulla et al. 2007; Sweis et al. 2011). This can be either day 1 or day 2 of monitoring, and they then use similar cut-off values. Pandolfino et al. (2003) reported high sensitivity and specificity values with this type of analysis: 83.8% and 84.5%, respectively.Table 28Diagnostic accuracy of catheter-free monitoring compared with catheter-based monitoring for diagnosing GORD in adultsStudyEvidence level and qualityPopulationIndex test & cut-off pointReference standard & cut-off pointSensitivity %[95%CI]Specificity %[95%CI]PPV %[95%CI]NPV %[95%CI]LR+LR–des Varannes et al. (2005)In-subject simultaneous recording studyLevel: II Quality: Patient selection: ?Index test: Reference standard: ?Flow and timing: C1 P236 subjects suspected of GORDBravo pH monitoring (48-hour)Time under pH 4 >2.9%Catheter-based monitoring (24-hour)Time under pH 4 >4.2%78.6% [0.49–0.94]89.5% [0.65–0.98]84.6% [0.54–0.97]85.0% [0.61–0.96]7.490.24Wenner, Johnsson et al. (2007)Randomised crossover trialLevel: IIQuality: Patient selection: Index test: Reference standard: ?Flow and timing: C1 P231 subjects suspected of GORDBravo pH monitoring (48-hour)Time under pH 4 >4.4%Catheter-based monitoring (24-hour)Time under pH 4 >3.4%86.4% [0.64–0.96]77.8% [40.1–0.96]90.5% [0.68–0.98]70.0% [0.35–0.92]3.890.17Hakanson et al. (2009)Case-control study with in-subject simultaneous recordingLevel: III-3 Quality: Patient selection: ?Index test: Reference standard: ?Flow and timing: C1 P292 subjects (45 healthy volunteers and 47 patients)Bravo pH monitoring (48-hour)Time under pH 4 >1.9%Catheter-based monitoring (24-hour)Time under pH 4 >4.0%73.6% [0.59–0.84]92.3% [0.78–0.98]92.9% [0.79–0.98]72.0% [0.57–0.83]9.560.29? = unable to determine / unclear risk; = low risk; = high risk; Table 29Diagnostic accuracy of catheter-free monitoring compared to clinical diagnosis for diagnosing GORD in adultsStudyEvidence level and qualityPopulationIndex test & cut-off pointReference standard & cut-off pointSensitivity % [95%CI]Specificity % [95%CI]PPV %[95%CI]NPV %[95%CI]LR+LR–Accuracy[95%CI]Wenner, Johansson et al. (2007), Wenner et al. (2008)Diagnostic case-control studyLevel: III-3 Quality:Patient selection: Index test: ?Reference standard: Flow and timing: ?CXP3119 subjects (64 patients and 55 controls)Bravo pH monitoring (48-hour)Time under pH 4 >1.9, 2.2, 2.3, 3.2, 3.6 and 4.4 Clinical diagnosis1.9: 88%2.2: 86%2.3: 83%3.2: 68%3.6: 64%4.4: 59%1.9: 75%2.2: 80%2.3: 80%3.2: 85%3.6: 91%4.4: 96%--1.9: 3.522.2: 4.302.3: 4.153.2: 4.533.6: 7.114.4: 14.751.9: 0.162.2: 0.182.3: 0.213.2: 0.383.6: 0.404.4: 0.43-Bansal et al. (2009)Diagnostic case-control study Level: III-3Quality: Patient selection: Index test: ?Reference standard: Flow and timing:?CXP256 subjects (40 patients and 16 controls)Bravo pH monitoring (48-hour) Time under pH 4 >4.4% for the proximal location (6?cm above GOJ), and time under pH 4 >10.6% for the distal location (1?cm above GOJ)Clinical diagnosis (no symptoms of reflux in control population)Proximal: 67%Distal: 60%Proximal: 66%Distal: 88%-----Ayazi et al. (2009) (2)Diagnostic case-control studyLevel: III-3Quality:Patient selection: ?Index test: ?Reference standard: Flow and timing: ?CX P344 subjectsBravo pH monitoring (48-hour)Time under pH 4 >4.2%Clinical diagnosis100% [85–100]95% [76–100] ----98 [88–100]Ayazi et al. (2009) (3)Diagnostic case-control studyLevel: III-3Quality:Patient selection: Index test: ?Reference standard: Flow and timing: CXP338 subjects (28 patients and 10 controls)Bravo pH monitoring (48-hour) Time under pH 4 >4.2%Clinical diagnosis (minimal clinical evidence of GORD in control population)Abnormal combined 48?hours: 82%Abnormal first or second 24?hours:93%Abnormal combined 48?hours: 100%Abnormal first or second 24?hours:100%Abnormal combined 48?hours: 100%Abnormal first or second 24?hours:67%Abnormal combined 48?hours: 67%Abnormal first or second 24?hours:83%--Abnormal combined 48?hours: 87%Abnormal first or second 24?hours:95%Pandolfino et al. (2003)Diagnostic case-control studyLevel: III-3Quality: Patient selection: Index test: ?Reference standard: ?Flow and timing: CX P337 subjectsBravo pH monitoring (48-hour, day 1 (24-hour), worst day (W))Time under pH 4 >5.3%Clinical diagnosis24-h: 67.5%48-h: 64.9%W: 83.8%24-h: 89.7%48-h: 94.8%W: 84.5%24-h: 86.2%48-h: 92.3%W: 83.3%24-h: 74.5%48-h: 74.0%W: 84.6%24-h: 6.5548-h: 12.48W: 5.424-h: 0.3648-h: 0.37W: 0.19-? = unable to determine / unclear risk; = low risk; = high riskConcordance in acid exposure and reflux events in catheter-free monitoring versus catheter-based monitoringThere were nine studies that reported on the oesophageal acid exposure times during catheter-free monitoring compared with catheter-based monitoring in adults ( REF _Ref363115951 \h \* MERGEFORMAT Table 30). Four of these studies were in-subject simultaneous recording studies or randomised crossover trials, which means that both tests were conducted in the same patient population, allowing all confounding factors to be automatically controlled for PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl
Y051bT4xOTU8L1JlY051bT48SURUZXh0PjEwNy0xMjwvSURUZXh0PjxEaXNwbGF5VGV4dD4oQXp6
YW0gZXQgYWwuIDIwMTI7IGRlcyBWYXJhbm5lcyBldCBhbC4gMjAwNTsgSGFrYW5zb24gZXQgYWwu
IDIwMDk7IFdlbm5lciwgSm9obnNzb24sIGV0IGFsLiAyMDA3KTwvRGlzcGxheVRleHQ+PHJlY29y
ZD48cmVjLW51bWJlcj4xOTU8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4i
IGRiLWlkPSJ4enc1ZWZkZmxkZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjE5NTwva2V5Pjwv
Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw
ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+QXp6YW0sIFIuIFMuPC9hdXRob3I+PGF1
dGhvcj5TYWxsdW0sIFIuIEEuPC9hdXRob3I+PGF1dGhvcj5CcmFuZGFvLCBKLiBGLjwvYXV0aG9y
PjxhdXRob3I+TmF2YXJyby1Sb2RyaWd1ZXosIFQuPC9hdXRob3I+PGF1dGhvcj5OYXNpLCBBLjwv
YXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydGFtZW50
byBkZSBHYXN0cm9lbnRlcm9sb2dpYSwgRmFjdWxkYWRlIGRlIE1lZGljaW5hIGRhIFVuaXZlcnNp
ZGFkZSBkZSBTYW8gUGF1bG8sIFNhbyBQYXVsbywgU1AsIEJyYXNpbC4gcmltb25AYWphdG8uY29t
LmJyPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q29tcGFyYXRpdmUgc3R1ZHkgb2YgdHdv
IG1vZGVzIG9mIGdhc3Ryb2Vzb3BoYWdlYWwgcmVmbHV4IG1lYXN1cmluZzogY29udmVudGlvbmFs
IGVzb3BoYWdlYWwgcEggbW9uaXRvcmluZyBhbmQgd2lyZWxlc3MgcEggbW9uaXRvcmluZzwvdGl0
bGU+PHNlY29uZGFyeS10aXRsZT5BcnEgR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxh
bHQtdGl0bGU+QXJxdWl2b3MgZGUgZ2FzdHJvZW50ZXJvbG9naWE8L2FsdC10aXRsZT48L3RpdGxl
cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BcnEgR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48
YWJici0xPkFycXVpdm9zIGRlIGdhc3Ryb2VudGVyb2xvZ2lhPC9hYmJyLTE+PC9wZXJpb2RpY2Fs
PjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BcnEgR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRs
ZT48YWJici0xPkFycXVpdm9zIGRlIGdhc3Ryb2VudGVyb2xvZ2lhPC9hYmJyLTE+PC9hbHQtcGVy
aW9kaWNhbD48cGFnZXM+MTA3LTEyPC9wYWdlcz48dm9sdW1lPjQ5PC92b2x1bWU+PG51bWJlcj4y
PC9udW1iZXI+PGVkaXRpb24+MjAxMi8wNy8wNzwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+
QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DYXBzdWxlIEVu
ZG9zY29weS9hZHZlcnNlIGVmZmVjdHMvIG1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhh
Z2VhbCBwSCBNb25pdG9yaW5nL2FkdmVyc2UgZWZmZWN0cy8gaW5zdHJ1bWVudGF0aW9uPC9rZXl3
b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJl
Zmx1eC8gZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29y
ZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBy
b3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+U2Vuc2l0aXZpdHkgYW5kIFNwZWNp
ZmljaXR5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTI8L3llYXI+PHB1Yi1k
YXRlcz48ZGF0ZT5BcHItSnVuPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTY3OC00
MjE5IChFbGVjdHJvbmljKSYjeEQ7MDAwNC0yODAzIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9u
LW51bT4yMjc2Njk5NjwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0
cDovL3d3dy5zY2llbG8uYnIvcGRmL2FnL3Y0OW4yLzAzLnBkZjwvdXJsPjwvcmVsYXRlZC11cmxz
PjwvdXJscz48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXBy
b3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0
aG9yPmRlcyBWYXJhbm5lczwvQXV0aG9yPjxZZWFyPjIwMDU8L1llYXI+PFJlY051bT4yMjQ8L1Jl
Y051bT48SURUZXh0PjE2ODItNjwvSURUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjI0PC9yZWMt
bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFl
MngwMzVycDJmejIyc2V3cnZyMHdyIj4yMjQ8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUg
bmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9y
cz48YXV0aG9yPmRlcyBWYXJhbm5lcywgUy4gQi48L2F1dGhvcj48YXV0aG9yPk1pb24sIEYuPC9h
dXRob3I+PGF1dGhvcj5EdWNyb3R0ZSwgUC48L2F1dGhvcj48YXV0aG9yPlplcmJpYiwgRi48L2F1
dGhvcj48YXV0aG9yPkRlbmlzLCBQLjwvYXV0aG9yPjxhdXRob3I+UG9uY2hvbiwgVC48L2F1dGhv
cj48YXV0aG9yPlRoaWJhdWx0LCBSLjwvYXV0aG9yPjxhdXRob3I+R2FsbWljaGUsIEouIFAuPC9h
dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+SW5zdGl0dXQgZGVz
IE1hbGFkaWVzIGRlIGwmYXBvcztBcHBhcmVpbCBEaWdlc3RpZiwgQ0hVLSBIb3RlbCBEaWV1LCBO
YW50ZXMsIEZyYW5jZS4gYnJ1bGV5QGVhc3luZXQuZnI8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0
aXRsZT5TaW11bHRhbmVvdXMgcmVjb3JkaW5ncyBvZiBvZXNvcGhhZ2VhbCBhY2lkIGV4cG9zdXJl
IHdpdGggY29udmVudGlvbmFsIHBIIG1vbml0b3JpbmcgYW5kIGEgd2lyZWxlc3Mgc3lzdGVtIChC
cmF2byk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+R3V0PC9zZWNvbmRhcnktdGl0bGU+PGFsdC10
aXRsZT5HdXQ8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5HdXQ8
L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5HdXQ8
L2Z1bGwtdGl0bGU+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTY4Mi02PC9wYWdlcz48dm9sdW1l
PjU0PC92b2x1bWU+PG51bWJlcj4xMjwvbnVtYmVyPjxlZGl0aW9uPjIwMDUvMDQvMjI8L2VkaXRp
b24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdv
cmQ+PGtleXdvcmQ+Q2Fwc3VsZXM8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxr
ZXl3b3JkPkdhc3RyaWMgQWNpZGl0eSBEZXRlcm1pbmF0aW9uLyBpbnN0cnVtZW50YXRpb248L2tl
eXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29y
ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRy
YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdl
ZDwva2V5d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5L2luc3RydW1lbnRhdGlv
bi9tZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPlBhdGllbnQgQ29tcGxpYW5jZTwva2V5d29yZD48
a2V5d29yZD5SZXByb2R1Y2liaWxpdHkgb2YgUmVzdWx0czwva2V5d29yZD48a2V5d29yZD5UZWxl
bWV0cnkvaW5zdHJ1bWVudGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+
PHllYXI+MjAwNTwveWVhcj48cHViLWRhdGVzPjxkYXRlPkRlYzwvZGF0ZT48L3B1Yi1kYXRlcz48
L2RhdGVzPjxpc2JuPjAwMTctNTc0OSAoUHJpbnQpJiN4RDswMDE3LTU3NDkgKExpbmtpbmcpPC9p
c2JuPjxhY2Nlc3Npb24tbnVtPjE1ODQzNDE3PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVk
LXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcG1jL2FydGljbGVzL1BNQzE3
NzQ3ODMvcGRmL2d1dDA1NDAxNjgyLnBkZjwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48Y3Vz
dG9tMj5QTUMxNzc0NzgzPC9jdXN0b20yPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTM2
L2d1dC4yMDA1LjA2NjI3NDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFz
ZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9s
YW5ndWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5IYWthbnNvbjwvQXV0aG9yPjxZ
ZWFyPjIwMDk8L1llYXI+PFJlY051bT4yNTU8L1JlY051bT48SURUZXh0PjI3Ni04MzwvSURUZXh0
PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjU1PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBh
cHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4yNTU8
L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv
cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhha2Fuc29uLCBCLiBTLjwv
YXV0aG9yPjxhdXRob3I+QmVyZ2dyZW4sIFAuPC9hdXRob3I+PGF1dGhvcj5HcmFucXZpc3QsIFMu
PC9hdXRob3I+PGF1dGhvcj5ManVuZ3F2aXN0LCBPLjwvYXV0aG9yPjxhdXRob3I+VGhvcmVsbCwg
QS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRt
ZW50IG9mIFN1cmdlcnksIENlbnRlciBvZiBHYXN0cm9pbnRlc3RpbmFsIERpc2Vhc2UsIEVyc3Rh
IEhvc3BpdGFsLCBTdG9ja2hvbG0sIFN3ZWRlbi4gYmVuZ3QuaGFrYW5zb25AZXJzdGFkaWFrb25p
LnNlPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q29tcGFyaXNvbiBvZiB3aXJlbGVzcyA0
OC1oIChCcmF2bykgdmVyc3VzIHRyYWRpdGlvbmFsIGFtYnVsYXRvcnkgMjQtaCBlc29waGFnZWFs
IHBIIG1vbml0b3Jpbmc8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+U2NhbmQgSiBHYXN0cm9lbnRl
cm9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5TY2FuZGluYXZpYW4gam91cm5hbCBvZiBn
YXN0cm9lbnRlcm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0
bGU+U2NhbmQgSiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+U2NhbmRpbmF2aWFu
IGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBl
cmlvZGljYWw+PGZ1bGwtdGl0bGU+U2NhbmQgSiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxh
YmJyLTE+U2NhbmRpbmF2aWFuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwv
YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjI3Ni04MzwvcGFnZXM+PHZvbHVtZT40NDwvdm9sdW1lPjxu
dW1iZXI+MzwvbnVtYmVyPjxlZGl0aW9uPjIwMDgvMTIvMDI8L2VkaXRpb24+PGtleXdvcmRzPjxr
ZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2Fz
ZS1Db250cm9sIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBwSCBNb25pdG9y
aW5nLyBpbnN0cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29zY29weTwva2V5
d29yZD48a2V5d29yZD5GZWFzaWJpbGl0eSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFs
ZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC8gZGlhZ25vc2lzPC9r
ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxr
ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlJlZ3Jlc3Npb24gQW5hbHlzaXM8
L2tleXdvcmQ+PGtleXdvcmQ+UmVwcm9kdWNpYmlsaXR5IG9mIFJlc3VsdHM8L2tleXdvcmQ+PGtl
eXdvcmQ+U3RhdGlzdGljcywgTm9ucGFyYW1ldHJpYzwva2V5d29yZD48L2tleXdvcmRzPjxkYXRl
cz48eWVhcj4yMDA5PC95ZWFyPjwvZGF0ZXM+PGlzYm4+MTUwMi03NzA4IChFbGVjdHJvbmljKSYj
eEQ7MDAzNi01NTIxIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xOTA0MDE3NjwvYWNj
ZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL2luZm9ybWFoZWFsdGhj
YXJlLmNvbS9kb2kvcGRmcGx1cy8xMC4xMDgwLzAwMzY1NTIwODAyNTg4MTA5PC91cmw+PC9yZWxh
dGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDgwLzAwMzY1NTIw
ODAyNTg4MTA5PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3Zp
ZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdl
PjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPldlbm5lcjwvQXV0aG9yPjxZZWFyPjIwMDc8
L1llYXI+PFJlY051bT4zMzI8L1JlY051bT48SURUZXh0PjIzOS00NTwvSURUZXh0PjxyZWNvcmQ+
PHJlYy1udW1iZXI+MzMyPC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBk
Yi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4zMzI8L2tleT48L2Zv
cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+
PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPldlbm5lciwgSi48L2F1dGhvcj48YXV0aG9y
PkpvaG5zc29uLCBGLjwvYXV0aG9yPjxhdXRob3I+Sm9oYW5zc29uLCBKLjwvYXV0aG9yPjxhdXRo
b3I+T2JlcmcsIFMuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl
c3M+RGVwYXJ0bWVudCBvZiBTdXJnZXJ5LCBMdW5kIFVuaXZlcnNpdHkgSG9zcGl0YWwsIFNFLTIy
MSA4NSBMdW5kLCBTd2VkZW4uPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+V2lyZWxlc3Mg
ZXNvcGhhZ2VhbCBwSCBtb25pdG9yaW5nIGlzIGJldHRlciB0b2xlcmF0ZWQgdGhhbiB0aGUgY2F0
aGV0ZXItYmFzZWQgdGVjaG5pcXVlOiByZXN1bHRzIGZyb20gYSByYW5kb21pemVkIGNyb3NzLW92
ZXIgdHJpYWw8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9zZWNv
bmRhcnktdGl0bGU+PGFsdC10aXRsZT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRl
cm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QW0gSiBH
YXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2Yg
Z2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1
bGwtdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEFtZXJp
Y2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+
PHBhZ2VzPjIzOS00NTwvcGFnZXM+PHZvbHVtZT4xMDI8L3ZvbHVtZT48bnVtYmVyPjI8L251bWJl
cj48ZWRpdGlvbj4yMDA2LzExLzE1PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwv
a2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkNhdGhldGVyaXphdGlvbjwv
a2V5d29yZD48a2V5d29yZD5DaXJjYWRpYW4gUmh5dGhtL3BoeXNpb2xvZ3k8L2tleXdvcmQ+PGtl
eXdvcmQ+Q3Jvc3MtU2VjdGlvbmFsIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2Vh
bCBwSCBNb25pdG9yaW5nPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy8gbWV0YWJvbGlzbTwv
a2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Rm9sbG93LVVwIFN0dWRp
ZXM8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJpYyBBY2lkLyBtZXRhYm9saXNtPC9rZXl3b3JkPjxr
ZXl3b3JkPkdhc3Ryb2Vzb3BoYWdlYWwgUmVmbHV4LyBkaWFnbm9zaXMvbWV0YWJvbGlzbTwva2V5
d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNl
bnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUg
QWdlZDwva2V5d29yZD48a2V5d29yZD5RdWVzdGlvbm5haXJlczwva2V5d29yZD48a2V5d29yZD5S
ZXByb2R1Y2liaWxpdHkgb2YgUmVzdWx0czwva2V5d29yZD48a2V5d29yZD5SZXRyb3NwZWN0aXZl
IFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+VGVsZW1ldHJ5LyBtZXRob2RzPC9rZXl3b3JkPjwv
a2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5GZWI8L2Rh
dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzAgKFByaW50KSYjeEQ7MDAwMi05
MjcwIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xNzEwMDk3MTwvYWNjZXNzaW9uLW51
bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2FqZy9qb3Vy
bmFsL3YxMDIvbjIvcGRmL2FqZzIwMDc0MWEucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxz
PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL2ouMTU3Mi0wMjQxLjIwMDYuMDA5Mzku
eDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08
L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29y
ZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Azzam et al. 2012; des Varannes et al. 2005; Hakanson et al. 2009; Wenner, Johnsson et al. 2007). Results between the two styles of monitoring test are therefore expected to be more similar than when two different patient samples are compared. However, three of these studies reported a significant difference in acid exposure times between catheter-free and catheter-based monitoring. Two studies reported more acid exposure time with the catheter-based system PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZXMgVmFyYW5uZXM8L0F1dGhvcj48WWVhcj4yMDA1PC9Z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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZXMgVmFyYW5uZXM8L0F1dGhvcj48WWVhcj4yMDA1PC9Z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ADDIN EN.CITE.DATA (des Varannes et al. 2005; Hakanson et al. 2009), and one study reported more acid exposure with the wireless system PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BenphbTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Azzam et al. 2012).The remaining five studies also reported concordance data regarding acid exposure times, but in different patient groups PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbmc8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbmc8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA (Ang et al. 2010; Grigolon et al. 2011; Martinez de Haro et al. 2008; Schneider et al. 2007; Wong et al. 2005). None of the studies reported significant differences in acid exposure times between the two measurement methods. There was one study that reported concordance data on oesophageal acid exposure in children PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Dcm9mZmllPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Dcm9mZmllPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE.DATA (Croffie et al. 2007). It reported significantly more reflux detected with wireless monitoring compared with catheter-based monitoring (p=0.0107). The tests were not performed in the same patient population; however, it was an RCT and therefore any baseline differences between the two groups are probably due to chance rather than a form of bias ( REF _Ref379484053 \h \* MERGEFORMAT Table 31).Two level II studies and two level III-2 studies reported not only on acid exposure time concordance, but also on variation in the number of reflux events ( REF _Ref363133126 \h \* MERGEFORMAT Table 32). Three of the four studies—two level II and one level III-2—reported significantly more reflux events with the catheter-based monitoring system PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbmc8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbmc8L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA (Ang et al. 2010; des Varannes et al. 2005; Wenner et al. 2007b). Two of these studies used a within-subjects design, i.e. both tests were conducted in the same subjects, and in one they were compared simultaneously PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZXMgVmFyYW5uZXM8L0F1dGhvcj48WWVhcj4yMDA1PC9Z
ZWFyPjxSZWNOdW0+MjI0PC9SZWNOdW0+PElEVGV4dD4xNjgyLTY8L0lEVGV4dD48RGlzcGxheVRl
eHQ+KGRlcyBWYXJhbm5lcyBldCBhbC4gMjAwNSk8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1u
dW1iZXI+MjI0PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0i
eHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4yMjQ8L2tleT48L2ZvcmVpZ24t
a2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRy
aWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPmRlcyBWYXJhbm5lcywgUy4gQi48L2F1dGhvcj48YXV0
aG9yPk1pb24sIEYuPC9hdXRob3I+PGF1dGhvcj5EdWNyb3R0ZSwgUC48L2F1dGhvcj48YXV0aG9y
PlplcmJpYiwgRi48L2F1dGhvcj48YXV0aG9yPkRlbmlzLCBQLjwvYXV0aG9yPjxhdXRob3I+UG9u
Y2hvbiwgVC48L2F1dGhvcj48YXV0aG9yPlRoaWJhdWx0LCBSLjwvYXV0aG9yPjxhdXRob3I+R2Fs
bWljaGUsIEouIFAuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl
c3M+SW5zdGl0dXQgZGVzIE1hbGFkaWVzIGRlIGwmYXBvcztBcHBhcmVpbCBEaWdlc3RpZiwgQ0hV
LSBIb3RlbCBEaWV1LCBOYW50ZXMsIEZyYW5jZS4gYnJ1bGV5QGVhc3luZXQuZnI8L2F1dGgtYWRk
cmVzcz48dGl0bGVzPjx0aXRsZT5TaW11bHRhbmVvdXMgcmVjb3JkaW5ncyBvZiBvZXNvcGhhZ2Vh
bCBhY2lkIGV4cG9zdXJlIHdpdGggY29udmVudGlvbmFsIHBIIG1vbml0b3JpbmcgYW5kIGEgd2ly
ZWxlc3Mgc3lzdGVtIChCcmF2byk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+R3V0PC9zZWNvbmRh
cnktdGl0bGU+PGFsdC10aXRsZT5HdXQ8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48
ZnVsbC10aXRsZT5HdXQ8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48
ZnVsbC10aXRsZT5HdXQ8L2Z1bGwtdGl0bGU+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTY4Mi02
PC9wYWdlcz48dm9sdW1lPjU0PC92b2x1bWU+PG51bWJlcj4xMjwvbnVtYmVyPjxlZGl0aW9uPjIw
MDUvMDQvMjI8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3
b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2Fwc3VsZXM8L2tleXdvcmQ+PGtleXdvcmQ+RmVt
YWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3RyaWMgQWNpZGl0eSBEZXRlcm1pbmF0aW9uLyBpbnN0
cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRp
YWdub3Npczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9n
ZW4tSW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5
d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5
L2luc3RydW1lbnRhdGlvbi9tZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPlBhdGllbnQgQ29tcGxp
YW5jZTwva2V5d29yZD48a2V5d29yZD5SZXByb2R1Y2liaWxpdHkgb2YgUmVzdWx0czwva2V5d29y
ZD48a2V5d29yZD5UZWxlbWV0cnkvaW5zdHJ1bWVudGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PC9r
ZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNTwveWVhcj48cHViLWRhdGVzPjxkYXRlPkRlYzwvZGF0
ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAwMTctNTc0OSAoUHJpbnQpJiN4RDswMDE3LTU3
NDkgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE1ODQzNDE3PC9hY2Nlc3Npb24tbnVt
Pjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvcG1j
L2FydGljbGVzL1BNQzE3NzQ3ODMvcGRmL2d1dDA1NDAxNjgyLnBkZjwvdXJsPjwvcmVsYXRlZC11
cmxzPjwvdXJscz48Y3VzdG9tMj5QTUMxNzc0NzgzPC9jdXN0b20yPjxlbGVjdHJvbmljLXJlc291
cmNlLW51bT4xMC4xMTM2L2d1dC4yMDA1LjA2NjI3NDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+
PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48
bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZXMgVmFyYW5uZXM8L0F1dGhvcj48WWVhcj4yMDA1PC9Z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=
ADDIN EN.CITE.DATA (des Varannes et al. 2005). Therefore, it can be concluded that the difference found in the number of reflux events recorded may be due to differences between the tests themselves and not other confounding factors such as the patient population variability or day-to-day variability in reflux. Table 30Concordance of acid exposure times using both monitoring tests in adultsStudyStudy designN% of total time pH <4 wireless pH monitoring% of total time pH <4 conventional pH catheterp-valueWenner, Johnsson et al. (2007)Randomised crossover trialLevel: IIQuality: 20/2631 patientsMedian: 7.3Median: 6.30.837 ades Varannes et al. (2005)In-subject simultaneous recording studyLevel: II Quality: 20/2633 patientsMedian: 2.4 (10th–90th percentile: 0.4–8.7)Median: 3.6 (10th–90th percentile: 0.7–8.6)0.0001 aAzzam et al. (2012)In-subject simultaneous recording studyLevel: II Quality: 17/26C1 (for accuracy)P225 patientsMedian: 6.1 (range: 0.1–21.4)Median: 4.1 (range: 0.1–13.8)0.001 aHakanson et al. (2009)Case-control study with in-subject simultaneous recordingLevel: IIQuality: 14/261st series: 26 patients, 27 controls2nd series: 21 patients, 18 controlsPatients 1st: median 3.2 (day 1)Patients 2nd: median 2.4 (day 1)Controls 1st: median 0.6 (day 1)Controls 2nd: median 1.3 (day 1)Patients 1st: median 6.8 Patients 2nd: median 7.1 Controls 1st: median 1.9Controls 2nd: median 4.4<0.001 a<0.001 a<0.05 a<0.05 aWong et al. (2007)Randomised controlled trialLevel: IIQuality: 16.5/26Catheter-free monitoring: 25 patientsCatheter-based monitoring: 25 patientsMedian: 1.9 (on PPI)Median: 10.2 (off PPI)Median: 4.8 (on PPI)Median: 7.8 (off PPI)0.70.78 bGrigolon et al. (2011)Matched-pairs retrospective cohort studyLevel: III-2 Quality: 16.5/26Wireless monitoring: 51 patientsCatheter-based monitoring: 51 patientsMedian 24h: 3.5 (1st and 3rd quartile: 1.2–6.6)Median 48h: 4.0 (1st and 3rd quartile: 1.8–7.4)Median 96h: 4.7 (1st and 3rd quartile: 1.9–9.4)Median: 3.5 (1st and 3rd quartile: 1.6–8.8)-Ang et al. (2010)Comparative study of diagnostic yieldLevel: III-2Quality: 14/26Wireless monitoring: 66 patientsCatheter-based monitoring: 55 patientsDay 1: 3.80 ± 6.09Day 2: 3.91 ± 5.32Overall: 3.86 ± 5.364.40 ± 5.34Day 1: 0.57 bDay 2: 0.61 bOverall: 0.57 bMartinez de Haro et al. (2008)Non-randomised controlled trial Level: III-2 Quality: 11/26Control group: 10 (simultaneous recording)No oesophagitis: 10 (5 catheter-based monitoring, 5 catheter-free monitoring)Non-Barrett’s oesophagitis (5 catheter-based monitoring, 5 catheter-free monitoring)Barrett’s oesophagitis (5 catheter-based monitoring, 5 catheter-free monitoring)Controls: mean 1.7No oesophagitis: mean 6.1Non-Barrett’s oesophagitis: mean 8.2Barrett’s oesophagitis: mean 27.3Controls: mean 1.1No oesophagitis: mean 5.8Non-Barrett’s oesophagitis: mean 7.9Barrett’s oesophagitis: mean 22.4-Schneider et al. (2007)Non-randomised controlled trialLevel: III-2Quality: 9/26Control group: 10 Oesophagitis: 68 catheter-free monitoring, 55 catheter-based monitoring After Nissen fundoplication: 43Controls: median 0.8Patients: median 14 Post-surgery: median 0.9Controls: median 1 Patients: median 12Post-surgery: median 1.20.1 b0.8 b0.9 baAnalysis was done using a Wilcoxon signed rank test.bAnalysis was done using the Mann-Whitney U-test.Table 31Concordance of acid exposure times using both monitoring tests in childrenStudyStudy designNReflux index wireless pH monitoringReflux index conventional pH catheterp-valueCroffie et al. (2007)Randomised controlled trialLevel: IIQuality:14.5/2627 patientsMean: 2.5 (range: 0.2–16.6)Mean: 1.6 (range: 0.1–10.8)0.0107aaAnalysis was done using the Mann-Whitney U-test.Table 32Number of reflux events in catheter-free monitoring compared with catheter-based monitoringStudyStudy designNWireless pH monitoringConventional pH catheter Test and p-valueWenner, Johnsson et al. (2007)Randomised crossover trialLevel: IIQuality: 20/2631 patientsMedian: 53 Median: 129<0.0001 ades Varannes et al. (2005)In-subject simultaneous recording studyLevel: II Quality: 20/2636 patientsMedian: 23 (10th– 90th percentile: 4–41) Median: 40 (10th–90th percentile: 7–84) 0.0001 aAng et al. (2010)Comparative study of diagnostic yieldLevel: III-2Quality: 14/26Catheter-free monitoring: 66 patients Catheter-based monitoring: 51 patients(Mean ± SD)Day 1: 27 ± 27Day 2: 31 ± 34(Mean ± SD)99 ± 111 <0.005 b<0.005 bSchneider et al. (2007) Non-randomised controlled trialLevel: III-2Quality: 9/26Control group: 10 Oesophagitis: 68 catheter-free monitoring, 55 catheter-based monitoringAfter Nissen fundoplication: 43 Median in controls: 23 Median in patients: 247Median post-surgery: 24Median in controls: 18Median in patients: 187Median post-surgery: 180.6 b0.09 b0.07 baAnalysis was done using a Wilcoxon signed rank testbAnalysis was done using the Mann-Whitney U-testDiagnostic yield Six studies report diagnostic yield in both wireless and catheter-based monitoring. Two of the studies were in-subject simultaneous recording studies, where both methods of pH monitoring were conducted at the same time in the same subjects. Both these studies reported no significant difference in diagnostic yield between the two tests. Only two comparative diagnostic yield studies of medium quality PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Kushnir, Sayuk & Gyawali 2011; Sweis et al. 2009) reported significant differences—more patients were diagnosed with catheter-free monitoring compared with catheter-based monitoring (p-values <0.001) ( REF _Ref363120408 \h Table 33). In the larger of the two comparative diagnostic yield studies, 357/462 (77.2%) patients were diagnosed with the wireless pH test, compared with 849/1605 (52.9%) with the catheter-based test (Kushnir, Sayuk & Gyawali 2011).Table 33Diagnostic yield using catheter-free monitoring compared to catheter-based monitoringStudyEvidence level and qualityNWireless pH monitoring (%)Catheter-based pH monitoring (%)Cut-off value for positive test a p-valueWenner, Johnsson et al. (2007)Randomised crossover trialLevel: IIQuality: 20/2631 patients suspected of GORD21/31 (68)(5 were discordant)22/31 (71)(5 were discordant)CFPM: 4.4%CBPM: 3.4%-Azzam et al. (2012)In-subject simultaneous recording studyLevel: II Quality: 17/2625 patients19/25 (76)16/25 (64)Total: 4.5%Upright: 8.4%Supine: 3.5%0.355 bHakanson et al. (2009)Case-control study with in-subject simultaneous recordingLevel: IIQuality: 14/2692 subjects (45 volunteers and 47 patients)42/92 (45.7)53/92 (57.6)CFPM: 2.0%CBPM: 4.0%-Sweis et al. (2009)Comparative study of diagnostic yieldLevel: III-2 Quality: 15/26129 patients in the wireless group (intolerant of the catheter) 102 patients in the catheter groupCut-off 5.3%: 92/129 (71)Cut-off 4.2%: 98/129 (76)Cut-off 4.2%: 49/102 (48)CFPM: 5.3%CBPM: 4.2%Both: 4.2%<0.001 c<0.001 cAng et al. (2010)Comparative study of diagnostic yieldLevel: III-2 Quality: 14/26Wireless group: 66 patientsCatheter group: 55 patientsOverall: 26/66 (39.4)On day 1 only: 5/66 (7.6)On day 2 only: 8/66 (12.1)Both day 1 and 2: 13/66 (19.7)Overall: 20/55 (36.4)CFPM day 1: 5.8%CFPM day 2: 4.5%CFPM both days: 4.2%CBPM: 4.2%-Kushnir, Sayuk & Gyawali (2011)Comparative study of diagnostic yieldLevel: III-2Quality: 13.5/26462 patients in the wireless group 1,605 patients in the catheter group357/462 (77.2)849/1,605 (52.9)CFPM: 4.0%CBPM: 4.0%<0.001 cCFPM: catheter-free pH monitoringCBPM: catheter-based pH monitoringaCut-off value is presented in the percentage of time the pH <4; the test result is positive when the percentage is higher than the cut-off value.bUnclear which statistical test was used.cAnalysis was done using the Chi square test.As the monitoring period can be lengthened with the wireless pH method (most tests are 48?hours instead of the 24?hours with the traditional catheter-based method), this is likely to increase diagnostic yield. Six studies reported an additional yield on day 2 of monitoring, varying from 2.0% to 15.6% with a median of 7.8% ( REF _Ref362339424 \h \* MERGEFORMAT Table 34). This means that 2.0%–15.6% of patients only get a positive test result above the cut-off value after day 2, and these patients would not have been diagnosed with GORD if they had only had a 24-hour monitoring period.Table 34Yield comparison between 24 hours and 48 hours with catheter-free monitoringStudyStudy designNCut-off value aTotal yield day 1Total yield day 2Overall detection increase (%)Prakash & Clouse (2005)Retrospective case series121 patients5.33%NANA15 (7.5%)Grigolon et al. (2011)Matched pairs cohort study51 patients4.7%24 patients (47.1%)25 patients (49.0%)2.0%Garrean et al. (2008) Prospective case series40 patients5.3%10 patients (25.0%)14 patients (35.0%)10.0%Pandolfino et al. (2003)Diagnostic case-control study37 patients5.33%12 patients (32.4%)15 patients (40.5%)8.1%Scarpulla et al. (2007)Retrospective case series34 patients4.2%12 patients (35.3%)14 patients (41.2%)5.9%Karamanolis et al. (2012)Post-test case series32 patientsDay 1: 5.8%Day 2: 4.5%12 patients (37.5%)17 patients (53.1%)15.6%aCut-off value is presented in the percentage of time the pH <4; the test result is positive when the percentage is higher than the cut-off value.Fourteen studies reported diagnostic yield with the wireless test (and no comparator). Since there is no consensus on what the threshold is for diagnosing GORD, studies used different cut-off points, different scores (composite pH score, acid exposure time, reflux events), different placements in the oesophagus (proximal, distal) and different analysis (an abnormal score on only one day, an abnormal score on both days, worst day analysis) to establish a diagnosis. Therefore, there is a large variation in diagnostic yield, varying from 6.1%—only abnormal on day 2 in patients suspected of GORD (Turner et al. 2007), to 92.9%—abnormal score overall in patients with strong clinical GORD evidence (Ayazi et al. 2009) (see Tables 81 and 82 in REF _Ref364237535 \h \* MERGEFORMAT Appendix H).Does it change patient management?Summary—Does catheter-free (wireless) ambulatory oesophageal pH monitoring change clinical management, compared with no pH monitoring, for patients with symptoms of GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?No studies were available that reported on a change in management based on catheter-free monitoring in the population who would otherwise have had no monitoring, i.e. those who could not tolerate catheter-based monitoring. Five studies reported on change in patient management after catheter-free monitoring in patients who could have potentially tolerated a catheter-based test. One comparative study reported that concordance between the results of the test and management of GORD was higher in the catheter-free monitoring group (78%) than in the catheter-based monitoring group (58%; p<0.05). As with the comparative study, before-and-after case series also reported that the management received did not always correspond to the results of the test. One study reported that 42.2% of patients (38/90) continued to take anti-reflux medication despite a negative pH test result. Only 17 patients recalled being instructed to stop taking PPIs. In another case series, 12/38 patients underwent surgery for GORD even though only 9 of these had a positive diagnosis based on catheter-free monitoring. In a further case series, catheter-free monitoring led to a change in management in 63% of patients referred for monitoring; and in a paediatric study, catheter-free monitoring resulted in a change in management in 88% of patients. Patients with an abnormal study result were more likely to have a change in management than patients with a normal result.From the literature it can be assumed that the results of catheter-free monitoring do influence subsequent management, although not all patients have management consistent with the results of pH monitoring. It is expected that the key changes based on results of catheter-free monitoring are that patients who are found not to have GORD have their (mostly ineffective) PPI treatment suspended, whereas patients who have their GORD confirmed have an additional option of surgical treatment.Studies were included to assess change in management following catheter-free (wireless) oesophageal pH monitoring according to criteria outlined a priori in REF _Ref362247931 \h \* MERGEFORMAT Box 5. No studies were identified that met the population inclusion criteria. Five studies that did not meet the a priori inclusion criteria reported on change in patient management after catheter-free monitoring in patients who were suspected of GORD but who could have potentially tolerated a catheter-based test. Furthermore, none of the studies had ‘no pH monitoring’ as a comparator. However, due to a lack of more relevant data, these studies are discussed below.Box 5Inclusion criteria for identification of studies relevant to an assessment of change in management following catheter-free (wireless) ambulatory oesophageal pH monitoringSelection criteriaInclusion criteriaPopulationPatients with symptoms of GORD in whom a catheter-based test has failed or in whom catheter-based monitoring is anatomically inappropriateInterventionCatheter-free (wireless) ambulatory oesophageal pH monitoring ComparatorsNo pH monitoringOutcomes% change in management plan including surgeries performed and changes in medication plansTime to diagnosisStudy designRandomised or non-randomised controlled trials and cohort studies, case-control studies, case series, or systematic reviews of these study designsSearch periodCatheter-free monitoring was introduced in 2001, so the search period will be 2001 – 5/2013LanguageStudies in languages other than English were excluded unless they represented a higher level of evidence than that available in the English language evidence-baseOne of the studies, a retrospective case series conducted in Chicago, Illinois PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYXdyb248L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYXdyb248L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Gawron et al. 2012), reported on the number of patients who continued to take anti-reflux medication despite a negative pH test result. A total of 38 out of 90 patients (42.2%) reported current PPI use despite negative results from a pH study—66 catheter-free and 24 catheter-based monitoring—and 13 of these patients were on twice-daily PPIs. Only 17 patients (18.9%) recalled being instructed to stop taking PPIs after the test. Review data showed documented instructions to stop PPI therapy for only 15 patients (16.7%). In a case series by Sweis et al. (2011), medical therapy or conservative advice was pursued by the physician in 68% (26/38) of the patients, with the outcome assessed at a median of 24?months (range 12–36 months) after a 96-hour wireless test. Anti-reflux surgery was performed in 12/38 (32%) patients, of which 9 had a positive diagnosis based on pathologic acid exposure, 10 had a positive reflux symptom association based on the wireless test, and 2 were operated on despite a negative pH test result. One of these patients had pathological supine reflux and a large hiatal hernia on endoscopy, and the other had ongoing symptoms of non-acid food and fluid regurgitation with normal endoscopy and manometry. Another study, a matched-pairs retrospective cohort PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcmlnb2xvbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcmlnb2xvbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA (Grigolon et al. 2011), compared the change in management after catheter-free monitoring with management changes following catheter-based monitoring. Anti-reflux medication was used in 43/50 (86%) and 38/50 (76%) patients before the wireless and traditional pH monitoring, respectively (baseline rates not significantly different). After the test, concordance between results of the test and treatment for GORD was higher in the wireless than in the traditional group. That is, those with GORD should be treated with medication or surgery, and those without GORD should stop medication—78% versus 58% of the patients (p <0.05). There were 11 discordant cases in the wireless group and 21 in the catheter-based group: that is, 10 and 14 patients, respectively, who were taking PPIs before the test continued treatment despite a negative or indeterminate test; and 1 and 7, respectively, who were not taking PPIs before the test continued to do so despite a positive test result. Treatment for GORD at the time of a follow-up telephone interview 1–2?years after the test was discordant with the treatment recommended after the test in 12 (24%) and 15 (31%) patients in the wireless and traditional groups, respectively (not statistically significant). The majority of discordant cases, 11 in the former and 10 in the latter group, were patients who continued taking PPIs immediately after the test but who had stopped them by the time of the interview. The remaining discordant cases did not undergo GORD treatment after the test but were taking it at the time of the interview ( REF _Ref367188361 \h \* MERGEFORMAT Table 35).Table 35Concordance between results of the test and treatment for GORD Discordant cases and treatment changes Catheter-free monitoring group (n=50)Catheter-based monitoring group (n=50)Discordant cases (between results of test and treatment)11/50 (22%)21/50 (42%) PPIs despite negative or indeterminate test10/50 (20%)14/50 (28%)No treatment despite positive test1/50 (2%)7/50 (14%)Discordant cases (between treatment and recommended treatment after test) 1–2?years after test12/50 (24%)15/50 (31%)Stopped PPIs during follow-up11/50 (22%)10/50 (20%)Started treatment during follow-up1/50 (2%)5/50 (10%)Source: PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcmlnb2xvbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcmlnb2xvbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA Grigolon et al. (2011)Two case series by Lacy et al. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA (2009, 2011) in paediatric and adult populations, respectively, reported specific management changes after wireless pH monitoring ( REF _Ref362262154 \h \* MERGEFORMAT Table 36). Table 36Specific management changes after wireless oesophageal pH monitoringSpecific management changesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA Lacy et al. (2011) n=167 (adult)n (%)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA Lacy et al. (2009) n=44 (paediatric)n (%)Referred for surgery69 (41)1 (2.3)Increased dose of medication (PPI or H2RA)32 (19)1 (2.3)Initiated medication (PPI)-24 (54.5)Medication changed (PPI or from H2RA to PPI)19 (11)7 (15.9)Medication stopped (PPI or H2RA)28 (17)9 (20.5)Added medication (hyoscyamine, sucralfate, metoclopramide)21 (13)2 (4.6)Other reason (decreased dose of medication, medication change not otherwise specified)19 (11)-In the larger of two case series by Lacy et al. (2011), conducted in adults, the results of the wireless pH-monitoring capsule directly led to a change in diagnosis in 22% of all patients referred for testing. The diagnosis changed most frequently in those patients undergoing evaluation for chronic cough (50%), followed by ENT symptoms (36%), acid reflux symptoms while off PPIs (29%), and chest pain (26%).The diagnosis was more likely to be changed in patients studied while off PPI therapy compared with being monitored while on PPI therapy. Wireless pH-testing results led to a change in management in 63% of all patients referred for monitoring. Clinical management changes were more likely to occur in patients studied off PPI (77%) compared with once daily (43%) or twice daily (45%) PPI therapy (p<0.001). In the earlier study by Lacy et al. (2009), conducted in children, management changed in 44/50 (88%) patients, and no follow up was available for two patients (4%). Patients with an abnormal study result, i.e. acid exposure time >6%, (n=30) were more likely to get a change in management than those with a normal result (n=14; p<0.0001). Does change in management improve patient outcomes?Summary—Do alterations in clinical management and treatment options have an impact on the health outcomes of patients with symptoms of GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?For people initially suspected of having GORD who are given alternative diagnoses correctly after catheter-free monitoring (true negatives), it is assumed that their clinical management would be optimised as a result of obtaining the correct diagnosis. Patients who receive a false positive would likely continue to receive ineffective PPI treatment and suffer a delay in receiving their correct diagnosis. A false negative would likely result in suspension of PPI treatment and a delay in diagnosis while an alternative diagnosis is sought. No relevant studies were identified regarding the impact of false negatives; however, two studies on false positives were included. These studies reported that infants with infantile spasms with delayed treatment as a result of a false GORD diagnosis had a poorer outcome and worse treatment response than infants without a delay in diagnosis and treatment. Furthermore, two systematic reviews on true positives were included to answer the question of whether anti-reflux surgery for GORD leads to better health outcomes compared with medical treatment in patients with GORD with a positive pH-test result. The first, medium-quality review reported that improved outcomes were more common after surgical than medical treatment, with significant differences in objective outcomes (pH-reflux duration, oesophagitis, LOS pressure etc.) in 5/6 included RCTs and 2/3 cohort studies. Subjective outcomes were also more common among surgical patients in 7/8 studies. The second, more recent, high-quality review compared medical management with laparoscopic fundoplication surgery. Four RCTs were included. Significant improvements in quality of life (QoL) were reported at 3?months and 1?year after surgery, compared with medical treatment. All studies reported significant increases in GORD-specific QoL postoperatively, compared with medical treatment. Post-operative complications were rare. Two of the four RCTs included in the latter review published 5-year follow-up studies after the Cochrane review was conducted. Most patients achieve and remain in remission at 5?years with anti-reflux surgery, and fundoplication continued to give better pain relief than medical management. It should be noted, however, that these trials consisted solely of PPI responders, and their results do not generalise to patients who are refractory to PPI therapy.The expected treatment changes that may result from having a catheter-free monitoring test are likely to benefit QoL.To answer the question of whether a change in management leads to improved patient health outcomes, a second literature search was done based on the PICO criteria outlined a priori in REF _Ref371065728 \h \* MERGEFORMAT Box 6. For people initially suspected of having GORD but eventually given an alternative diagnosis (true negatives) and a subsequent change in management, it was assumed that their management has been optimised as a result of obtaining the correct diagnosis. Box 6Inclusion criteria for identification of studies relevant to an assessment of health outcomes following a change in managementSelection criteriaInclusion criteria true positivesInclusion criteria false positivesInclusion criteria false negativesPopulationPeople with GORDPeople who are wrongly diagnosed with GORDPeople with undiagnosed GORDInterventionOptimal treatment for GORD (PPIs, H2 receptor antagonists, surgery) (Unnecessary) treatment for GORD (PPIs, H2 receptor antagonists, surgery) Possible cessation of PPI therapy and consideration and/or treatment trial for other diagnosesComparatorsAlternative treatment No GORD treatment and/or optimal treatment for true condition Optimal treatment for GORD (PPIs, H2 receptor antagonists, surgery) OutcomesAdverse events from treatment, quality of life, reduction in progression to Barrett’s oesophagus and/or oesophageal cancer, symptom resolution or symptom reductionAdverse events from inappropriate use of GORD treatment, quality of life, adverse events from delay in appropriate treatment for differential diagnosis Quality of life, progression to Barrett’s oesophagus and/or oesophageal cancer, symptom resolution Study designSystematic reviews, meta-analysis, evidence-based clinical practice guidelinesLevel 1 evidence if available, otherwise randomised or non-randomised controlled trials and cohort studies, case-control studies, case series, or systematic reviews of these study designsLevel 1 evidence if available, otherwise randomised or non-randomised controlled trials and cohort studies, case-control studies, case series, or systematic reviews of these study designsSearch periodMost recent studies foundNo limitsNo limitsLanguageStudies in languages other than English were excluded unless they represented a higher level of evidence than that available in the English language evidence-baseTrue positives Patients suspected of GORD are usually given a trial of PPI therapy; where this is not completely successful in managing their symptoms, pH monitoring may be undertaken. If the patient has a (true) positive pH-test result, there may be a change in management in that the patient would have the option to undergo anti-reflux surgery. This is not generally recommended unless acid-reflux has been positively identified as the cause of symptoms. A combination of surgical and medical treatment was therefore included as the intervention (the optimal treatment), and medical treatment was included as the comparator (the alternative treatment). This raises the question of whether anti-reflux surgery for GORD leads to better health outcomes, compared with medical treatment, in patients with GORD with a true positive pH-test result?Out of 5,553 studies (3,708 after duplicates were removed), 114 full-text articles were studied. Three relevant systematic reviews based on these criteria were identified; however, the most recent review PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbCBUYWxhbHdhaDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbCBUYWxhbHdhaDwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll
YXI+PFJlY051bT4xMDwvUmVjTnVtPjxJRFRleHQ+NDA5LTQxNTwvSURUZXh0PjxEaXNwbGF5VGV4
dD4oQWwgVGFsYWx3YWggJmFtcDsgV29vZHdhcmQgMjAxMyk8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+
PHJlYy1udW1iZXI+MTA8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRi
LWlkPSJleGVlenN4c25hcHJ6Y2V3dHRteDl0ZmgyMnI1dGFyYXphcjUiPjEwPC9rZXk+PC9mb3Jl
aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj
b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5BbCBUYWxhbHdhaCwgTmFybWVlbjwvYXV0aG9y
PjxhdXRob3I+V29vZHdhcmQsIFN1c2FuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3Jz
PjxhdXRoLWFkZHJlc3M+Q2hhcmdlIE51cnNlLCBFbmRvc2NvcHksIFNhdWRpIEFyYW1jbyBEaGFo
cmFuIEhlYWx0aCBDYXJlIENlbnRyZSYjeEQ7TGVjdHVyZXIsIEZsb3JlbmNlIE5pZ2h0aW5nYWxl
IFNjaG9vbCBvZiBOdXJzaW5nIGFuZCBNaWR3aWZlcnksIEtpbmcmYXBvcztzIENvbGxlZ2UgTG9u
ZG9uPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+R2FzdHJvLW9lc29waGFnZWFsIHJlZmx1
eC4gUGFydCAzOiBtZWRpY2FsIGFuZCBzdXJnaWNhbCB0cmVhdG1lbnQ8L3RpdGxlPjxzZWNvbmRh
cnktdGl0bGU+QnJpdGlzaCBKb3VybmFsIG9mIE51cnNpbmc8L3NlY29uZGFyeS10aXRsZT48L3Rp
dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5Ccml0aXNoIEpvdXJuYWwgb2YgTnVyc2luZzwv
ZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjQwOS00MTU8L3BhZ2VzPjx2b2x1bWU+MjI8
L3ZvbHVtZT48bnVtYmVyPjc8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+R2FzdHJvZXNvcGhh
Z2VhbCBSZWZsdXggLS0gU3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFs
IFJlZmx1eCAtLSBEcnVnIFRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+T21lcHJhem9sZSAtLSBU
aGVyYXBldXRpYyBVc2U8L2tleXdvcmQ+PGtleXdvcmQ+U3VyZ2VyeSwgTGFwYXJvc2NvcGljPC9r
ZXl3b3JkPjxrZXl3b3JkPkh1bWFuPC9rZXl3b3JkPjxrZXl3b3JkPlN5c3RlbWF0aWMgUmV2aWV3
PC9rZXl3b3JkPjxrZXl3b3JkPk1lZGxpbmU8L2tleXdvcmQ+PGtleXdvcmQ+RW1iYXNlPC9rZXl3
b3JkPjxrZXl3b3JkPkNJTkFITCBEYXRhYmFzZTwva2V5d29yZD48a2V5d29yZD5Db2NocmFuZSBM
aWJyYXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vzb3BoYWdlYWwgUmVmbHV4IC0tIFN5bXB0
b21zPC9rZXl3b3JkPjxrZXl3b3JkPlF1YWxpdHkgb2YgTGlmZTwva2V5d29yZD48a2V5d29yZD5T
dXJnZXJ5LCBMYXBhcm9zY29waWMgLS0gRWNvbm9taWNzPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ry
b2VudGVyb2xvZ3kgTnVyc2luZzwva2V5d29yZD48a2V5d29yZD5SYW5kb21pemVkIENvbnRyb2xs
ZWQgVHJpYWxzPC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+
PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWVzPC9rZXl3b3JkPjxrZXl3b3JkPkhlYXJ0YnVybjwv
a2V5d29yZD48a2V5d29yZD5Fc29waGFnaXRpczwva2V5d29yZD48a2V5d29yZD5Qcm90b24gUHVt
cCBJbmhpYml0b3JzIC0tIEVjb25vbWljczwva2V5d29yZD48a2V5d29yZD5TdXJnZXJ5LCBEaWdl
c3RpdmUgU3lzdGVtIC0tIEVjb25vbWljczwva2V5d29yZD48a2V5d29yZD5SZWN1cnJlbmNlPC9r
ZXl3b3JkPjxrZXl3b3JkPlF1YXNpLUV4cGVyaW1lbnRhbCBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3
b3JkPlBvc3RvcGVyYXRpdmUgQ29tcGxpY2F0aW9uczwva2V5d29yZD48a2V5d29yZD5PbWVwcmF6
b2xlIC0tIEVjb25vbWljczwva2V5d29yZD48a2V5d29yZD5Db21wYXJhdGl2ZSBTdHVkaWVzPC9r
ZXl3b3JkPjxrZXl3b3JkPkludHJhb3BlcmF0aXZlIENvbXBsaWNhdGlvbnM8L2tleXdvcmQ+PC9r
ZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMzwveWVhcj48L2RhdGVzPjxpc2JuPjA5NjYtMDQ2MTwv
aXNibj48YWNjZXNzaW9uLW51bT4yMDEyMDg1NDk5LiBMYW5ndWFnZTogRW5nbGlzaC4gRW50cnkg
RGF0ZTogMjAxMzA0MjYuIFJldmlzaW9uIERhdGU6IDIwMTMwNTE3LiBQdWJsaWNhdGlvbiBUeXBl
OiBqb3VybmFsIGFydGljbGU8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJs
Pmh0dHA6Ly9wcm94eS5saWJyYXJ5LmFkZWxhaWRlLmVkdS5hdS9sb2dpbj91cmw9aHR0cDovL3Nl
YXJjaC5lYnNjb2hvc3QuY29tL2xvZ2luLmFzcHg/ZGlyZWN0PXRydWUmYW1wO2RiPWM4aCZhbXA7
QU49MjAxMjA4NTQ5OSZhbXA7c2l0ZT1laG9zdC1saXZlJmFtcDtzY29wZT1zaXRlPC91cmw+PHVy
bD5GVUxMVEVYVDo8L3VybD48dXJsPmh0dHA6Ly93d3cuaW50ZXJudXJzZS5jb20vY2dpLWJpbi9n
by5wbC9saWJyYXJ5L2FydGljbGUuY2dpP3VpZD05Nzk5NDthcnRpY2xlPUJKTl8yMl83XzQwOV80
MTU8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PHJlbW90ZS1kYXRhYmFzZS1uYW1lPmM4aDwv
cmVtb3RlLWRhdGFiYXNlLW5hbWU+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5FQlNDT2hvc3Q8
L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA (Al Talalwah & Woodward 2013) was excluded as it provided no additional new data and was of lesser quality than the other identified systematic reviews. As a result, two systematic reviews were included PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbGxnb29kPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbGxnb29kPC9BdXRob3I+PFllYXI+MjAwMDwvWWVhcj48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ADDIN EN.CITE.DATA (Allgood & Bachmann 2000; Wileman et al. 2010). Allgood and Bachmann (2000) aimed to evaluate and summarise all comparative studies of the effectiveness of surgical and medical management of GORD. Six RCTs and three cohort studies were identified. The review was of medium quality and did not distinguish between the different medical and surgical treatments. Both laparoscopic and open anti-reflux surgical procedures were included, as well as both Nissen-Rossetti (360?) and Toupet (180?) fundoplication. Improved outcomes were more common after surgical than medical treatment, with significant differences in objective outcomes (pH-reflux duration, oesophagitis, LOS pressure etc.) in 5/6 included RCTs and 2/3 cohort studies. Five studies (4 RCTs and 1 cohort study) mentioned changes in oesophageal pH; and three studies (2 RCTs and 1 cohort study) reported a significantly better response to surgery, whereas one RCT only showed a significantly higher response to surgery than to medication for symptoms, and not for continuous medication. Subjective outcomes (symptoms and patients’ satisfaction) were also more common among surgical patients in 7/8 studies. The overall conclusion by the authors was that surgery is consistently more effective across a range of patients and for a range of both short-term and long-term outcomes.The other, more recent included systematic review is a high-quality Cochrane review ADDIN EN.CITE <EndNote><Cite><Author>Wileman Samantha</Author><Year>2010</Year><RecNum>613</RecNum><DisplayText>(Wileman Samantha et al. 2010)</DisplayText><record><rec-number>613</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">613</key></foreign-keys><ref-type name="Electronic Article">43</ref-type><contributors><authors><author>Wileman Samantha, M.</author><author>McCann, Sharon</author><author>Grant Adrian, M.</author><author>Krukowski Zygmunt, H.</author><author>Bruce, Julie</author></authors></contributors><titles><title>Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults</title><secondary-title>Cochrane Database of Systematic Reviews</secondary-title></titles><periodical><full-title>Cochrane Database of Systematic Reviews</full-title></periodical><number>3</number><keywords><keyword>Fundoplication [methods]</keyword><keyword>Gastroesophageal Reflux [surgery] [therapy]</keyword><keyword>Health Status</keyword><keyword>Quality of Life</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Adult[checkword]</keyword><keyword>Humans[checkword]</keyword><keyword>Hm-uppergi</keyword></keywords><dates><year>2010</year></dates><publisher>John Wiley & Sons, Ltd</publisher><accession-num>CD003243</accession-num><urls><related-urls><url>;(Wileman et al. 2010). The aim was to compare medical management (either PPIs or H2 receptor antagonists) with laparoscopic fundoplication surgery for the treatment of GORD in adults. Twelve papers were included that reported data on multiple time points of four clinical trials with a total of 1,232 randomised participants, published between 2005 and 2009. All four studies reported health-related QoL, and two studies were combined using fixed effect models. This showed that there were significant improvements in health-related QoL at 3?months and 1?year after surgery, compared with medical therapy (mean difference SF36 general health score: –5.23, 95%CI –6.83 to –3.62, I2 = 0%). One other study reported higher vitality scores compared with medical therapy at 1 and 3?years postoperatively (p<0.001), and the fourth study reported a higher QoL at 3?months and 1?year after surgery, compared with medical therapy (p<0.001). All included studies reported significant increases in GORD-specific QoL postoperatively, compared with medical treatment. The authors reported that symptoms of heartburn, reflux and bloating were improved after surgery, compared with medical therapy, but some patients had persistent postoperative dysphagia. Postoperative complications were rare, but surgery is not without risk and postoperative adverse events did occur. The authors suggest that there is evidence that surgery is more effective than medical management for the treatment of GORD, at least in the short to medium term. Two of the four included RCTs in the Cochrane review (the ‘LOTUS trial’ and the ‘REFLUX trial’) published 5-year follow-up studies after the review was conducted, to give more information on the long-term results of surgery and medication for GORD PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA (Galmiche et al. 2011; Grant, Cotton et al. 2013). The LOTUS randomised trial was conducted in academic hospitals in 11 different European countries between October 2001 and April 2009; it included 554 patients, of which 372 completed the 5-year follow-up PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA (Galmiche et al. 2011). Initial recruitment for the REFLUX trial was done in 21 UK hospitals and 810 patients were included—357 patients were recruited to a randomised comparison and 453 to non-randomised preference groups PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant, Cotton et al. 2013). The aim was to evaluate maintenance therapy with medication vs laparoscopic anti-reflux surgery. In the LOTUS trial, only esomeprazole was used in the medical management group.The LOTUS trial reported that, at 5?years, an estimated 85% (95%CI, 81%–90%) of patients in the surgery group and 92% (95%CI, 89%–96%) in the esomeprazole group remained in remission (log-rank p=0.048). In the REFLUX trial QoL was measured on a disease-specific REFLUX questionnaire; among responders at 5?years the randomised surgery group scored significantly higher compared with the medication group, with a mean difference of 8.5 (95%CI 3.9, 13.1, p<0.001) for intention-to-treat analyses and 11.5 (95%CI 4.2, 18.7, p=0.002) adjusted for treatment received. Short Form-36 scores and mean EuroQol questionnaire 5 dimensions (EQ-5D) scores favoured the surgical group in all domains at all time points, although differences decreased over time. The prevalence of GORD-related symptoms for both treatment groups in both trials can be found in REF _Ref371674608 \h \* MERGEFORMAT Table 37. In the REFLUX trial heartburn, regurgitation and belching were reported less frequently in the group randomised to surgery compared with the medication group, with no significant differences in ‘difficulty swallowing’, ‘wind from the bowel’ and ‘wanting to be sick but being unable’ ( REF _Ref371674608 \h \* MERGEFORMAT Table 37). Galmiche et al. (2011) reported that most patients achieve and remain in remission at 5?years with either medication treatment or laparoscopic surgery. However, the results of both trials are inconsistent, as the majority of the medication group in the REFLUX trial had heartburn at least once a week at the 5-year follow-up. Grant, Cotton et al. (2013; REFLUX trial) concluded that, after 5?years, laparoscopic fundoplication continued to give better relief of GORD symptoms than medical management. It should be noted that these trials consisted solely of (partial or complete) PPI responders, and their results do not generalise to patients who are refractory to PPI therapy. Therefore, these results, especially in the medication groups, need to be interpreted with caution, as the patients who would undergo catheter-free monitoring may be refractory to PPI treatment. Table 37Prevalence of symptoms at 5-year follow-up of LOTUS and REFLUX trials Prevalence of symptomsEsomeprazole group LOTUS (n=192)Surgery group LOTUS (n=180)p-value LOTUSMedication group REFLUX (n) Surgery group REFLUX (n) Heartburn16%8%0.1478 (73.6%)46 (41.4%)Acid regurgitation13%2%<0.00141 (36.6%)29 (24.6%)Dysphagia5%11%<0.00128 (25.5%)27 (22.9%)Bloating28%40%<0.001--Flatulence/wind from bowel40%57%<0.00196 (87.3%)104 (88.1%)Belching---83 (75.5%)71 (60.7%)Nausea but unable to be sick---19 (17.1%)17 (14.4%)Adverse events24.1%28.6%---Sources: PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxtaWNoZTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+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ADDIN EN.CITE.DATA Galmiche et al. (2011); Grant, Cotton et al. (2013)False positives People in the false positive group would be people who have a positive result on the pH test despite not truly having GORD. This would mean that they would be treated for GORD, either medical treatment or surgery, unnecessarily after their pH-test result. Studies on unnecessary GORD treatment and GORD misdiagnosis were searched and eight were identified PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXZpbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXZpbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Auvin et al. 2012; Kessing, Bredenoord & Smout 2011; Napuri et al. 2010; Starr 2006, 2007; Susman 2009; Sweetman, Ng & Kerrigan 2007; Taddio et al. 2011). However, six of these studies had to be excluded. Three case reports reported on heart disease patients who were wrongly diagnosed with GORD but one had to be excluded because the patient died before he was able to undergo pH monitoring ADDIN EN.CITE <EndNote><Cite><Author>Susman</Author><Year>2009</Year><RecNum>4281</RecNum><IDText>288</IDText><DisplayText>(Susman 2009)</DisplayText><record><rec-number>4281</rec-number><foreign-keys><key app="EN" db-id="zdzptdeprf9tf0e9xeovwvslddfxtv95te9s">4281</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Susman, J. L.</author></authors></contributors><titles><title>"GERD" turns out to be heart disease</title><secondary-title>The Journal of family practice</secondary-title></titles><periodical><full-title>The Journal of family practice</full-title></periodical><pages>288</pages><volume>58</volume><number>5</number><dates><year>2009</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(Susman 2009), and two patients reported that they responded sufficiently to anti-reflux medication before further investigations (e.g. pH monitoring) were undertaken PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGFycjwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdGFycjwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Starr 2006, 2007). One study reported three case reports where achalasia was initially misdiagnosed as GORD; however, no relevant outcomes were reported ADDIN EN.CITE <EndNote><Cite><Author>Kessing</Author><Year>2011</Year><RecNum>4250</RecNum><IDText>1020-1024</IDText><DisplayText>(Kessing, Bredenoord & Smout 2011)</DisplayText><record><rec-number>4250</rec-number><foreign-keys><key app="EN" db-id="zdzptdeprf9tf0e9xeovwvslddfxtv95te9s">4250</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kessing, B. F.</author><author>Bredenoord, A. J.</author><author>Smout, A. J. P. M.</author></authors></contributors><auth-address>Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, Netherlands</auth-address><titles><title>Erroneous diagnosis of gastroesophageal reflux disease in achalasia</title><secondary-title>Clinical Gastroenterology and Hepatology</secondary-title></titles><periodical><full-title>Clinical Gastroenterology and Hepatology</full-title></periodical><pages>1020-1024</pages><volume>9</volume><number>12</number><keywords><keyword>Achalasia</keyword><keyword>Esophageal Manometry</keyword><keyword>Gastroesophageal Reflux Disease</keyword><keyword>Surgical Fundoplication</keyword></keywords><dates><year>2011</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(Kessing, Bredenoord & Smout 2011). Finally, two studies on GORD misdiagnosis in infants were excluded because they did not report health outcomes PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYWRkaW88L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UYWRkaW88L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Taddio et al. 2011; Wileman et al. 2010). Two studies on GORD misdiagnosis of small infants were included, as these studies gave some evidence on health-related consequences of delayed diagnosis of conditions initially misdiagnosed as GORD PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXZpbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdXZpbjwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Auvin et al. 2012; Napuri et al. 2010). Although these infants did not undergo pH monitoring, it gives an indication of the impact of a false positive GORD diagnosis on health outcomes in infants. Auvin et al. (2012) reported that in 83 infants diagnosed with infantile spasms, 7% were initially diagnosed with GORD. This misdiagnosis was an important reason for diagnostic delay, and a diagnostic delay of more than 30?days was associated with a poor outcome (e.g. seizures, mental delay) (RR=12.08 [1.52–96.3]). In the multivariate analysis a poor outcome 2?years after diagnosis was also predicted by diagnostic delay of more than 30?days (RR=31.70 [2.30–437.68]). Napuri et al. (2010) included 156 infants also diagnosed with infantile spasms. Of these patients, 17% were initially diagnosed with GORD. The authors reported that response to treatment was significantly better when treatment lag was less than 6?weeks (40% responders) than when it was longer (20% responders; p=0.021). These results show that infants with infantile spasms benefit from early diagnosis, and a false GORD diagnosis could unnecessarily delay treatment, leading to worse health outcomes.False negativesNo studies were identified that met the criteria for false negatives in REF _Ref371065728 \h \* MERGEFORMAT Box 6.Other relevant considerationsDefining the population and the potential for ‘leakage’It can be difficult to determine whether a person is ‘unable’ to tolerate a catheter. The catheter-free monitoring test is viewed as more convenient and can lead to a higher diagnostic yield due to prolonged monitoring, compared with catheter-based monitoring. Physicians could be inclined to give more patients catheter-free monitoring to avoid discomfort and embarrassment, especially in children. Furthermore, it is shown that catheter-free monitoring has less impact on normal daily activities, which makes the recording more reliable. Therefore, it is possible that the population using catheter-free monitoring may expand beyond those who are currently considered unable to tolerate catheter-based monitoring, when the alternative is no monitoring. That is, the use of the wireless test could start ‘leaking’ into the population currently receiving the catheter-based test. Because of the higher costs of catheter-free monitoring compared with catheter-based monitoring, this ‘leakage’ could lead to extra costs. This scenario is examined in the economics section of the report. Catheter-based monitoring is normally inserted transnasally with manometric guidance, whereas catheter-free monitoring is usually inserted through the mouth using endoscopy, although manometric guidance is possible with catheter-free monitoring. However, as the population eligible for catheter-free monitoring does not tolerate a catheter through the nose, they are unlikely to tolerate manometry, leaving transoral endoscopy as the only option to guide insertion. The costs for endoscopy are higher than for manometry, and this is one of the reasons that the costs for the new MBS item are higher than for MBS item 11810 (catheter-based monitoring). Therefore, if ‘leakage’ takes place and catheter-free monitoring would be performed with manometric guidance through the nose, the fee should be reassessed.What are the economic considerations? Economic evaluationOverviewThe DAP identified two key economic questions. These were:What is the cost-effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring, compared with no pH monitoring, for patients with symptoms of GORD who have previously failed a catheter-based test or where catheter-based monitoring is anatomically inappropriate?What is the cost-effectiveness of catheter-free (wireless) ambulatory oesophageal pH monitoring, compared with catheter-based oesophageal pH monitoring, in patients with symptoms of GORD?To address these questions, two separate economic models are required.Model 1 ScenarioAn evaluation where the population is restricted, as per the proposed listing, to only those patients who cannot tolerate catheter-based monitoring, i.e. who have tried and failed, or are anatomically unsuitable. In this case ‘no alternative pH monitoring’ is the appropriate comparator. Initially, the base-case assumes 100% sensitivity and specificity of catheter-free (wireless) pH monitoring on the grounds that catheter-based pH monitoring is an imperfect reference standard and the true accuracy of either test is unknown. However, the sensitivity and specificity of wireless pH monitoring relative to catheter-based monitoring, based on the results of the systematic review, are also modelled for a sensitivity analysis. This modelled evaluation is intended to answer the first economic question.Model 2 ScenarioAn evaluation where the population accesses wireless pH monitoring as an alternative to catheter-based pH monitoring (the comparator). Within this scenario the assumptions of relative accuracy associated with wireless pH monitoring, referenced to catheter-based monitoring, are also varied and presented as sensitivity analyses. This modelled evaluation is intended to answer the second economic question.In reality, while the proposed listing restricts the population to that in Model 1, given the reported patient preference and convenience associated with wireless monitoring, it may be anticipated that there will be some leakage of wireless pH monitoring beyond the requested listing. Therefore, future MBS-funded clinical practice may include patients who could actually tolerate catheter-based pH monitoring but have a strong preference for wireless monitoring, such as the population in Model 2. It might be expected that the overall population of potential wireless pH-monitoring patients would be made up a combination of patients from each of the model populations. Therefore, results are also presented for various weighted combinations of Models 1 and 2 such that a pragmatic estimate of cost-effectiveness incorporating varying levels of leakage beyond the listing can be made. In both models it is assumed that the monitoring will result in changed health outcomes, and therefore a cost–utility analysis is undertaken that measures incremental differences in quality-adjusted life years (QALYs) and GORD-related resource costs between wireless pH monitoring and the nominated comparator. The analysis is conducted primarily from the Australian health system perspective and, given the lack of long-term clinical data, is assessed over a 15-year time horizon to minimise uncertainty cost-effectiveness. It should be noted that a range of time horizons is explored in sensitivity analyses; however, if longer time horizons are required to demonstrate cost-effectiveness, there will be increasing uncertainty associated with the extended extrapolation and analysis.Economic literature reviewA search to identify existing literature containing economic models relating to pH monitoring and management of GORD symptoms was undertaken (see REF _Ref379440541 \h \* MERGEFORMAT Appendix J). Six citations specifically relating to economic analysis of pH monitoring were identified. Of these, only two related to the relevant clinical pathway (i.e. following endoscopy). PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA Lee et al. (2008) used wireless monitoring but was not restricted to patients who could not tolerate catheter-based monitoring; and the other study (Kleiman et al. 2013) used catheter-based monitoring. Both were cost analyses that did not consider clinical outcomes. None of the existing literature identified was adequate to answer the economic questions posed in the DAP; therefore, further development of economic models was required.In addition, a broader literature search to identify other economic models in the area of gastro-oesophageal reflux was undertaken, with the intent that identified references may provide potential sources of data or validation for various parameters/inputs required in the assessment-developed models. Populations and settingsThe populations modelled are intended to represent Australian patients who would be candidates for wireless pH monitoring funded by Medicare.The clinical pathway describes both the currently available catheter-based pH monitoring and the proposed wireless pH monitoring as being used as a diagnostic tool in patients who, despite a normal endoscopy, have ongoing GORD symptoms that are refractory to PPI use. There is not a single definition in the literature of what it means to be ‘refractory to PPIs’; both the accepted dose range and the acceptability of anything less than a complete response with respect to symptom relief vary.Based on Medicare data, catheter-based pH monitoring is currently undertaken across all ages of the Australian population, from babies to 85+?year olds. The average and median age group is 45–54?year?olds, but the age group with the single largest use is 55–64?year?olds. Of all pH-monitoring patients, 61% are female. To approximate this population, each model assumes that suspected GORD patients receiving pH monitoring are 55?years of age and that there is a male:female ratio of 40%:60%. This assumption is used to estimate background mortality.The setting of the model begins in the outpatient setting with patients in the care of a specialist gastroenterologist. However, on being assigned the proposed intervention, the patient would have the wireless pH-monitoring capsule placed by a gastroenterologist, generally in either an endoscopy suite or day facility, and temporarily become a hospital inpatient for this procedure—93% of endoscopy patients who subsequently receive pH monitoring were inpatients for their initial endoscopy5. In contrast, empirical medical treatment is assumed to be undertaken in the outpatient setting (physician rooms); and only around 4% of MBS claims for catheter-based pH monitoring are for hospital-based patients, as the catheter is generally inserted without sedation.Given the patient definition, it is assumed that patients entering the model will have GORD symptoms and, on average, a QoL commensurate with ongoing symptoms that will be unchanged unless successful treatment is achieved. Likewise, it will be assumed that patients entering the model are, on average, consuming resources equivalent to a standard single daily dose of PPI treatment, although, in reality, pre-existing use and dosing of GORD medication is likely to be heterogeneous. This use is assumed to continue in the first cycle where the intervention (i.e. pH testing/monitoring) is allocated in Model 2, but in the comparator arm of Model 1 (i.e. no pH testing/monitoring plus empirical treatment) it is assumed that there would be a trial of high-dose PPIs immediately.Structure and rationale of the economic evaluationThe structures of the economic models are consistent with the clinical pathway presented in REF _Ref379455005 \h \* MERGEFORMAT Figure 3. A health state diagram showing potential transitions between health states is presented in REF _Ref379458137 \h \* MERGEFORMAT Figure 8. Immediately on entering the model, patients are assumed to be allocated to either receive pH monitoring (Model 1 intervention and Model 2 both arms) or empirical treatment with high-dose PPIs (Model 1 comparator). Figure 8Health state diagram for the economic modelsThe model is constructed in two phases: Phase 1: The first phase represents the first year following the decision to pH monitor or not. In this year patient diagnoses and management strategies are established. Patients are assumed to enter phase 1 of the model with symptoms and be receiving routine daily average-dose GORD medication. Depending on the model scenario, patients are then assigned to receive either:wireless pH monitoring or no monitoring (ongoing medical treatment) [Model 1]orwireless pH monitoring or catheter-based monitoring [Model 2]A summary of the structure of the mechanics of the economic model is presented in REF _Ref379456626 \h Table 38.Table 38Summary of the economic evaluation (applies to both models)Time horizonBase-case analysis of 15 yearsOutcomesQuality-adjusted life yearsMethods used to generate resultsMarkov model (with half-cycle correction)Cycle length1 yearDiscount rate5% for both costs and outcomesSoftware packages usedTreeAge Pro and Excel (hybrid)It is assumed that only patients who have a positive pH test result will be eligible for surgery, and the subsequent uptake of surgery by a percentage of patients following pH monitoring is a key difference between the intervention and the comparator in Model 1. In patients who have a normal pH-test result it is assumed that other diagnoses are investigated and treated. Patients who do not get a pH-test result, due to test failure or allocation to the comparator group, and who do not respond to high-dose PPIs may be investigated for other diagnoses and receive other treatment. However, expert opinion suggests that this would not occur universally in all patients—a number would simply remain as unsuccessfully treated and refractory NERD cases. This assumption is a key driver in the model. The extent to which alternative diagnoses are sought without a negative pH test result is varied and tested in the sensitivity analysis. The specific values associated with all transitions between health states are discussed in the relevant sections under ‘Inputs to the economic evaluation’. The initial phase of each model has six cycles of 2?months, and at the end of the 1-year period it is assumed that diagnoses and treatment paths have been determined.Phase 2: The second phase calculates the long-term costs and outcomes associated with the patient’s diagnosis and treatment as established at the end of the first year of investigation and treatment (phase 1). It is assumed that no new diagnoses or changes in treatment are made in phase 2 and that all patients either remain in the health state in which they ended phase 1, or they die (at the background mortality rate—applied equally across all patients). Costs and outcomes associated with treatment options are calculated in yearly cycles with a 5% annual discount rate. The base-case accrues costs and outcomes for a further 14?years (i.e. total model duration of 15?years); however, timeframes from 1?year to 25?years are tested in the sensitivity analysis. The decision analytic structure for the model pathways is shown in REF _Ref377977732 \h \* MERGEFORMAT Figure 9 .Figure 9 Decision analytic structure of the economic evaluation. Model 1 represents the decision between wireless pH monitoring and non-selective high-dose GORD PPI therapy. Model 2 represents the decision between wireless pH monitoring and catheter-based monitoring.Assumptions incorporated into the model structure:Only one test failure—patients failing a pH-monitoring test obtain a result on a subsequent test.Patients would not tolerate a manometric pH test; therefore, this is not incorporated anywhere in the model as an alternative or subsequent diagnostic tool. Likewise, endoscopic procedures for management of GORD are not included as it is assumed that fundoplication is the standard surgical technique and there is a lack of evidence regarding efficacy of the alternative treatments.Underlying disease is delineated by acid reflux into the oesophagus or not. While this is not a true reflection of the real population, which has mixed/multiple disease aetiologies, it is considered a justifiable simplification for use in the model. Although segregated in the model, the clinical implications of mixed aetiologies are incorporated in the model results because it is assumed that there is an imperfect success rate associated with acid treatments, and the cost of some ongoing acid treatments (PPIs) is incorporated into the expected costs of treatment for alternative diagnoses.Surgery is repeated in 10% of patients and assumed to occur within the same year as the initial surgery. This is consistent with Australian MBS data on surgical revisions PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant, Cotton et al. 2013). The diagrammatic structure suggests that only one repeat surgery may be undertaken per patient; however, this strict interpretation is not essential. The final outcome from surgery, either success or failure, is based on overall surgical population outcomes that capture all revisions.Patients that have a diagnosis of acid-related symptoms and who fail to resolve their symptoms with surgery remain on a double dose of PPIs for the remainder of the model. Likewise, patients that have a diagnosis of acid-related symptoms and elect medical management remain on a double dose of PPIs for the remainder of the model, irrespective of whether or not they have successful symptom control. The assumption of a high-dose requirement is consistent with the population initially being considered ‘refractory’ ADDIN EN.CITE <EndNote><Cite><Author>Fass</Author><Year>2009</Year><RecNum>62</RecNum><DisplayText>(Fass 2009)</DisplayText><record><rec-number>62</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">62</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fass, Ronnie</author></authors></contributors><titles><title>Proton Pump Inhibitor Failure - What Are the Therapeutic Options?</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><pages>S33-S38</pages><volume>104</volume><number>S2</number><dates><year>2009</year><pub-dates><date>//print</date></pub-dates></dates><publisher>American College of Gastroenterology Ltd</publisher><isbn>0002-9270</isbn><urls><related-urls><url>;(Fass 2009).Inputs to the economic evaluationA summary list of all the variables used in the model is presented in REF _Ref379440517 \h Table 85 in REF _Ref379440541 \h Appendix K.Population and test parametersPrevalence, test diagnostic yield and failure rateThere is no direct evidence concerning the true underlying prevalence of acid-related GORD in the symptomatic, endoscopy-negative patient population who would be referred for pH monitoring in the Australian setting. Assuming that the catheter-free pH-monitoring test is accurate, prevalence is estimated based on its diagnostic yield. The clinical report provides a broad range of yields, between 25.7% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj
TnVtPjI3NjwvUmVjTnVtPjxJRFRleHQ+NDI5LTM1PC9JRFRleHQ+PERpc3BsYXlUZXh0PihMYWN5
IGV0IGFsLiAyMDExKTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yNzY8L3JlYy1u
dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZkZmxkZHo1YWUy
eDAzNXJwMmZ6MjJzZXdydnIwd3IiPjI3Njwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBu
YW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3Jz
PjxhdXRob3I+TGFjeSwgQi4gRS48L2F1dGhvcj48YXV0aG9yPkR1a293aWN6LCBBLiBDLjwvYXV0
aG9yPjxhdXRob3I+Um9iZXJ0c29uLCBELiBKLjwvYXV0aG9yPjxhdXRob3I+V2Vpc3MsIEouIEUu
PC9hdXRob3I+PGF1dGhvcj5UZWl4ZWlyYSwgUC48L2F1dGhvcj48YXV0aG9yPktlbGxleSwgTS4g
TC4sIEpyLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlNl
Y3Rpb24gb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgRGFydG1vdXRoLUhpdGNo
Y29jayBNZWRpY2FsIENlbnRlciwgTGViYW5vbiwgTkggMDM3NTYsIFVTQS4gYnJpYW4ubGFjeUBo
aXRjaGNvY2sub3JnPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q2xpbmljYWwgdXRpbGl0
eSBvZiB0aGUgd2lyZWxlc3MgcEggY2Fwc3VsZTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIENs
aW4gR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Sm91cm5hbCBvZiBj
bGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+
PGZ1bGwtdGl0bGU+SiBDbGluIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3Vy
bmFsIG9mIGNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L3BlcmlvZGljYWw+PGFs
dC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQ2xpbiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxl
PjxhYmJyLTE+Sm91cm5hbCBvZiBjbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9h
bHQtcGVyaW9kaWNhbD48cGFnZXM+NDI5LTM1PC9wYWdlcz48dm9sdW1lPjQ1PC92b2x1bWU+PG51
bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxMC8xMC8zMDwvZWRpdGlvbj48a2V5d29yZHM+PGtl
eXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2Fwc3VsZSBFbmRvc2NvcHkvaW5zdHJ1bWVu
dGF0aW9uL21ldGhvZHMvIHV0aWxpemF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkNoZXN0IFBhaW4v
IGRpYWdub3Npcy9waHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29w
aGFnZWFsIHBIIE1vbml0b3JpbmcvIGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5G
ZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Np
cy9waHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IZWFsdGggQ2FyZSBT
dXJ2ZXlzPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5IeWRyb2dl
bi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3
b3JkPk1hbm9tZXRyeS9tZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3
b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+UXVlc3Rp
b25uYWlyZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHVi
LWRhdGVzPjxkYXRlPk1heS1KdW48L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM5
LTIwMzEgKEVsZWN0cm9uaWMpJiN4RDswMTkyLTA3OTAgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Np
b24tbnVtPjIxMDMwODc1PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5o
dHRwOi8vZ3JhcGhpY3MudHgub3ZpZC5jb20vb3ZmdHBkZnMvRlBERE5DRkJGQkVQSUcwMC9mczA0
Ny9vdmZ0L2xpdmUvZ3YwMzEvMDAwMDQ4MzYvMDAwMDQ4MzYtMjAxMTA1MDAwLTAwMDA5LnBkZjwv
dXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5
Ny9NQ0cuMGIwMTNlMzE4MWYzYTQ4YzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1k
YXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+
ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYWN5PC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48UmVj
TnVtPjI3NjwvUmVjTnVtPjxJRFRleHQ+NDI5LTM1PC9JRFRleHQ+PERpc3BsYXlUZXh0PihMYWN5
IGV0IGFsLiAyMDExKTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yNzY8L3JlYy1u
dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZkZmxkZHo1YWUy
eDAzNXJwMmZ6MjJzZXdydnIwd3IiPjI3Njwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBu
YW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3Jz
PjxhdXRob3I+TGFjeSwgQi4gRS48L2F1dGhvcj48YXV0aG9yPkR1a293aWN6LCBBLiBDLjwvYXV0
aG9yPjxhdXRob3I+Um9iZXJ0c29uLCBELiBKLjwvYXV0aG9yPjxhdXRob3I+V2Vpc3MsIEouIEUu
PC9hdXRob3I+PGF1dGhvcj5UZWl4ZWlyYSwgUC48L2F1dGhvcj48YXV0aG9yPktlbGxleSwgTS4g
TC4sIEpyLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlNl
Y3Rpb24gb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgRGFydG1vdXRoLUhpdGNo
Y29jayBNZWRpY2FsIENlbnRlciwgTGViYW5vbiwgTkggMDM3NTYsIFVTQS4gYnJpYW4ubGFjeUBo
aXRjaGNvY2sub3JnPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+Q2xpbmljYWwgdXRpbGl0
eSBvZiB0aGUgd2lyZWxlc3MgcEggY2Fwc3VsZTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIENs
aW4gR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Sm91cm5hbCBvZiBj
bGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+
PGZ1bGwtdGl0bGU+SiBDbGluIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3Vy
bmFsIG9mIGNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L3BlcmlvZGljYWw+PGFs
dC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQ2xpbiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxl
PjxhYmJyLTE+Sm91cm5hbCBvZiBjbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9h
bHQtcGVyaW9kaWNhbD48cGFnZXM+NDI5LTM1PC9wYWdlcz48dm9sdW1lPjQ1PC92b2x1bWU+PG51
bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxMC8xMC8zMDwvZWRpdGlvbj48a2V5d29yZHM+PGtl
eXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2Fwc3VsZSBFbmRvc2NvcHkvaW5zdHJ1bWVu
dGF0aW9uL21ldGhvZHMvIHV0aWxpemF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkNoZXN0IFBhaW4v
IGRpYWdub3Npcy9waHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29w
aGFnZWFsIHBIIE1vbml0b3JpbmcvIGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5G
ZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Np
cy9waHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IZWFsdGggQ2FyZSBT
dXJ2ZXlzPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5IeWRyb2dl
bi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3
b3JkPk1hbm9tZXRyeS9tZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3
b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+UXVlc3Rp
b25uYWlyZXM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHVi
LWRhdGVzPjxkYXRlPk1heS1KdW48L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTM5
LTIwMzEgKEVsZWN0cm9uaWMpJiN4RDswMTkyLTA3OTAgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Np
b24tbnVtPjIxMDMwODc1PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5o
dHRwOi8vZ3JhcGhpY3MudHgub3ZpZC5jb20vb3ZmdHBkZnMvRlBERE5DRkJGQkVQSUcwMC9mczA0
Ny9vdmZ0L2xpdmUvZ3YwMzEvMDAwMDQ4MzYvMDAwMDQ4MzYtMjAxMTA1MDAwLTAwMDA5LnBkZjwv
dXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5
Ny9NQ0cuMGIwMTNlMzE4MWYzYTQ4YzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1k
YXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+
ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA (Lacy et al. 2011) and 78.3% PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Eb21pbmd1ZXM8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFy
PjxSZWNOdW0+MjI2PC9SZWNOdW0+PElEVGV4dD4yNC05PC9JRFRleHQ+PERpc3BsYXlUZXh0PihE
b21pbmd1ZXMsIE1vcmFlcy1GaWxobyAmYW1wOyBEb21pbmd1ZXMgMjAxMSk8L0Rpc3BsYXlUZXh0
PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjI2PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBh
cHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4yMjY8
L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv
cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkRvbWluZ3VlcywgRy4gUi48
L2F1dGhvcj48YXV0aG9yPk1vcmFlcy1GaWxobywgSi4gUC48L2F1dGhvcj48YXV0aG9yPkRvbWlu
Z3VlcywgQS4gRy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVz
cz5MYWJvcmF0b3JpbyBkZSBNb3RpbGlkYWRlIERpZ2VzdGl2YSwgUmlvIGRlIEphbmVpcm8sIFJK
LCBCcmF6aWwuIGdlcnNvbmRvbWluZ3Vlc0BncmRnYXN0cm8uY29tLmJyPC9hdXRoLWFkZHJlc3M+
PHRpdGxlcz48dGl0bGU+SW1wYWN0IG9mIHByb2xvbmdlZCA0OC1oIHdpcmVsZXNzIGNhcHN1bGUg
ZXNvcGhhZ2VhbCBwSCBtb25pdG9yaW5nIG9uIGRpYWdub3NpcyBvZiBnYXN0cm9lc29waGFnZWFs
IHJlZmx1eCBkaXNlYXNlIGFuZCBldmFsdWF0aW9uIG9mIHRoZSByZWxhdGlvbnNoaXAgYmV0d2Vl
biBzeW1wdG9tcyBhbmQgcmVmbHV4IGVwaXNvZGVzPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFy
cSBHYXN0cm9lbnRlcm9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5BcnF1aXZvcyBkZSBn
YXN0cm9lbnRlcm9sb2dpYTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRp
dGxlPkFycSBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+QXJxdWl2b3MgZGUgZ2Fz
dHJvZW50ZXJvbG9naWE8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPkFycSBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+QXJxdWl2b3MgZGUg
Z2FzdHJvZW50ZXJvbG9naWE8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4yNC05PC9w
YWdlcz48dm9sdW1lPjQ4PC92b2x1bWU+PG51bWJlcj4xPC9udW1iZXI+PGVkaXRpb24+MjAxMS8w
NS8wNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5
d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQs
IDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkNhcHN1bGUgRW5kb3Njb3B5L2FkdmVyc2Ug
ZWZmZWN0cy8gaW5zdHJ1bWVudGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhh
Z2VhbCBwSCBNb25pdG9yaW5nL2FkdmVyc2UgZWZmZWN0cy8gaW5zdHJ1bWVudGF0aW9uPC9rZXl3
b3JkPjxrZXl3b3JkPkVzb3BoYWdvc2NvcHkvYWR2ZXJzZSBlZmZlY3RzLyBpbnN0cnVtZW50YXRp
b24vbWV0aG9kczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2Fz
dHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8
L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5
d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5L2FkdmVyc2UgZWZmZWN0cy8gaW5z
dHJ1bWVudGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UmV0cm9zcGVjdGl2ZSBTdHVk
aWVzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTE8L3llYXI+PHB1Yi1kYXRl
cz48ZGF0ZT5KYW4tTWFyPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTY3OC00MjE5
IChFbGVjdHJvbmljKSYjeEQ7MDAwNC0yODAzIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51
bT4yMTUzNzUzODwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDov
L3d3dy5zY2llbG8uYnIvcGRmL2FnL3Y0OG4xL2EwNnY0OG4xLnBkZjwvdXJsPjwvcmVsYXRlZC11
cmxzPjwvdXJscz48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNl
LXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5v
dGU+AG==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Eb21pbmd1ZXM8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFy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ADDIN EN.CITE.DATA (Domingues, Moraes-Filho & Domingues 2011), although none are in a population that exactly matches that defined in the model. For the purposes of the model, the prevalence of acid-related GORD is estimated to be 40% of the endoscopy-negative population for monitoring. This estimate is broadly consistent (within 10%) with numerous studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BeWF6aTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BeWF6aTwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+PFJl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 EN.CITE.DATA (Ayazi et al. 2009, 2011; Bhat, McGrath & Bielefeldt 2006; Grigolon et al. 2011; Scarpulla et al. 2007) and also with a study in a similarly defined population that used pH manometry as an alternative diagnostic test ADDIN EN.CITE <EndNote><Cite><Author>Broeders</Author><Year>2010</Year><RecNum>51</RecNum><DisplayText>(Broeders et al. 2010)</DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Broeders, J. A.</author><author>Draaisma, W. A.</author><author>Bredenoord, A. J.</author><author>Smout, A. J.</author><author>Broeders, I. A.</author><author>Gooszen, H. G.</author></authors></contributors><titles><title>Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease</title><secondary-title>British Journal of Surgery</secondary-title></titles><periodical><full-title>British Journal of Surgery</full-title></periodical><pages>845-852</pages><volume>97</volume><number>6</number><dates><year>2010</year></dates><publisher>John Wiley & Sons, Ltd.</publisher><isbn>1365-2168</isbn><urls><related-urls><url>;(Broeders et al. 2010). The systematic review results presented earlier identified that where comparative evidence was available between 48-hour wireless monitoring and 24-hour catheter-based monitoring, a (median) additional yield of 7.8% was associated with the longer duration of the wireless test (see REF _Ref362339424 \h \* MERGEFORMAT Table 34). Clinical opinion supports the assumption that the additional yield is accurate and represents true positive patients. However, given that this cannot be verified with an alternative reference standard, it is only incorporated into a supplementary analyses for model 2 (see below). The test is assumed to have a failure rate of 7.5%, based on the median technical failure rate reported in ‘Is it effective – REF _Ref379441632 \h \* MERGEFORMAT Technical efficacy’.Test accuracy The systematic review presents varying results to describe test accuracy, depending on the reference standard, pH cut-off used and duration of monitoring. Given the heterogeneity of the test accuracy studies, a meta-analysis was not considered appropriate. Although the DAP specifies that 24-hour catheter-based monitoring should be considered as the reference standard, the repeated and clinically accepted finding of an increased yield of accurate positive results from the wireless pH-monitoring studies run over 48?hours (see ‘ REF _Ref379442554 \h \* MERGEFORMAT Results of assessment’) does not support the use of catheter-based monitoring as a perfect reference standard.In the economic models the base-case analysis assumes perfect accuracy (i.e. 100% sensitivity and specificity) associated with wireless pH monitoring, given the lack of a reliable reference standard. However, supplementary exploratory analyses were also undertaken:(for models 1 and 2) using test accuracy data where catheter-based monitoring is considered the reference standard. The highest quality study available (level II diagnostic evidence) indicated that, against this reference, the catheter-free test, with a cut-off point of 4.4% of the time that pH <4, had a sensitivity of 86.4% and specificity of 77.8% (see ‘ REF _Ref379442724 \h Is it accurate?’) (for model 2) assuming that catheter-free monitoring is 100% accurate, but the sensitivity of catheter-based monitoring is 80.5% and the specificity 100%. This assumes that catheter-free monitoring has better test performance than catheter-based monitoring, based on the 7.8% increased diagnostic yield (accepted to be true positives) associated with 48-hour catheter-free monitoring over catheter-based monitoring, i.e. subtracting the 7.8% additional yield from the diagnostic yield, to assume that 24-hour catheter-based monitoring would only identify 32.2% (rather than 40%) of patients as pH positive. Implications for true (and false) positive and negative test resultsWhere patients are positively diagnosed with acid-positive NERD, either medical or surgical management options may be appropriate—both strategies are considered to offer an acceptable level of symptom resolution. Numerous clinical comparisons and cost-effectiveness analyses have been published in the literature, from varying perspectives and with varying findings, such that it would be beyond the scope of this report to conclusively determine a single ‘preferred’ treatment route. The model assumes that both treatment options result in an 89% success rate with respect to providing satisfactory symptom management. This effectiveness rate for surgery is supported in the literature ADDIN EN.CITE <EndNote><Cite><Author>Beck</Author><Year>2009</Year><RecNum>57</RecNum><DisplayText>(Beck et al. 2009)</DisplayText><record><rec-number>57</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">57</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Beck, P. E.</author><author>Watson, D. I.</author><author>Devitt, P. G.</author><author>Game, P. A.</author><author>Jamieson, G. G.</author></authors></contributors><auth-address>Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia.</auth-address><titles><title>Impact of gender and age on the long-term outcome of laparoscopic fundoplication</title><secondary-title>World J Surg</secondary-title><alt-title>World journal of surgery</alt-title></titles><periodical><full-title>World J Surg</full-title><abbr-1>World journal of surgery</abbr-1></periodical><alt-periodical><full-title>World J Surg</full-title><abbr-1>World journal of surgery</abbr-1></alt-periodical><pages>2620-6</pages><volume>33</volume><number>12</number><edition>2009/09/23</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Female</keyword><keyword>Fundoplication/ methods</keyword><keyword>Gastroesophageal Reflux/ surgery</keyword><keyword>Humans</keyword><keyword>Laparoscopy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Sex Factors</keyword><keyword>Treatment Outcome</keyword><keyword>Young Adult</keyword></keywords><dates><year>2009</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1432-2323 (Electronic)
0364-2313 (Linking)</isbn><accession-num>19771470</accession-num><urls></urls><electronic-resource-num>10.1007/s00268-009-0216-y</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(Beck et al. 2009; ADDIN EN.CITE <EndNote><Cite><Author>Broeders</Author><Year>2010</Year><RecNum>51</RecNum><DisplayText>(Broeders et al. 2010)</DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Broeders, J. A.</author><author>Draaisma, W. A.</author><author>Bredenoord, A. J.</author><author>Smout, A. J.</author><author>Broeders, I. A.</author><author>Gooszen, H. G.</author></authors></contributors><titles><title>Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease</title><secondary-title>British Journal of Surgery</secondary-title></titles><periodical><full-title>British Journal of Surgery</full-title></periodical><pages>845-852</pages><volume>97</volume><number>6</number><dates><year>2010</year></dates><publisher>John Wiley & Sons, Ltd.</publisher><isbn>1365-2168</isbn><urls><related-urls><url> et al. 2010), and it may be considered a conservative assumption that appropriate medical management is equally effective, although of some inconvenience given the requirement for regular medication. This is broadly consistent with the findings of the REFLUX trial, which found similar but marginally higher QoL outcome scores in patients assigned to surgical management over medical management ADDIN EN.CITE <EndNote><Cite><Author>Grant</Author><Year>2013</Year><RecNum>692</RecNum><IDText>1-167</IDText><DisplayText>(Grant, AM, Boachie, et al. 2013)</DisplayText><record><rec-number>692</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">692</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grant, A. M.</author><author>Boachie, C.</author><author>Cotton, S. C.</author><author>Faria, R.</author><author>Bojke, L.</author><author>Epstein, D. M.</author><author>Ramsay, C. R.</author><author>Corbacho, B.</author><author>Sculpher, M.</author><author>Krukowski, Z. H.</author><author>Heading, R. C.</author><author>Campbell, M. K.</author></authors></contributors><auth-address>Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, UK. a.grant@abdn.ac.uk</auth-address><titles><title>Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial)</title><secondary-title>Health Technol Assess</secondary-title><alt-title>Health technology assessment (Winchester, England)</alt-title></titles><periodical><full-title>Health Technol Assess</full-title><abbr-1>Health technology assessment (Winchester, England)</abbr-1></periodical><alt-periodical><full-title>Health Technol Assess</full-title><abbr-1>Health technology assessment (Winchester, England)</abbr-1></alt-periodical><pages>1-167</pages><volume>17</volume><number>22</number><edition>2013/06/08</edition><dates><year>2013</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>2046-4924 (Electronic)
1366-5278 (Linking)</isbn><accession-num>23742987</accession-num><urls></urls><electronic-resource-num>10.3310/hta17220</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(Grant, Boachie et al. 2013).In the base-case, medical management of confirmed acid reflux (e.g. a positive pH-monitoring test) is assumed to consist of high-dose (twice daily) PPIs and a once-daily H2 antagonist (i.e. ranitidine). The assumption that medical treatment is successful in refractory patients appears contradictory—it is contingent on the assumption that the initial patient population has been selected using a ‘loose’ definition of ‘refractory’. But this is consistent with the literature, which reports that while many GORD patients are labelled ‘refractory’ to standard doses of PPIs, many respond to twice-daily PPIs, and in rare cases (e.g. fast metabolisers) response rates can be achieved with even high doses and/or combinations with additional products (e.g. H2 antagonists, antacids). Nor it is uncommon that medication is not taken in an optimal dosing manner. If this is investigated and addressed, cases previously considered refractory may also have satisfactory medical treatment results PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdW5hcmF0bmFtPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HdW5hcmF0bmFtPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE.DATA (Fass 2009; HYPERLINK \l "_ENREF_56" \o "Gunaratnam, 2006 #63" Gunaratnam et al. 2006; PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GYXNzPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GYXNzPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA Scarpignato 2012). Thus, it would appear that many supposedly ‘refractory’ patients can have successful medical treatment following a confirmation of their diagnosis.The implications associated with test results for patients in the model are depicted in REF _Ref371672909 \h \* MERGEFORMAT Table 39 and REF _Ref379458464 \h \* MERGEFORMAT Table 40.Table 39Implications for true positive and true negative test results for patients in the economic evaluation (base-case)True health statepH-monitoring test resultImplicationsNERD due to acidic reflux (positive)Positive(true)Option of medical management (ongoing high-dose PPIs +/– an H2 antagonist) or surgical managementSymptoms not due to acid reflux (e.g. FH, HO, OeO ) (negative)Negative(true)Alternative diagnoses investigated and successfully treated, as specified in the DAP NERD = non-erosive reflux disease; PPIs = proton pump inhibitors, H2 = histamine 2 (receptor); FH = functional heartburn; HO = hypersensitive oesophagus; OeO = oesinophilic oesophagitisTable 40Additional implications for false positive and false negative patients in the supplementary economic evaluationTrue health statepH-monitoring test resultImplicationsNERD due to acidic reflux (positive)Negative(false)Alternative diagnoses investigated and other treatments trialled Alternative treatment is assumed to be 0% effective in patients incorrectly identified to have an alternative diagnosisSymptoms not due to acid reflux (e.g. FH, HO, OeO) (negative)Positive(false)Option of medical management (ongoing high-dose PPIs +/– an H2 antagonist) or surgical managementGORD treatment is assumed to be 0% effective in patients incorrectly identified to be acid-symptom positive patientsNERD = non-erosive reflux disease; PPIs = proton pump inhibitors, H2 = histamine 2 (receptor); FH = functional heartburn; HO = hypersensitive oesophagus; OeO = oesinophilic oesophagitisTest or treatment uptake ratesCatheter-free monitoring uptake The model assumes that patients who do not wish to undertake wireless monitoring will not participate or be charged for it and, as such, they are not relevant or included in the cost-effectiveness model. Therefore, for the purposes of assessing cost-effectiveness, it is assumed that all patients in the intervention arm initially take up wireless monitoring. However, there is a technical failure rate of 7.5% (see ‘ REF _Ref379441632 \h \* MERGEFORMAT Technical efficacy’) and therefore some patients will not get a meaningful test result. The model assumes that half of the patients who experience a technical failure will re-attempt the test and subsequently get a result, and half will not re-attempt the test. This ratio is arbitrary and tested in the sensitivity analyses.Medication uptake The model assumes that where medical management is the selected treatment, patients adhere to recommended treatment regimens and purchase medication accordingly. This applies to situations both where medication is prescribed for suspected or confirmed GORD and where other medications are prescribed for a non-GORD diagnosis (see ‘Healthcare resources’ below for a description of assumed medication regimens). Strictly speaking, this assumption may overestimate medication usage but, given that patients are by definition symptomatic and apparently seeking relief, it would seem reasonable. Surgery uptake Based on the literature regarding fundoplication surgery for reflux, it is considered that this surgery is only appropriate for patients who have a positive pH-monitoring test result. The estimate that 25% of patients who have a positive result have subsequent surgery is based on a calibration of the estimated diagnostic yield (40%), with available Medicare data indicating that in Australia 10% of patients who undergo pH monitoring have subsequent surgeries.Surgery revision (re-operation) Medicare Australia data showed that 10% of fundoplication surgery was revised. This rate is incorporated into the model as the rate of uptake of repeat surgery. This re-operation rate is consistent with many literature reports (PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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ADDIN EN.CITE.DATA Beck et al. 2009; Grant et al. 2008: 11.3%; ADDIN EN.CITE <EndNote><Cite><Author>Broeders</Author><Year>2010</Year><RecNum>51</RecNum><DisplayText>(Broeders et al. 2010)</DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Broeders, J. A.</author><author>Draaisma, W. A.</author><author>Bredenoord, A. J.</author><author>Smout, A. J.</author><author>Broeders, I. A.</author><author>Gooszen, H. G.</author></authors></contributors><titles><title>Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease</title><secondary-title>British Journal of Surgery</secondary-title></titles><periodical><full-title>British Journal of Surgery</full-title></periodical><pages>845-852</pages><volume>97</volume><number>6</number><dates><year>2010</year></dates><publisher>John Wiley & Sons, Ltd.</publisher><isbn>1365-2168</isbn><urls><related-urls><url> et al. 2010: 13.6%). Lower rates, as claimed in some publications ( ADDIN EN.CITE <EndNote><Cite><Author>Anvari</Author><Year>2011</Year><RecNum>669</RecNum><IDText>2547-2554</IDText><DisplayText>(Anvari et al. 2011)</DisplayText><record><rec-number>669</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">669</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Anvari, Mehran</author><author>Allen, Christopher</author><author>Marshall, John</author><author>Armstrong, David</author><author>Goeree, Ron</author><author>Ungar, Wendy</author><author>Goldsmith, Charles</author></authors></contributors><titles><title>A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes</title><secondary-title>Surgical Endoscopy</secondary-title><alt-title>Surg Endosc</alt-title></titles><periodical><full-title>Surg Endosc</full-title><abbr-1>Surgical endoscopy</abbr-1></periodical><alt-periodical><full-title>Surg Endosc</full-title><abbr-1>Surgical endoscopy</abbr-1></alt-periodical><pages>2547-2554</pages><volume>25</volume><number>8</number><keywords><keyword>Gastroesophageal reflux disease</keyword><keyword>GERD</keyword><keyword>Laparoscopic antireflux surgery</keyword><keyword>Laparoscopic Nissen fundoplication</keyword><keyword>Medical therapy</keyword><keyword>Proton pump inhibitors</keyword></keywords><dates><year>2011</year><pub-dates><date>2011/08/01</date></pub-dates></dates><publisher>Springer-Verlag</publisher><isbn>0930-2794</isbn><urls><related-urls><url> et al. 2011: 7.8%; ADDIN EN.CITE <EndNote><Cite><Author>Mahon</Author><Year>2005</Year><RecNum>64</RecNum><IDText>695-699</IDText><DisplayText>(Mahon et al. 2005)</DisplayText><record><rec-number>64</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">64</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mahon, D.</author><author>Rhodes, M.</author><author>Decadt, B.</author><author>Hindmarsh, A.</author><author>Lowndes, R.</author><author>Beckingham, I.</author><author>Koo, B.</author><author>Newcombe, R. G.</author></authors></contributors><titles><title>Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux</title><secondary-title>British Journal of Surgery</secondary-title></titles><periodical><full-title>British Journal of Surgery</full-title></periodical><pages>695-699</pages><volume>92</volume><number>6</number><dates><year>2005</year></dates><publisher>John Wiley & Sons, Ltd.</publisher><isbn>1365-2168</isbn><urls><related-urls><url> et al. 2005: 3.7%; REFLUX trial PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant, Cotton et al. 2013): 4.5%) are tested in a sensitivity analysis.Investigations/treatment for alternative diagnosis It is unknown what proportion of patients remain symptomatic while on PPIs and then, on returning to the doctor, further diagnostic investigations or alternative medications are prescribed. The literature suggests that many patients prescribed PPIs do not have follow-up re-evaluation, and ongoing inappropriate use of PPIs is continued PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZWlkZWxiYXVnaDwvQXV0aG9yPjxZZWFyPjIwMTA8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IZWlkZWxiYXVnaDwvQXV0aG9yPjxZZWFyPjIwMTA8L1ll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ADDIN EN.CITE.DATA (Heidelbaugh, Goldberg & Inadomi 2010; Heidelbaugh et al. 2012). The assumption that many patients remain on PPIs rather than have alternative diagnoses investigated is supported by HESP clinical opinion. There is little evidence to quantify the extent of this occurrence. Considering that the patient group is already those seeking attention for refractory symptoms, and specialists are involved, a conservative estimate that only 10% of patients will not be reassessed and will continue high-dose PPIs indefinitely was applied in the economic models’ base-case for the purposes of the assessment—i.e. 90% of patients that are non-responsive to high-dose PPIs will not continue medication and be prescribed alternative treatments. This assumption is tested in a sensitivity analysis.Clinical outcomesTreatment outcomesTable 41 summarises the treatment outcomes associated with the treatment pathways in the model. For the purpose of modelling QALYs, effectiveness refers to the extent that the different treatments result in patients being free of, or satisfactorily managed for, the GORD or GORD-like symptoms for which they initially sought diagnosis and treatment.Table 41Health outcomes associated with treatment pathways in the modelManagement strategyEffectiveness rateSourceSurgical management (fundoplication) in acid-related NERD89%(range tested:50%–100%)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWNrPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWNrPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA (Beck et al. 2009; Broeders et al. 2010; Grant, Cotton et al. 2013)Medical management (high-dose PPIs and H2 antagonists) in acid-related NERD89%(range tested:50%–100%)Conservatively assumed equivalent to surgery and broadly consistent with the REFLUX trial PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant, Cotton et al. 2013)Medical management: treatment for alternative diagnosis (non–acid related symptoms)100%DAP specified—assumedMedical management (high-dose PPIs and H2 antagonists) or surgical management (fundoplication) in symptomatic medical conditions that are NOT due to acid-reflux(i.e. applied in scenario of false positive test result)0%Assumed Medical management: using treatment for alternative diagnoses (non–acid related conditions) for symptoms of true acid-related NERD(i.e. applied in scenario of false negative test result)0%Assumed PPIs = proton pump inhibitors; H2 = histamine 2 (receptor); NERD = non-erosive reflux diseaseMortalityA low rate of mortality directly due to fundoplication surgery is incorporated into the model. This rate is estimated at 5 deaths per 10,000 patients (0.05%), based on the REFLUX trial, chapter III PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl
Y051bT4xPC9SZWNOdW0+PElEVGV4dD4xLTE4MSwgaWlpLWl2PC9JRFRleHQ+PERpc3BsYXlUZXh0
PihHcmFudCwgQSBldCBhbC4gMjAwOCk8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+
MTwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Ind6eHJ0YTUw
ZDl4ZXNwZXhmYTZ2cjlzbXhyZmR2czIwZnQ5OSI+MTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYt
dHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxh
dXRob3JzPjxhdXRob3I+R3JhbnQsIEEuPC9hdXRob3I+PGF1dGhvcj5XaWxlbWFuLCBTLjwvYXV0
aG9yPjxhdXRob3I+UmFtc2F5LCBDLjwvYXV0aG9yPjxhdXRob3I+Qm9qa2UsIEwuPC9hdXRob3I+
PGF1dGhvcj5FcHN0ZWluLCBELjwvYXV0aG9yPjxhdXRob3I+U2N1bHBoZXIsIE0uPC9hdXRob3I+
PGF1dGhvcj5NYWNyYW4sIFMuPC9hdXRob3I+PGF1dGhvcj5LaWxvbnpvLCBNLjwvYXV0aG9yPjxh
dXRob3I+VmFsZSwgTC48L2F1dGhvcj48YXV0aG9yPkZyYW5jaXMsIEouPC9hdXRob3I+PGF1dGhv
cj5Nb3dhdCwgQS48L2F1dGhvcj48YXV0aG9yPktydWtvd3NraSwgWi48L2F1dGhvcj48YXV0aG9y
PkhlYWRpbmcsIFIuPC9hdXRob3I+PGF1dGhvcj5UaHVyc3osIE0uPC9hdXRob3I+PGF1dGhvcj5S
dXNzZWxsLCBJLjwvYXV0aG9yPjxhdXRob3I+Q2FtcGJlbGwsIE0uPC9hdXRob3I+PC9hdXRob3Jz
PjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+SGVhbHRoIFNlcnZpY2VzIFJlc2VhcmNoIFVu
aXQsIFVuaXZlcnNpdHkgb2YgQWJlcmRlZW4sIFVLLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRp
dGxlPlRoZSBlZmZlY3RpdmVuZXNzIGFuZCBjb3N0LWVmZmVjdGl2ZW5lc3Mgb2YgbWluaW1hbCBh
Y2Nlc3Mgc3VyZ2VyeSBhbW9uZ3N0IHBlb3BsZSB3aXRoIGdhc3Ryby1vZXNvcGhhZ2VhbCByZWZs
dXggZGlzZWFzZSAtIGEgVUsgY29sbGFib3JhdGl2ZSBzdHVkeS4gVGhlIFJFRkxVWCB0cmlhbDwv
dGl0bGU+PHNlY29uZGFyeS10aXRsZT5IZWFsdGggVGVjaG5vbCBBc3Nlc3M8L3NlY29uZGFyeS10
aXRsZT48YWx0LXRpdGxlPkhlYWx0aCB0ZWNobm9sb2d5IGFzc2Vzc21lbnQgKFdpbmNoZXN0ZXIs
IEVuZ2xhbmQpPC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SGVh
bHRoIFRlY2hub2wgQXNzZXNzPC9mdWxsLXRpdGxlPjxhYmJyLTE+SGVhbHRoIHRlY2hub2xvZ3kg
YXNzZXNzbWVudCAoV2luY2hlc3RlciwgRW5nbGFuZCk8L2FiYnItMT48L3BlcmlvZGljYWw+PGFs
dC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkhlYWx0aCBUZWNobm9sIEFzc2VzczwvZnVsbC10aXRs
ZT48YWJici0xPkhlYWx0aCB0ZWNobm9sb2d5IGFzc2Vzc21lbnQgKFdpbmNoZXN0ZXIsIEVuZ2xh
bmQpPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MS0xODEsIGlpaS1pdjwvcGFnZXM+
PHZvbHVtZT4xMjwvdm9sdW1lPjxudW1iZXI+MzE8L251bWJlcj48ZWRpdGlvbj4yMDA4LzA5LzE4
PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5Db3N0
LUJlbmVmaXQgQW5hbHlzaXM8L2tleXdvcmQ+PGtleXdvcmQ+RmFjdG9yIEFuYWx5c2lzLCBTdGF0
aXN0aWNhbDwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+RnVuZG9w
bGljYXRpb24vIG1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZs
dXgvIGRydWcgdGhlcmFweS8gc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9pbnRlc3Rp
bmFsIEFnZW50cy8gZWNvbm9taWNzLyB0aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+
SGVhbHRoIFJlc291cmNlcy91dGlsaXphdGlvbjwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl
eXdvcmQ+PGtleXdvcmQ+TGFwYXJvc2NvcHkvIGVjb25vbWljczwva2V5d29yZD48a2V5d29yZD5N
YWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk1vZGVs
cywgRWNvbm9tZXRyaWM8L2tleXdvcmQ+PGtleXdvcmQ+UXVhbGl0eSBvZiBMaWZlPC9rZXl3b3Jk
PjxrZXl3b3JkPlF1YWxpdHktQWRqdXN0ZWQgTGlmZSBZZWFyczwva2V5d29yZD48a2V5d29yZD5R
dWVzdGlvbm5haXJlczwva2V5d29yZD48a2V5d29yZD5TdXJnaWNhbCBQcm9jZWR1cmVzLCBNaW5p
bWFsbHkgSW52YXNpdmUvIGVjb25vbWljczwva2V5d29yZD48a2V5d29yZD5UZWNobm9sb2d5IEFz
c2Vzc21lbnQsIEJpb21lZGljYWw8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8
L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwODwveWVhcj48cHViLWRhdGVzPjxk
YXRlPlNlcDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjIwNDYtNDkyNCAoRWxlY3Ry
b25pYykmI3hEOzEzNjYtNTI3OCAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTg3OTYy
NjM8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+
TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9y
ZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant et al. 2008). Although described as a rate/patient, this rate is assumed to be derived from patient episodes, and therefore the event of an additional revision surgery is assumed to carry additional mortality risk. The same mortality rate is applied to surgery revision (10% of patients), such that the overall surgical mortality risk is 0.055% per patient. Some models do not include a surgical mortality rate at all (implicitly 0% rate), but Epstein et al. (2009) apply a rate of 4/3,397 (0.118%). These alternative estimates are tested as upper and lower limits in the sensitivity analysis.A background mortality rate is applied equally to all patients in each year of the model. This is a time-dependent transition probability, derived from the Australian Bureau of Statistics general Australian population mortality rates, in a 40%:60% male:female ratio, beginning at age 55?years and advancing 1?year of age with each year of the model.Healthcare resourcesHealthcare resources are included at the full MBS or Pharmaceutical Benefits Scheme (PBS) fee, i.e. including standard minimum patient co-payments, on the grounds that the patient and any mandatory co-payment are part of the societal healthcare system and the full fee is the accepted ‘resource cost’. Additional out-of-pocket patient contributions above the published MBS fee are not included in the economic model; these are regarded as privately negotiated arrangements that are external to the healthcare system. Consideration of the impact of the listing of catheter-free pH monitoring on government costs (i.e. excluding patient co-payments) and total costs (i.e. including patient co-payment and gap costs) is considered in the financial analysis (see ‘ REF _Ref379447679 \h \* MERGEFORMAT Financial and costing impact’). The modelled healthcare resource use and costs are presented in REF _Ref371349711 \h \* MERGEFORMAT Table 42.Table 42Testing-related healthcare resources used in the economic model Type of resource itemUnit costComponents/source of unit cost ApplicationWireless pH monitoring (one test)$1,682Proposed fee $913.64PlusAnaesthesia: (MBS items 17610; $43, 20740; $99, 23010; $19.80)Facility fee: (AR-DRG Z40Z) same day: $607All patients receiving test, plus repeated cost in % of patients with initial test failure who elect to repeat test.Regular-dose PPIs(per monthly prescription)$27.66Weighted average DPMQ of omeprazole 20mg, esomeprazole 20mg, esomeprazole 40mg and pantoprazole 40mg (based on Medicare usage data 2012–13)Assumed regimen of patients entering the model. In the intervention arm, this regimen is maintained during the first 2?months while pH monitoring is carried out and before future treatment decisions are made on the basis of the test resultsHigh-dose PPIs(per monthly prescription)$48.69Twice the DPMQ of the average normal dose (weighted combination of omeprazole, esomeprazole and pantoprazole—as above—less 1x pharmacist dispensing fee)Assumed to be used as medical management strategy: (i) as empirical treatment in comparator arm, and(ii) in all patients diagnosed after pH monitoring as having an acid-related conditionLow-dose or intermittent-use PPIs(per monthly prescription)$9.22One-third of the cost of daily PPIs, on the basis that only one-third of patients require daily medication after surgery.Following successful fundoplication surgery (no ongoing symptoms), an ongoing medication cost is still assumedTreatment of alternative diagnosis(per monthly prescription(s))$47.27Average (unweighted) DPMQ cost of treatments reported as potentially used for alternative diagnoses (baclofen, TCA, SSRI, metoclopramide, domperidone etc.): $19.61, plus assumed to be taken with low-dose PPI: $27.66 = monthly drug costs: $47.27Assumed to be used as management strategy in all patients considered to have a condition that is not acid-related (i.e. after negative pH monitoring and in a proportion of patients who fail high-dose PPIs and have reassessment.)Fundoplication surgery(total costs per episode of surgery)$6,583$7,106(in 10% patients)Initial:Surgery MBS items – 119: $43, 31464: $871, 51303: $174Anaesthesia (~2?h?30?min) MBS items – 17610: $43, 20706: $138.60, 23111: $218Facility fee (AR-DRG G03C) ALOS 2.7?days: $5,138Revision:Surgery MBS items – 119: $43, 31466: $1,307, 51303: $261Anaesthesia (~2?h?30?min) MBS items – 17610: $43, 20706: $138.60, 23111: $218Facility fee (AR-DRG G03C) ALOS 2.7?days: $5,138Assumed to be used as the surgical management strategy in patients who choose this management strategy after they have been diagnosed as having an acid-related condition, confirmed with pH monitoring.Catheter-based monitoring(one test)$174.45MBS item 11810 (includes results)All patients receiving test, plus repeated cost in % of patients with initial test failure who elect to repeat test.DPMQ = Dispensed price maximum quantity (for PBS prescription); PBS = Pharmaceutical Benefits Scheme; PPI = proton pump inhibitor; TCA = tricyclic antidepressant; SSRI = selective serotonin reuptake inhibitor; ALOS = average length of stayUtility valuesAt all times, regardless of the specific management, the economic model assumes that patients are in one of three health utility states:experiencing GORD or GORD-like symptoms, i.e. unsuccessfully treated;free of GORD or GORD-like symptoms, i.e. successfully treated; ordead.The utility weights associated with the health states and the sources of these utilities are presented in REF _Ref379456865 \h \* MERGEFORMAT Table 43.Table 43Health state utilities used in the economic evaluationHealth stateUtility weightSourceUnsatisfactorily managed (normal medication refractory) NERD (or apparent NERD)0.56Baseline in REFLUX trial (0.72) less decrement for symptoms in Heudebert et al. ADDIN EN.CITE <EndNote><Cite><Author>Heudebert</Author><Year>1997</Year><RecNum>694</RecNum><IDText>1078-86</IDText><DisplayText>(Heudebert et al. 1997)</DisplayText><record><rec-number>694</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">694</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Heudebert, G. R.</author><author>Marks, R.</author><author>Wilcox, C. M.</author><author>Centor, R. M.</author></authors></contributors><auth-address>Department of Medicine, Birmingham Veterans Administration Medical Center, and University of Alabama at Birmingham, 35294-3296, USA. gheudebert@gim.dom.uab.edu</auth-address><titles><title>Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis</title><secondary-title>Gastroenterology</secondary-title><alt-title>Gastroenterology</alt-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><alt-periodical><full-title>Gastroenterology</full-title></alt-periodical><pages>1078-86</pages><volume>112</volume><number>4</number><edition>1997/04/01</edition><keywords><keyword>Adult</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Esophagitis/ drug therapy/ surgery</keyword><keyword>Fundoplication</keyword><keyword>Health Care Costs</keyword><keyword>Humans</keyword><keyword>Markov Chains</keyword><keyword>Middle Aged</keyword><keyword>Monte Carlo Method</keyword><keyword>Omeprazole/ therapeutic use</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>1997</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0016-5085 (Print)
0016-5085 (Linking)</isbn><accession-num>9097989</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(1997) (0.18) Approach as per ADDIN EN.CITE <EndNote><Cite><Author>Bojke</Author><Year>2007</Year><RecNum>674</RecNum><IDText>829-41</IDText><DisplayText>(Bojke, Hornby & Sculpher 2007)</DisplayText><record><rec-number>674</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">674</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bojke, L.</author><author>Hornby, E.</author><author>Sculpher, M.</author></authors></contributors><auth-address>Centre for Health Economics, University of York, York, UK. lg116@york.ac.uk</auth-address><titles><title>A comparison of the cost effectiveness of pharmacotherapy or surgery (laparoscopic fundoplication) in the treatment of GORD</title><secondary-title>Pharmacoeconomics</secondary-title><alt-title>PharmacoEconomics</alt-title></titles><periodical><full-title>Pharmacoeconomics</full-title><abbr-1>PharmacoEconomics</abbr-1></periodical><alt-periodical><full-title>Pharmacoeconomics</full-title><abbr-1>PharmacoEconomics</abbr-1></alt-periodical><pages>829-41</pages><volume>25</volume><number>10</number><edition>2007/09/25</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Cost-Benefit Analysis</keyword><keyword>Drug Therapy/ economics</keyword><keyword>Fundoplication/ economics</keyword><keyword>Gastroesophageal Reflux/ drug therapy/economics/ surgery</keyword><keyword>Great Britain</keyword><keyword>Health Care Costs/statistics & numerical data</keyword><keyword>Humans</keyword><keyword>Laparoscopy/economics</keyword><keyword>Markov Chains</keyword><keyword>Middle Aged</keyword><keyword>Models, Statistical</keyword><keyword>Quality-Adjusted Life Years</keyword><keyword>Software</keyword></keywords><dates><year>2007</year></dates><isbn>1170-7690 (Print)
1170-7690 (Linking)</isbn><accession-num>17887805</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>Bojke, Hornby & Sculpher (2007)Satisfactorily managed NERD (or apparent NERD)0.78 (2)REFLUX trial post-surgery (average 2–5?years) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmFudDwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Grant, Cotton et al. 2013)Death0AssumedHowever, depending on the treatment pathway a patient follows, utility adjustments (decrements) are applied to account for the side effects or encumbrances relating to GORD treatment. These are described in REF _Ref379456894 \h \* MERGEFORMAT Table 44.Table 44Utility adjustments used in the economic evaluationTreatment eventUtility weightSource(s)ApplicationSurgery—acute inconvenience–0.5 (decrement) for 2?weeks/surgery= a –0.02 QALY (decrement/episode of surgery)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db21heTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db21heTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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ADDIN EN.CITE.DATA Comay et al. (2008; Heudebert et al. (1997)Given that each patient is assigned 1.1 episodes of surgery, to account for the 10% revision rate, each patient undergoing surgery acquires a decrement of –0.022 QALYs to account for the decreased utility associated with revision surgeriesDaily medication decrement–0.01 (decrement each year on medication)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcmd1ZWRhczwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bcmd1ZWRhczwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+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=
ADDIN EN.CITE.DATA Arguedas et al. (2004; Comay et al. (2008)Applied to all patients without GORD symptoms but requiring ongoing medication to maintain symptom relief, to account for inconvenience of regular medication requirement It is noted that this value is less than the difference between post-surgery and medical management groups in REFLUX (Grant, Cotton et al. 2013); therefore, this may be considered a conservative estimate.QALY = quality-adjusted life yearsIt is assumed that:all patients with refractory NERD and refractory NERD-like symptoms have the same utility weight while symptomatic, i.e. when entering the model or during the model if they are unsuccessfully treated. Likewise, all successfully treated patients, either true NERD or those with an alternative diagnosis, have the same symptom-free utility weightall symptomatic patients are taking medication, although without adequate effect, and that the disutility of medication is incorporated into the disutility associated with being symptomaticall patients with a negative pH-test result and/or diagnosis other than NERD will require other ongoing treatment for their alternative diagnosis. Outputs from the economic evaluationIncremental costs and effectivenessThe overall costs and outcomes, and incremental costs and outcomes, as calculated for the intervention and comparator in each model, with the base-case assumptions, are shown in Table 45 and Table 46.Table 45 Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERDCostIncremental costEffectiveness (QALYs)Incremental effectivenessICERIntervention$8,7057.874Comparator$6,927$1,7787.7510.123$14,457QALY = quality-adjusted life years; ICER = incremental cost-effectiveness ratioTable 46 Model 2: Cost-effectiveness of wireless pH monitoring vs catheter-based pH monitoring in patients with refractory NERDCostIncremental costEffectiveness (QALYs)Incremental effectivenessICERIntervention$8,7057.874Comparator$7,136$1,5697.878–0.004DominatedQALY = quality-adjusted life years; ICER = incremental cost-effectiveness ratioAlthough the base-case comparison of catheter-free (wireless) pH monitoring and catheter-based pH monitoring assumes equivalent efficacy, accuracy and subsequent treatment decisions following positive or negative test results, wireless pH monitoring results in fewer gains in health outcomes. This is due to the increased technical failure rate associated with wireless monitoring (7.5% vs 0.89%), and the subsequent increased number of ‘no result’ patients (50% of test failures) who revert to empirical treatment, i.e. the comparator in Model 1.Weighted combinations of models 1 and 2As neither Model 1 nor Model 2 are predicted to represent the actual patient market, the following analysis considers combinations of these models, which include all patients in the proposed listing combined with various extents of leakage into the existing catheter-based monitoring market. The relative sizes of these markets are discussed under ‘Background’ and ‘Financial and costing impact’, where it is estimated that the existing catheter-based market is approximately 10 times the proposed catheter-free market. Therefore, a 10% leakage of catheter-based-monitoring patients to catheter-free monitoring will result in a 50%:50% ratio of catheter-free patients representing Model 1 and 2. A summary of the cost-effectiveness of the intervention where this leakage occurs, and of further leakage scenarios is presented in REF _Ref379457712 \h \* MERGEFORMAT Table 47.Table 47 Societal ICERs following the proposed listing, allowing for various levels of leakage to include patients tolerant of catheter-based pH monitoring accessing wireless monitoringExtent of catheter-based monitoring leakage(% of catheter market) aWeighting of catheter-based aWeighting of ‘no test’Weighted costs bWeighted QALYs cICER d0%0%100%$6,9277.751$14,45710%50%50%$7,0327.815$28,12920%67%33%$7,0667.836$42,69430%75%25%$7,0847.846$58,42940%80%20%$7,0947.853$75,27850%83%17%$7,1017.857$93,43660%86%14%$7,1067.860$113,06170%88%13%$7,1107.862$134,33980%89%11%$7,1137.864$157,48790%90%10%$7,1157.865$182,764100%91%9%$7,1177.866$210,478aThe catheter-suitable market is estimated at 10x the size of the catheter-intolerant market; therefore, a 10% leakage in this market represents an equal number of patients to the intolerant market etc.bWeighted combination of comparator, catheter-based: 7.878 QALYs; and no pH monitoring: 7.751 QALYs cWeighted combination of comparator, catheter-based: $7,136; and no pH monitoring: $6,927 dIn all cases the ICER is calculated against the proposed intervention of 100% wireless monitoring, which, on average, has a cost of $8,705 and accrues 7.874 QALYs (per patient). The combination analysis above suggests that the cost-effectiveness of the proposed listing is highly dependent on limiting the leakage of use in patients who could otherwise tolerate catheter-based monitoring. If this leakage is relatively small (e.g. under 20%), the proposed listing is more likely to be considered cost-effective in typical Australian ICER interpretation, whereas if there is extensive leakage (e.g. greater than 50%), the proposed listing is unlikely to be considered cost-effective in broadly accepted terms.Scenario and sensitivity analysesMany variables in the models are uncertain, with estimates derived from mixed sources other than local Australian data, i.e. literature reports, expert opinion and arbitrary estimates; therefore, the impacts of these variables are examined in sensitivity analyses. The key sensitivity analyses relate to the accuracy of the wireless pH test, the extent that doctors will look for other diagnoses and discontinue high-dose PPIs in non-responders and the timeframe of the cost–utility analysis. Other variables and inputs are also tested.Sensitivity analyses in Model 1: Wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERDThe cost-effectiveness of wireless monitoring vs no monitoring is dependent on the accuracy, particularly the specificity, of the test ( REF _Ref379457727 \h \* MERGEFORMAT Table 48). Using the accuracy data estimated in the report, which is known to be imperfect given the imperfect reference standard (catheter-based monitoring) and inconsistent test result interpretation criteria, wireless monitoring is dominated by the comparator in the sensitivity analysis, thus producing fewer health outcomes at a higher cost. This is found in all analyses conducted where the test specificity of catheter-free monitoring is less than 95%. However, the cost-effectiveness of the wireless test hardly changes, relative to the base-case, when the sensitivity of the test is reduced to 86% as long as 100% specificity is maintained.Table 48Sensitivity analyses around wireless pH-test accuracy for Model 1Catheter-free test:Cost ($)Catheter-free test:Outcomes (QALYs)No pH test:Cost ($)No pH test:Outcomes (QALYs)ICERBase-case (100% accurate)$8,7057.874$6,927 7.751$14,457With sensitivity of 86% and specificity of 77%$9,0607.577$6,927 7.751DominatedWith sensitivity of 100% and specificity of 77%$9,1687.587$6,9277.751DominatedWith sensitivity of 86% and specificity of 100%$8,5977.863$6,9277.751$14,912With sensitivity of 90% and specificity of 90%$8,8297.742$6,9277.751DominatedWith sensitivity of 95% and specificity of 95%$8,7677.803$6,9277.751$35,388QALY = quality-adjusted life years (gained); ICER = incremental cost-effectiveness ratioThere are no data available to estimate the extent to which untested patients in this symptomatic population remain on PPIs despite the lack of efficacy and potentially an alternative diagnosis and treatment being more appropriate. It is suggested that the base-case estimate, where only 10% of patients remain inappropriately followed up, is conservative. Alternative assumptions are shown in REF _Ref379457753 \h \* MERGEFORMAT Table 49. The cost-effectiveness of wireless monitoring increases substantially if it is assumed that more than 10% of patients remain on inappropriate treatment, although at no time does it become less expensive. However, if active follow-up of alternative diagnoses and discontinuation of inappropriate PPIs occurred in 99% of patients, pH monitoring would be unlikely to be considered cost-effective. If 100% of patients were followed up, the wireless pH test would be dominated, as empirical medication treatment would achieve greater outcomes at less cost.Table 49Sensitivity analyses around the assumption of PPI discontinuation for Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERD% of non-responders to high-dose PPIs that remain on inappropriate treatmentCatheter-free test:Cost ($)Catheter-free test:Outcomes (QALYs)No pH test:Cost ($)No pH test:Outcomes (QALYs)ICER100% (all non-responders remain on high-dose PPI treatment)$8,7417.83$7,9826.593$61375% $8,7317.842$7,6246.915$1,19450% $8,7217.855$7,3567.237$2,20925% $8,7117.867$7,0887.558$5,253Base-case: 10% of non-responders remain on high-dose PPIs and 90% discontinue$8,7057.874$6,9277.751$14,4575%$8,7037.876$6,8747.816$30,4862.5%$8,7027.877$6,8477.848$63,9711%$8,7017.878$6,8317.867$170,0140% (all non-responders to high-dose PPIs investigated/treated for alternative diagnoses)$8,7017.879$6,8207.880DominatedNERD = non-erosive reflux disease; ICER = incremental cost-effectiveness ratio, PPI = proton pump inhibitors; QALY = quality-adjusted life years (gained)An analysis of cost-effectiveness when considered across different time horizons was also undertaken ( REF _Ref379457782 \h \* MERGEFORMAT Table 50). The cost-effectiveness of pH monitoring is substantially improved as time horizons of a longer duration are considered. This is driven by the fact that the most significant costs are incurred in the first year (i.e. costs of the test and of subsequent surgery), as is the QALY decrement associated with surgery; however, both cost savings due to reduced expenditure on high-dose PPIs, and QALY benefits associated with discontinued use of medication, accrue every year thereafter. The ICER does not change substantially after 20?years, given that discounting and background mortality reduce the overall impact of distant years. Table 50Sensitivity analyses around the time horizon measured in Model 1: Cost-effectiveness of wireless pH monitoring vs no monitoring (empirical treatment) in patients with refractory NERDCatheter-free test:Cost ($)Catheter-free test:Outcomes (QALYs)No pH test:Cost ($)No pH test:Outcomes (QALYs)ICER1 year $3,0110.73$6810.729$2,330,1505 years$5,1253.382$3,0003.336$46,19910 years$7,1785.957$5,2525.868$21,642Base-case: timeframe 15?years$8,7057.874$6,927 7.751$14,45720 years$9,8149.265$8,1439.119$11,44625 years$10,58210.229$8,98710.067$9,847QALY = quality-adjusted life years (gained); ICER = incremental cost-effectiveness ratioAdditional sensitivity analyses undertaken on Model 1 showed that the model was not particularly sensitive to discounting, surgical mortality rates, technical failure rates, re-test uptake rate after technical failure, fundoplication surgery costs, or the cost of investigation and treatment of alternative diagnoses. The results of these analyses are presented in REF _Ref378948439 \h \* MERGEFORMAT Table 86 in Appendix K.Sensitivity analyses in Model 2: Wireless pH monitoring vs catheter-based monitoringSensitivity analyses around test accuracy were also undertaken for Model 2 ( REF _Ref379457802 \h \* MERGEFORMAT Table 51). The wireless test is dominated by the less expensive and more technically reliable catheter-based test, even when assuming perfect accuracy of the wireless test (compared with catheter-based monitoring); predictably, for all analyses where the wireless test has less-accurate test parameters, it remains dominated. Where the catheter-based test is assumed to be imperfect, with a sensitivity of 0.805, but other (including all wireless) test accuracy parameters are assumed perfect, the wireless test has a positive but relatively high ICER. This suggests that the transfer of patients from catheter-based to wireless monitoring when it is not needed is unlikely to be cost-effective, irrespective of whether or not the clinical yield and sensitivity of wireless pH monitoring is higher than catheter-based monitoring. This is consistent with the wording of the proposed listing to restrict funding to patients who are unable to tolerate catheter-based monitoring.Table 51Sensitivity analyses around the accuracy of wireless pH monitoring and catheter-based monitoring in Model 2Catheter-free test:Cost ($)Catheter-free test:Outcomes (QALYs)Catheter-based test:Cost ($)Catheter-based test:Outcomes (QALYs)ICERBase-case (100% accurate)$8,7057.874$7,1367.878DominatedWith wireless test sensitivity of 86% and specificity of 77% (catheter-based test reference standard, assumed 100% accurate)$9,0607.577$7,1367.878DominatedWhere catheter-based monitoring is assumed to have a sensitivity of 80.5% and all other accuracy parameters are 100%$8,7057.874$6,9807.863$156,818With wireless sensitivity of 100% and specificity of 77%$9,1687.587$7,1367.878DominatedWith wireless sensitivity of 86% and specificity of 100%$8,5977.863$7,1367.878DominatedWith wireless sensitivity of 95% and specificity of 95%$8,7677.803$7,1367.878DominatedQALY = quality-adjusted life years (gained); ICER = incremental cost-effectiveness ratioFinancial and costing impactThe estimated financial costs associated with wireless pH monitoring have been determined using a combined market share and epidemiological approach. This involves consideration of the existing catheter-based pH-monitoring market, and also epidemiological estimates with regard to the extent of catheter intolerance (i.e. failure of catheter-based monitoring or anatomically inappropriate).Data sources used in the financial analysisExisting usage and costing data relating to existing catheter-based pH monitoring (item 11810) and endoscopy was provided by Medicare Australia, on request.The estimated percentage of patients <1 or >70?years of age (5–10%) is based on Medicare Local data concerning item 11810. The estimate of placement error is based on the analysis presented under ‘ REF _Ref379441632 \h \* MERGEFORMAT Technical efficacy’ on page PAGEREF _Ref379441632 \h 75.Estimates of patient catheter intolerance (~10%) are based on expert opinion and are supported by the literature PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl
Y051bT4zMTk8L1JlY051bT48SURUZXh0PjY2OS03NjwvSURUZXh0PjxEaXNwbGF5VGV4dD4oU3dl
aXMgZXQgYWwuIDIwMDkpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjMxOTwvcmVj
LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6dzVlZmRmbGRkejVh
ZTJ4MDM1cnAyZnoyMnNld3J2cjB3ciI+MzE5PC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBl
IG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhv
cnM+PGF1dGhvcj5Td2VpcywgUi48L2F1dGhvcj48YXV0aG9yPkZveCwgTS48L2F1dGhvcj48YXV0
aG9yPkFuZ2dpYW5zYWgsIFIuPC9hdXRob3I+PGF1dGhvcj5BbmdnaWFuc2FoLCBBLjwvYXV0aG9y
PjxhdXRob3I+QmFzYXZhcmFqdSwgSy48L2F1dGhvcj48YXV0aG9yPkNhbmF2YW4sIFIuPC9hdXRo
b3I+PGF1dGhvcj5Xb25nLCBULjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0
aC1hZGRyZXNzPkZ1bmN0aW9uYWwgR0kgRGlzZWFzZSBVbml0LCBDbGluaWMgZm9yIEdhc3Ryb2Vu
dGVyb2xvZ3kgYW5kIEhlcGF0b2xvZ3ksIFVuaXZlcnNpdHkgSG9zcGl0YWwgb2YgWnVyaWNoLCBa
dXJpY2gsIFN3aXR6ZXJsYW5kLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlBhdGllbnQg
YWNjZXB0YW5jZSBhbmQgY2xpbmljYWwgaW1wYWN0IG9mIEJyYXZvIG1vbml0b3JpbmcgaW4gcGF0
aWVudHMgd2l0aCBwcmV2aW91cyBmYWlsZWQgY2F0aGV0ZXItYmFzZWQgc3R1ZGllczwvdGl0bGU+
PHNlY29uZGFyeS10aXRsZT5BbGltZW50IFBoYXJtYWNvbCBUaGVyPC9zZWNvbmRhcnktdGl0bGU+
PGFsdC10aXRsZT5BbGltZW50YXJ5IHBoYXJtYWNvbG9neSAmYW1wOyB0aGVyYXBldXRpY3M8L2Fs
dC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbGltZW50IFBoYXJtYWNv
bCBUaGVyPC9mdWxsLXRpdGxlPjxhYmJyLTE+QWxpbWVudGFyeSBwaGFybWFjb2xvZ3kgJmFtcDsg
dGhlcmFwZXV0aWNzPC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10
aXRsZT5BbGltZW50IFBoYXJtYWNvbCBUaGVyPC9mdWxsLXRpdGxlPjxhYmJyLTE+QWxpbWVudGFy
eSBwaGFybWFjb2xvZ3kgJmFtcDsgdGhlcmFwZXV0aWNzPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNh
bD48cGFnZXM+NjY5LTc2PC9wYWdlcz48dm9sdW1lPjI5PC92b2x1bWU+PG51bWJlcj42PC9udW1i
ZXI+PGVkaXRpb24+MjAwOS8wMi8wMzwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVz
Y2VudDwva2V5d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3
b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgcEggTW9uaXRvcmluZy8gaW5zdHJ1bWVudGF0aW9uPC9r
ZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdvc2NvcHkvIG1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+
RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vzb3BoYWdlYWwgUmVmbHV4LyBkaWFnbm9z
aXM8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdv
cmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+UGF0aWVudCBTYXRpc2Zh
Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+UXVhbGl0eSBvZiBMaWZlPC9rZXl3b3JkPjxrZXl3b3Jk
PlF1ZXN0aW9ubmFpcmVzPC9rZXl3b3JkPjxrZXl3b3JkPlNldmVyaXR5IG9mIElsbG5lc3MgSW5k
ZXg8L2tleXdvcmQ+PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0
ZXM+PHllYXI+MjAwOTwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1hciAxNTwvZGF0ZT48L3B1Yi1k
YXRlcz48L2RhdGVzPjxpc2JuPjEzNjUtMjAzNiAoRWxlY3Ryb25pYykmI3hEOzAyNjktMjgxMyAo
TGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTkxODMxNDQ8L2FjY2Vzc2lvbi1udW0+PHVy
bHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly9vbmxpbmVsaWJyYXJ5LndpbGV5LmNvbS9zdG9y
ZS8xMC4xMTExL2ouMTM2NS0yMDM2LjIwMDguMDM5MjMueC9hc3NldC9qLjEzNjUtMjAzNi4yMDA4
LjAzOTIzLngucGRmP3Y9MSZhbXA7dD1oaDlxMG9obiZhbXA7cz0zMGUyYzFkOWM1ZTc1YmZjZWVm
NmZlYmM1MmYxNzc1NzBiMmU2MjMyPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJv
bmljLXJlc291cmNlLW51bT4xMC4xMTExL2ouMTM2NS0yMDM2LjIwMDguMDM5MjMueDwvZWxlY3Ry
b25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1k
YXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+
PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Sweis et al. 2009).Use and costs of the proposed wireless pH-monitoring strategyProposed feeThe proposed fee per occasion of wireless pH monitoring, as requested in the application, is $913.64. This fee has been calculated by the applicant on the basis that it includes:professional time (estimated at 50?minutes with a value of $350):performing the procedure (~27 minutes)downloading and reading of data (~20 minutes)equipment costs (estimated at $563.64):consumable pH transmitter capsule (Bravo) $430.30depreciation of capital—wireless receiver and recording system, including software (Bravo) $19,990, depreciated fully over 3?years/150 patients at $133.34/occasion.A significant proportion (62%) of the proposed fee is for equipment. It is noted that even after adjustment for currency exchange, the quoted equipment prices remain considerably higher than the 2006 prices published by the American Society for Gastrointestinal Endoscopy Technology Committee ADDIN EN.CITE <EndNote><Cite><Author>Chotiprashidi</Author><Year>2005</Year><RecNum>11</RecNum><IDText>485-7</IDText><DisplayText>(Chotiprashidi et al. 2005)</DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="wzxrta50d9xespexfa6vr9smxrfdvs20ft99">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chotiprashidi, P.</author><author>Liu, J.</author><author>Carpenter, S.</author><author>Chuttani, R.</author><author>DiSario, J.</author><author>Hussain, N.</author><author>Somogyi, L.</author><author>Petersen, B. T.</author></authors></contributors><titles><title>ASGE Technology Status Evaluation Report: wireless esophageal pH monitoring system</title><secondary-title>Gastrointest Endosc</secondary-title><alt-title>Gastrointestinal endoscopy</alt-title></titles><periodical><full-title>Gastrointest Endosc</full-title><abbr-1>Gastrointestinal endoscopy</abbr-1></periodical><alt-periodical><full-title>Gastrointest Endosc</full-title><abbr-1>Gastrointestinal endoscopy</abbr-1></alt-periodical><pages>485-7</pages><volume>62</volume><number>4</number><edition>2005/09/28</edition><keywords><keyword>Cost-Benefit Analysis</keyword><keyword>Equipment Design</keyword><keyword>Esophagus/ physiopathology</keyword><keyword>Gastric Acidity Determination/instrumentation</keyword><keyword>Gastroesophageal Reflux/physiopathology</keyword><keyword>Humans</keyword><keyword>Hydrogen-Ion Concentration</keyword><keyword>Monitoring, Ambulatory/economics/ instrumentation</keyword><keyword>Telemetry/economics/ instrumentation</keyword></keywords><dates><year>2005</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0016-5107 (Print)
0016-5107 (Linking)</isbn><accession-num>16185957</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2005.07.007</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(Chotiprashidi et al. 2005) presented in REF _Ref379470882 \h \* MERGEFORMAT Table 87 in REF _Ref379470901 \h \* MERGEFORMAT Appendix L, despite a general trend in other medical technology prices to have decreased over this time.Of concern is that the calculated depreciation of capital requires each doctor providing the service to perform 50 services each year to break even with respect to equipment costs. The predicted current patient demand for services, based on the restricted listing, estimates that less than 400 tests should be required per year. This would suggest that the market would only support 8 practitioners around Australia to purchase the equipment and provide the service whereas, currently, catheter-based pH monitoring is undertaken by at least 56 practitioners (Medicare Australia 2013). Reduced numbers of practitioners may either result in access difficulties or, if most practitioners who currently undertake catheter-based monitoring were to invest in a wireless pH-monitoring system, there would be economic pressure to either increase the patient cost beyond the schedule fee (i.e. have a large gap payment) or to over-service (‘leakage’).In addition, a technical failure rate of approximately 7.5% is associated with the wireless pH-monitoring procedure, most commonly involving placement failure of the wireless capsule without results, such that an additional capsule is required. Clarification is needed as to who (e.g. doctor, patient, private insurer, manufacturer) bears this cost—capsule (~$430) or procedure ($914).Other issues of note that relate to the proposed fee include the following: Automatic annual indexation may not be appropriate given the equipment component.If the Bravo capsule component funding were to be obtained through an alternative source (e.g. the Department of Health’s Prostheses List), revision of the fee would be required. It is anticipated that the service would be typically undertaken in the inpatient setting, such that the MBS would rebate 75% of the fee ($685.23) and the patient contribution would be $228.32.Associated resourcesIn addition, with each occasion of wireless pH monitoring, additional resources, from both MBS and healthcare facility providers, beyond the procedure item will be incurred. These relate to the requirement for anaesthesia while the capsule insertion takes place, and are listed in REF _Ref377978110 \h \* MERGEFORMAT Table 52 and REF _Ref379467457 \h \* MERGEFORMAT Table 53. Both the placement of the capsule by endoscopy, and the later interpretation of results, are included in the proposed fee; therefore, neither an endoscopy nor follow-up consultation for interpretation of results can be claimed with the proposed item.Table 52Additional MBS item resources expected to be used concurrently with all occasions of the proposed interventionMBS itemDescriptionFull MBS cost (fee)MBS benefit a17610ANAESTHETIST, PRE-ANAESTHESIA CONSULTATION (Professional attendance by a medical practitioner in the practice of ANAESTHESIA) A BRIEF consultation involving a targeted history and limited examination (including the cardio-respiratory system). (etc)$43.00$32.2520740INITIATION OF MANAGEMENT OF ANAESTHESIA for upper gastrointestinal endoscopic procedures$99.00$74.2523010ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA (a) administration of anaesthesia performed in association with an item in the range 20100 to 21997… (etc)For a period of: FIFTEEN MINUTES OR LESS$19.80$14.85Total MBS resources$161.80$121.35a75% benefit applied, assuming most claims are in the inpatient settingTable 53 Other resources expected to be used concurrently with all occasions of the proposed interventionType of resourceDescriptionAverage costHealthcare facility costEndoscopy and follow-up care (AR-DRG Z40Z)$607Furthermore, at least 5% of patients currently obtaining pH monitoring are 75?years or older (Medicare data), and it might be estimated that another 5% are infants or between the ages of 70 and 74?years, such that up to 10% of patients would be eligible for the anaesthesia age-modifier fee. Also, in cases where insertion is difficult or a technical failure occurs during insertion but can be rectified without abandoning the procedure, increased fees associated with an increased duration of anaesthesia might be expected. The relevant item numbers associated with these occasional additional resources are shown below in REF _Ref379466968 \h \* MERGEFORMAT Table 54.Table 54 Additional MBS item resources expected to be used concurrently in approximately 5%–10% of the proposed interventionsMBS itemDescriptionFull cost (fee)MBS benefit a25015ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA - where the patient is less than 12 months of age or 70 years or greater $19.80$14.8523021[From 23010: ANAESTHESIA….(a) administration of anaesthesia performed in association with an item in the range 20100 to 21997… (etc)]For a period of: 16 MINUTES TO 20 MINUTES$39.60$29.70Total MBS resources$59.40$44.55Average additional MBS expenditure/patient (5–10%)$2.97–$5.94$2.23–$4.46a75% benefit applied, assuming most claims are in the inpatient settingIt is plausible that on very rare occasions serious complications or side effects associated with endoscopy and sedation may occur (e.g. oesophageal tear, haemorrhage). However, there is no quantitative report of the occurrence of these complications associated with wireless pH monitoring and, due to their unknown but expected very low incidence, they are not included in the costing assessment. Likewise, the MBS costs associated with potential downstream treatment decisions (e.g. fundoplication surgery), although included in the economic model, are not included in the costing analysis, given that they are not directly or routinely associated with the proposed intervention.For the remainder of the costing analysis, an associated MBS expenditure of $166 per patient in addition to the proposed fee will be assumed, equal to the sum of $161?+?$5—rounded values from REF _Ref377978110 \h \* MERGEFORMAT Table 52 and REF _Ref379466968 \h Table 54. Of this, $125 is assumed to be paid as benefits and $41 as a patient co-payment.A summary of the total costs and funding sources directly associated with the proposed intervention are presented in REF _Ref379467006 \h \* MERGEFORMAT Table 55. Without knowledge of the actual fees that doctors intend to charge for the proposed listing, it is not possible to calculate the additional patient out-of-pocket payments. Table 55 Total costs directly associated with a service of wireless pH monitoring under the proposed MBS listingDescriptionMBS rebate (benefits paid)Patient MBS co-paymentPrivate insurance or patient costTotalProposed listing$685.32$228.32$0$913.64Associated MBS items$125$41$0$166Facility fee$0$0$607$607Total contributions$810.32$269.32$607$1,686.64Estimated volume per yearThe proposed listing is restricted to use in patients who are indicated for but cannot tolerate a catheter-based pH test. It is estimated that this equates to approximately 5%–10% of the number of patients who receive catheter-based pH monitoring PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VpczwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl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ADDIN EN.CITE.DATA (Sweis et al. 2009). To estimate the number of patients eligible for wireless monitoring under the proposed listing, the upper end of the estimate (10%) is applied to the number of catheter-based patients from existing Medicare data. The number of claims for catheter-based monitoring has increased by an average of approximately 4% each year over the past 4?years (2009–13), and therefore in the base-case it is assumed that an ongoing annual growth rate of 4% will apply to all pH monitoring. An estimate of the number of pH tests expected to be undertaken using this calculation is presented in REF _Ref379467518 \h \* MERGEFORMAT Table 56.Table 56Projected number of wireless pH tests annually under the proposed listing (base-case estimates)2012–132013–14 a 2014–15 a 2015–16 a 2016–17 aBase-caseNumber of catheter-based tests 3,5903,7343,8834,0384,200Estimated number of wireless tests(10% of catheter-based pH tests)359373388404420Total pH tests3,9494,1074,2714,4424,620aprojected to increase annually at 4%There is uncertainty around the estimated growth rate; if only the most recent data is considered (2011–13), catheter-based monitoring has increased annually by 8%. If this annual growth rate is maintained, costs associated with listing will increase more rapidly. The impact of an increased growth rate on the number of tests is tested in a sensitivity analysis in REF _Ref379467545 \h \* MERGEFORMAT Table 57. There is also considerable uncertainty with respect to whether ‘leakage’ beyond the eligibility criteria for wireless monitoring will occur. The incentives for use include:Patient preference: there are reports that some patients feel considerable embarrassment and discomfort with the transnasal catheter in situ, and they may avoid attending work or leaving their home. The wireless monitoring system, on the other hand, is relatively discreet, with most patients reporting that they can maintain normal daily activities during the monitoring interval. Therefore, this may result in some patients requesting wireless monitoring and claiming unsuitability for catheter-based monitoring. This ‘unsuitability’ would be based on patient preference rather than an ‘absolute’ intolerance PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Hirano 2006; Mearin et al. 1998).Clinical claim: despite the uncertain conclusion with respect to comparative accuracy and effectiveness, if doctors or patients are convinced that the wireless system reports an additional 10% accurate positive yield with respect to providing a diagnostic result, there is a clinical incentive to opt for wireless monitoring. Financial incentive for doctors: the proposed fee structure includes a component to cover capital depreciation of the pH-monitoring system, assuming that doctors have invested a significant capital outlay. This inherently results in an economic incentive for the doctor to favour this service rather than a strictly time-funded one, as a means to recoup their equipment costs (see earlier discussion under ‘Proposed fee’)Countering these incentives is the fact that wireless pH monitoring requires an endoscopy procedure with sedation. The need for sedation, and therefore admittance to a hospital and third-party observation plus transport home afterward, involves considerable additional risk, money and inconvenience for the patient, such that it will not always be the preferred alternative. There are no data available to make a quantitative estimate as to the extent that leakage to wireless monitoring in place of catheter-based monitoring is likely to occur in practice. For the purposes of a sensitivity analysis, the financial analysis presents cost estimates where the respective ratio of wireless:catheter-based pH monitoring is reversed, arbitrarily making a 91%:9% ratio, with the intention that this be considered the upper estimate of plausible leakage. Estimated numbers of wireless tests under this scenario are also calculated in REF _Ref379467545 \h \* MERGEFORMAT Table 57.Table 57Sensitivity analyses for the projected number of wireless pH tests under the proposed listing2012–132013–14 a2014–15 a2015–16 a2016–17 a1: Increased annual growth rate of 8%Number of catheter-based test a3,5903,8774,1874,5224,884Estimated number of wireless tests(10% of catheter-based pH tests)3593884194524882: Assuming extensive leakage beyond the restrictionNumber of catheter-based tests 388404420Number of wireless tests (upper limit)3,8834,0384,200Total pH tests 4,2714,4424,620aprojected to increase annually at 8%In the majority of patients it is anticipated that pH monitoring would only occur once in their lifetime. However, in a minority of patients who continue to have symptoms despite different medication regimens or surgery, repeat monitoring (e.g. on/off treatment) may be indicated. The MBS claims data does not differentiate between individual one-off patient tests and repeat tests in the same patient; therefore, assuming that repeat monitoring would occur similarly across both pH-monitoring technologies, the extent of repeat monitoring will not affect the costing estimates. There is a significant technical failure rate with wireless pH monitoring that is generally associated with capsule placement. It is assumed that where a capsule has not been placed successfully, an MBS claim would not be submitted. Estimated MBS costs per yearThe direct costs to the MBS per year associated with the proposed listing—specifically for the new item—for directly associated items and in total are calculated in REF _Ref379467593 \h \* MERGEFORMAT Table 58. The government benefits paid and patient contributions are also estimated.Table 58 Total cost of the proposed intervention to the MBS (base-case)2013–14 a2014–15 a2015–16 a2016–17 aNumber of patients eligible for wireless test( REF _Ref379467518 \h \* MERGEFORMAT Table 56)373388404420Fees of the proposed item number ($913.64) b$341,117$354,761$368,952$383,710MBS benefits (75%)$255,871$266,106$276,750$287,820Patient co-payments $85,246$88,655$92,202$95,890MBS fees of associated items ($166)$61,978$64,457$67,035$69,717MBS benefits (75%)$46,670$48,537$50,478$52,497Patient co-payments$15,308$15,920$16,557$17,219Total MBS fees associated with listing$403,094$419,218$435,987$453,426MBS benefits payable (75%)$302,541$314,643$327,228$340,318Patient co-payments $100,553$104,575$108,758$113,109aestimated projectionsbMBS benefits payable per patient round up to $810.32, which results in a total benefits calculation slightly higher than 75% of the total fees.MBS = Medicare Benefits ScheduleSensitivity analyses around the MBS costs allowing for (i) increased growth and (ii) an estimate of the upper limit of plausible leakage are presented in REF _Ref379467873 \h \* MERGEFORMAT Table 59 and REF _Ref379467880 \h \* MERGEFORMAT Table 60, respectively.Table SEQ Table \* ARABIC 59 Sensitivity analysis: Projected MBS costs associated with wireless pH monitoring if patient numbers grow at increased annual rate of 8% 2014–152015–162016–17Estimated number of patients receiving wireless test with 8% annual growth rate419452488Fees of the proposed item number ($913.64) a$382,575$413,181$446,236MBS benefits (75%)$286,969$309,927$334,721Patient co-payments $95,606$103,255$111,515MBS fees of associated items ($166)$69,510$75,071$81,077MBS benefits (75%)$52,342$56,530$61,052Patient co-payments $17,168$18,542$20,025Total MBS fees associated with listing$452,086$488,253$527,313MBS benefits payable (75%)$339,311$366,456$395,773Patient co-payments $112,774$121,796$131,540a MBS benefits payable per patient round up to $810.32, which results in a total benefits calculation slightly higher than 75% of the total fees.MBS = Medicare Benefits ScheduleTable 60 Sensitivity analysis: Projected MBS costs associated with potential leakage (upper plausible extent) of wireless pH monitoring beyond the restriction (i.e. use in 90% of patients who are tolerant to catheter-based monitoring)2014–152015–162016–17Estimated number of patients receiving wireless test, including upper limit of plausible leakage3,8834,0384,200Fees of the proposed item number ($913.64) a$3,547,664$3,689,278$3,836,849MBS benefits (75%)$2,661,098$2,767,322$2,878,015Patient co-payments $886,567$921,956$958,834MBS fees of associated items ($166)$644,578$670,308$697,120MBS benefits (75%)$485,375$504,750$524,940Patient co-payments $159,203$165,558$172,180Total MBS fees associated with listing$4,192,242$4,359,586$4,533,970MBS benefits (75%)$3,146,473$3,272,072$3,402,955Patient co-payments $1,045,770$1,087,514$1,131,015a MBS benefits payable per patient round up to $810.32, which results in a total benefits calculation slightly higher than 75% of the total fees.MBS = Medicare Benefits ScheduleChanges in use and cost of current monitoring strategyTechnically, given that the listing is restricted to patients who cannot tolerate catheter-based monitoring, the comparator is ‘ongoing medical care without a diagnostic test and empirical treatment’. However, given the diversity of medical care and treatments that may be afforded (briefly described in ‘Economic evaluation’) and the lack of any evidence or suggestion that the proposed test will directly alter the actual number of consultations, the base-case comparator for the purposes of the financial analysis is simply ‘no pH test’.Therefore, in the base-case assumption for the proposed listing of wireless monitoring, public funding would be in addition to existing levels of catheter-based pH monitoring, and the extent of catheter-based monitoring would remain unchanged, i.e. there would be no cost offsets associated with the new test listing. Similarly, market growth is independent and the rate of market growth is not relevant.However, if wireless pH monitoring was to be undertaken in place of catheter-based monitoring, i.e. ‘leakage’ beyond the listing (as described under ‘Use and costs of the proposed wireless pH-monitoring strategy’), the extent of use of catheter-based monitoring would be expected to decrease 1:1 with the extent of increased ‘leaked’ use of wireless monitoring. In this sensitivity analysis scenario, an upper plausible limit of leakage to wireless monitoring, the estimated change in use and associated costs of catheter-based monitoring are calculated in REF _Ref379468075 \h \* MERGEFORMAT Table 61. The listed MBS fee for catheter-based monitoring (item 11810) is $174.75 (benefit: 75% = $130.85, 85% = $148.30). However, Medicare data from 2012–13 report that the average fee per service is $190.80, and the average benefit paid per service is $154.81, 96% being for out-of-hospital services and a significant quantity attracting additional Medicare Safety Net benefits; therefore, these values are used in the calculations.Table SEQ Table \* ARABIC 61 Sensitivity analysis: Changes in MBS costs of catheter-based monitoring associated with upper plausible limit of potential leakage to wireless pH monitoring beyond the restriction2013–14a 2014–15a 2015–16a 2016–17aExtent of current monitoring without proposed listing, or with proposed listing and no leakageProjected use of catheter-based pH monitoring (number of claims)3,7343,8834,0384,200Total projected fees: $712,371$740,876$770,450$801,268Estimated Medicare benefits payable (based on existing benefit paid/test$577,999$601,127$625,123$650,128Estimated patient contributions (based on existing contributions/test)$134,372$139,749$145,328$151,141With wireless test MBS-listed and significant leakageProjected use of catheter-based pH monitoring (number of claims)373388404420Total projected fees: $71,237$74,030$77,083$80,167Estimated Medicare benefits payable$57,800$60,066$62,543$65,045Estimated patient contributions$13,437$13,964$14,540$15,122Estimated difference (decrease) in number of claims for catheter-based monitoring if listing and leakage occurs–3,360–3,495–3,634–3,779Estimated difference (saving) in fees for catheter-based monitoring $641,134$666,846$693,367$721,102Difference (saving) in Medicare benefits payable$520,199$541,061$562,580$585,083Difference (saving) in patient contributions$120,935$125,785$130,788$136,019aestimated projectionsMBS = Medicare Benefits ScheduleFinancial implications to the Medical Benefits Schedule (MBS) In the base-case there is no evidence of direct or quantifiable cost offsets associated with the proposed wireless pH test. Therefore, assuming no leakage beyond the proposed restriction, the overall costs to the MBS remain those associated with the listing, as calculated in REF _Ref379467593 \h \* MERGEFORMAT Table 58. The total value of the MBS fees charged in the restricted population is estimated to grow annually, from approximately $420,000 (in 2014–15) to $455,000 (in 2016–17), and would be expected to exceed $500,000 by 2020. In 2014–15 the MBS would be expected to fund approximately $323,000 of this amount, with patient contributions of $97,000, increasing by 2016–17 to MBS funding of approximately $350,000 and patient contributions of approximately $105,000.Uncertainty scenariosIf the market growth rate increases annually by 8%, the overall MBS costs are as presented in REF _Ref379467873 \h \* MERGEFORMAT Table 59, with annual MBS costs increasing by an additional approximately $50,000 (2014–15) to $75,000 (2016–17).For the scenario analysis allowing for leakage beyond the restriction (i.e. from catheter-based monitoring) to an upper plausible extent, the overall MBS costs will increase substantially. These costs are calculated in REF _Ref379468344 \h \* MERGEFORMAT Table 62 and indicate that if substantial leakage occurs, total MBS fees could be increased by over $3.5?million in the 2014–15 financial year, with further increases annually. Government-funded benefits would increase to approximately $2.7?million and patients would additionally contribute approximately $850,000, annually, with ongoing growth expected.Table SEQ Table \* ARABIC 62 Sensitivity analysis: Net change in MBS costs associated with the proposed listing of wireless pH monitoring, assuming the upper plausible extent of leakage beyond the restriction2014–15 a 2015–16 a 2016–17 a MBS costs associated with proposed listing$4,192,242$4,359,586$4,533,970MBS benefits (75%) b $3,146,473$3,272,072$3,402,955Patient co-payments $1,045,770$1,087,514$1,131,015Savings in fees for substituted catheter-based monitoring (calculated in REF _Ref379468075 \h \* MERGEFORMAT Table 61)–$666,846–$693,367–$721,102Difference (saving) in Medicare benefits payable–$541,061–$562,580–$585,083Difference (saving) in patient contributions–$125,785–$130,788–$136,019Net change in total MBS costs$3,525,396$3,666,219$3,812,868Net change in MBS benefits $2,605,412$2,709,492$2,817,872Net change in patient contributions$919,985$956,726$994,996 a estimated projections; b MBS benefits payable per patient round up to $810.32, which results in a total benefits calculation slightly higher than 75% of the total fees.MBS = Medicare Benefits ScheduleClearly, the potential for leakage is significant, and the financial ramifications to the MBS are high should such leakage occur.Other Australian healthcare system costsCosts to the state and territory health systemsAlthough the proposed listing will occur in the hospital setting, it is assumed that MBS claims will only be made for patients admitted in private hospitals, and no additional public hospital funding is envisaged. It is currently unknown whether this technology is available to public hospital patients, and therefore accessibility may present an equity issue.Costs to the private health insurer and/or patientAs identified in REF _Ref379467457 \h \* MERGEFORMAT Table 53, the proposed listing does require utilisation of a hospital facility, at cost to either a private health insurer or the patient. The additional costs to the insurer or patient associated with hospitalisation are calculated in REF _Ref379468581 \h \* MERGEFORMAT Table 63.Table 63Costs of hospitalisation incurred by private insurer or patient (base-case)2014–15a 2015–16a 2016–17a Number of patients eligible for wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)388404420Hospital costs associated with test ($607/patient)$235,695$245,122$254,927aestimated projectionsSensitivity analysisThe additional hospitalisation costs that would be borne by private health insurers and/or patients according to (i) the alternative annual market growth rate (8%) and (ii) significant leakage beyond the restriction (i.e. replacing catheter-based tests) are estimated in Table 64.Table 64 Costs of hospitalisation incurred by private insurer or patient—alternative scenarios2014–15a2015–16a2016–17aIncreased market growth rateNumber of patients eligible for wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)419452488Hospital costs associated with test ($607/patient)$254,174$274,508$296,468Significant market leakageNumber of patients having wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)3,8834,0384,200Hospital costs associated with test ($607/patient))$2,356,981$2,451,066$2,549,109MBS = Medicare Benefits ScheduleTotal Australian healthcare system costsThe total costs to the Australian healthcare system are presented in REF _Ref379470177 \h Table 65.Table 65 Total Australian healthcare system costs (base-case)2014–15a2015–16a2016–17aNumber of patients eligible for wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)388404420MBS costs (Table 58)$419,218$435,987$453,426Private insurer/patient costs ( REF _Ref379468581 \h \* MERGEFORMAT Table 63) $235,695$245,122$254,927Total$654,913$681,109$708,353MBS = Medicare Benefits Schedule REF _Ref379470276 \h \* MERGEFORMAT Table 66 also calculates the total healthcare system costs (i) assuming an increased annual market growth rate of 8% (vs base-case of 4%) and (ii) assuming significant market leakage.Table 66Total Australian healthcare system costs—alternative scenarios2014–15a 2015–16a 2016–17a Increased market growth rateNumber of patients eligible for wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)419452488Net MBS costs ( REF _Ref379467593 \h \* MERGEFORMAT Table 58)$452,086$488,253$527,313Private insurer/patient costs ( REF _Ref379470336 \h \* MERGEFORMAT Table 64) $254,174$274,508$296,468Total healthcare costs$706,260$762,760$823,781Significant market leakageNumber of patients having wireless test ( REF _Ref379467518 \h \* MERGEFORMAT Table 56)3,8834,0384,200Net MBS costs ( REF _Ref379468344 \h \* MERGEFORMAT Table 62)$3,525,396$3,666,219$3,812,868Private insurer/patient costs ( REF _Ref379470336 \h \* MERGEFORMAT Table 64) $2,356,981$2,451,066$2,549,109Total healthcare costs$5,882,377$6,117,285$6,361,977MBS = Medicare Benefits ScheduleDiscussion Safety The population that would normally receive catheter-free monitoring in Australia comprises patients who cannot tolerate a transnasal catheter or in whom a catheter is anatomically inappropriate. Therefore, the appropriate comparator would be ‘no pH monitoring’, since this patient group does not receive pH monitoring in current practice. However, due to the absence of evidence on catheter-free monitoring in the right patient population and with the specified comparator, the selection criteria were amended to include patients suspected of GORD but who can possibly tolerate a transnasal catheter, which allowed the inclusion of catheter-based monitoring as a comparator. Of the 47 comparative and non-comparative studies identified in the literature, only one compared catheter-free monitoring with no monitoring; and only one included patients who were unable to tolerate catheter-based monitoring, with a group undergoing catheter-based monitoring as a comparator. Francis et al. (2012) used ‘no monitoring’ as a comparator when investigating safety issues on catheter-free monitoring 16?cm above the gastro-oesophageal junction (GOJ); however, 48?hours before proximal capsule placement a more distal capsule was placed approximately 6?cm above the GOJ. This means that there is a large probability that the distal capsule was still in the oesophagus at the time of placement of the proximal capsule, possibly causing additional discomfort since most capsules stay in place for more than 48?hours. One conclusion from this study is that a proximal capsule placement in addition to a ‘normal’ capsule placement can cause additional discomfort. Sweis et al. (2009) compared a group of patients who could not tolerate catheter-based monitoring and underwent catheter-free monitoring with patients suspected of GORD undergoing catheter-based monitoring. The catheter-free monitoring patients were significantly more satisfied with the test than the group undergoing catheter-based monitoring. This shows that patients who cannot tolerate a catheter are still capable of tolerating catheter-free monitoring. Therefore, even though there was only limited evidence on the population of interest that was outlined a priori, we can assume that this population is able to undergo catheter-free monitoring.Most adverse events reported in the included studies were related to discomfort caused either by the catheter or by the capsule attaching to the oesophageal mucosa. More-severe complications from catheter-free monitoring, such as a rupture in the oesophageal mucosa, are often caused by a technical failure or human error where the capsule fails to detach from the catheter while inserting the device. Capsule aspirations or dislodgements were reported in case reports and can be dangerous if they dislodge in the lung. This highlights the usefulness of case reports in describing safety outcomes; rare complications are unlikely to be reported by controlled studies or case series. Therefore, case reports can play an essential role in identifying complications from catheter-free monitoring, but caution should be exercised while commenting on rare complications based on case reports that have been presented for catheter-free monitoring but not for its comparator(s).There was limited data on adverse events of catheter-free monitoring in children. It is not clear if children are less likely to tolerate the transnasal catheter but, if this is the case, data on the safety of catheter-free monitoring in children is essential since they will constitute a considerable share of the catheter-free monitoring users. Croffie et al. (2007) reported more chest discomfort with the new test but less overall discomfort in children, compared with the catheter-based test. However, in four case series with a total of 410 children, two mucosal tears were reported using catheter-free monitoring, so severe adverse events do occur in children when using catheter-free monitoring. The percentage of patients who reported pain and discomfort attributable to catheter-free monitoring varied greatly between studies. In the non-comparative studies that reported chest pain or discomfort as an adverse event, rates varied between 0.27% and 45%. Some comparative studies reported a median discomfort score on a VAS, some used a different scale and others listed percentages of patients with adverse events. It is possible that patients would report some chest pain on a VAS, but would not report chest pain when the question ‘Do you have any side effects from monitoring?’ was asked. Results may be biased owing to different methods of reporting adverse events, variation in the physician’s experience in performing the procedure, and small sample sizes within the studies included in this assessment.EffectivenessTwo studies were identified that reported on the effectiveness of catheter-free (wireless) pH monitoring in terms of health outcomes. However, these studies did not meet the specific inclusion criteria a priori, as patients were those who could have potentially tolerated catheter-based monitoring. Health outcomes were similar between those monitored by the catheter-based test and those by the catheter-free test. Given the assumption that catheter-based monitoring is considered superior to no monitoring in those who can tolerate catheter-based monitoring, and the finding that the catheter-free system appears as good as the catheter-based system, it is expected that catheter-free monitoring improves health outcomes compared with no monitoring. However, the available direct evidence was limited and of low quality, so this justified the use of a supportive linked evidence approach, i.e. assessing the diagnostic accuracy of catheter-free monitoring and its impact on patient management. Nine studies compared technical failures in catheter-free monitoring with catheter-based monitoring failure rates. Even though only one study identified catheter-free monitoring as being at higher risk for technical failures, when a meta-analysis was conducted the relative risk was 3.3 (95%CI 1.63, 6.81; I2 = 0%, p=0.906; k = 8 studies) for the occurrence of technical failures while using catheter-free monitoring compared with catheter-based monitoring. The most commonly reported technical failures that caused problems in catheter-free monitoring were early capsule detachments (i.e. in the wrong place in the oesophagus or where the capsule fails to attach to the oesophageal mucosa), causing incomplete data capture and errors in placement of the system. A concern was raised that oesophageal acid exposure exhibited day-to-day variability. If this is the case, monitoring for 48?hours instead of 24?hours, as with traditional catheter-based monitoring, would give truer and more-accurate results. However, even though there were 20 studies reporting on day-to-day variability in adults, there was no consistency in their results. Fourteen studies reported no significant difference in oesophageal acid exposure when comparing the first day with the second day of monitoring, and three and two studies reported more acid exposure on day 1 and day 2, respectively. But there is evidence that increasing the monitoring period leads to an increased diagnostic yield: the incremental diagnostic yield when increasing the monitoring time from 24?hours to 48?hours varied from 2% to 15.6%, as reported by six studies. Because catheter-free monitoring has a standard monitoring period of 48?hours, it should be able to correctly diagnose more people than the standard catheter-based method, where a 24-hour monitoring period is used. Catheter-based monitoring was used as a reference standard for diagnostic accuracy in the current assessment; however, as there is an incremental diagnostic yield with catheter-free monitoring, the validity of this reference standard should be questioned. Sensitivity, specificity, PPV, NPV, LR+ and LR– were used in some studies to determine how well catheter-free monitoring classifies patients in having or not having GORD based on an arbitrary cut-off point, and for some studies the sensitivity and specificity could be calculated based on the available data. Catheter-based monitoring and clinical diagnosis were used as reference standards in three and five studies, respectively. A diagnostic test is ideal if its sensitivity, specificity, NPV and PPV all reach 100%, although this assumes a perfect reference standard and perfect concordance. Diagnostic tests in practice vary in this regard. For those compared against the potentially imperfect reference standard of catheter-based monitoring, lower sensitivity and specificity could be due to catheter-free monitoring being more accurate. Furthermore, the threshold for a positive/negative test result changes the characteristics of the index test. When the threshold for GORD diagnosis in a specific test is set lower, the sensitivity and NPV will be higher and the specificity and PPV will be lower. Decisions on determining the optimal balance of sensitivity and specificity require compromise. Currently, there is a lack of consensus as to the optimal cut-off value for diagnosis in catheter-free and catheter-based monitoring, and therefore the eight studies reporting sensitivity and specificity vary greatly in thresholds for diagnosis, which in turn leads to differences in specificity, sensitivity, NPV and PPV. With no consistency in cut-off values, a meta-analysis on diagnostic accuracy was not conducted. The majority of patients are already being treated with PPIs prior to the test, so a high sensitivity and NPV are important: the true value of the test may be ruling out those who don’t have the disease to reduce the number of patients with false negative results. Consensus on an appropriate cut-off value is therefore necessary to diagnose GORD consistently across different settings when using either catheter-free or catheter-based monitoring.When establishing a GORD diagnosis, not only does a cut-off value in acid exposure have to be determined, but people also have to agree on how the cut-off value will be used. For instance, a positive diagnosis can be based on one positive day (day 1 or day 2), two positive days (having a score above the threshold during both days), a positive score on the ‘worst day’ of monitoring, or a reflux symptom correlation (symptom index, sensitivity index or associated probability). In addition, whatever is decided as the cut-off value, the result should be used to guide management, and there was evidence that this is not always done. Furthermore, there should be one standard location of the capsule in the oesophagus. Most physicians agree on placing the capsule approximately 5?cm above the LOS or 6?cm above the SCJ, but there is no evidence stating that this is the optimal location for diagnosing GORD. Historically, this position was chosen for catheter-based monitoring because it was close enough to the SCJ to sense acid reflux and yet sufficiently distant from the stomach so that the electrode could not migrate too low and end up in the stomach itself PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYW5kb2xmaW5vPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE.DATA (Pandolfino et al. 2006). Often, reflux-related mucosal injuries, such as oesophagitis and Barrett’s metaplasia, are localised closer to the SCJ. With catheter-free monitoring the capsule can be attached to the oesophageal mucosa at any desired level that maintains a consistent position, so further discussion could be had regarding whether a more distal capsule placement would have a greater relevance to GORD diagnosis. A study by Wenner et al. (2008) showed improved diagnostic accuracy for pH monitoring at 1?cm, compared with 6?cm, above the GOJ in patients with typical reflux symptoms.Nine studies reported on concordance of oesophageal acid exposure times comparing catheter-free monitoring with catheter-based monitoring. There was no clear consistency in acid exposure time concordance, and discrepancy between the two monitoring methods was particularly clear in studies that used in-subject simultaneous recording. This was unexpected because the acid exposure times should closely match when measured in the same subject and at the same time, adjusting for all confounders. Pandolfino et al. (2005) investigated the differences in acid exposure and concluded that there was a consistent offset in pH measurement between the two tests in healthy volunteers. This offset was confirmed further by an in-vivo reference measurement using orange juice with a known pH. The dominant source of discrepancy between the two monitoring systems was an inaccuracy in catheter-free monitoring electrode calibration; after adjustment, the discrepancy improved by 40%. However, some differences still existed and were most pronounced during short reflux events. This corresponds to the results of this assessment, where three out of four studies on concordance in reflux events reported more reflux events in the catheter-based system. One possible explanation is that short drops in pH can be caused by factors unrelated to acid reflux ADDIN EN.CITE <EndNote><Cite><Author>Fox</Author><Year>2006</Year><RecNum>590</RecNum><DisplayText>(Fox 2006)</DisplayText><record><rec-number>590</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">590</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fox, M.</author></authors></contributors><titles><title>Bravo wireless versus catheter pH monitoring systems</title><secondary-title>Gut</secondary-title><alt-title>Gut</alt-title></titles><periodical><full-title>Gut</full-title></periodical><alt-periodical><full-title>Gut</full-title></alt-periodical><pages>434-5</pages><volume>55</volume><number>3</number><keywords><keyword>Capsules</keyword><keyword>Gastric Acidity Determination</keyword><keyword>Gastroesophageal Reflux/*diagnosis</keyword><keyword>Humans</keyword><keyword>Hydrogen-Ion Concentration</keyword><keyword>Monitoring, Ambulatory/methods</keyword><keyword>Reproducibility of Results</keyword><keyword>*Telemetry</keyword></keywords><dates><year>2006</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0017-5749 (Print)
0017-5749 (Linking)</isbn><accession-num>16474112</accession-num><urls><related-urls><url>;(Fox 2006); for example, due to the ingestion of mildly acidic fluids, movement of the catheter relative to the mucosa in catheter-based monitoring, and movement of the catheter relative to the GOJ during swallowing. On swallowing, the oesophagus shortens by a couple of centimetres due to muscle contractions. As it shortens, the catheter electrode in catheter-based monitoring moves towards the GOJ and may pass into the stomach where the pH is low. The catheter electrode can dip into the ‘acid pocket’ before the catheter returns to its original position. Other short pH drops can occur with peristaltic contractions or during transient LOS relaxation, and resolve without swallowing. Therefore, many of the short reflux events measured by catheter-based monitoring and not catheter-free monitoring could be artefacts that are not related to GORD. When pH monitoring indicates that there is pathological acid reflux, patients could undergo anti-reflux surgery. Two systematic reviews were identified to answer the question whether anti-reflux surgery for GORD leads to better health outcomes than medical treatment. Improved health outcomes were more common after surgical treatment compared with medical treatment in the short to medium term according to both systematic reviews. Two trials reported 5-year follow-up results and concluded that most patients remain in remission for 5?years after anti-reflux surgery, and this group continued to have better pain relief than the medication group. However, these trials consisted solely of patients who responded to PPI therapy, and it is not known if the results generalise to patients who do not respond to medical therapy.There were no studies identified that provided relevant information on the implications of non-treatment on false negative results. False negative patients would probably go off PPI therapy, and would either not undergo surgery or would delay surgical treatment, even though they have GORD. They would likely undergo investigations for alternative diagnoses. It was assumed that the management of false positive patients is not likely to change, although two studies mentioned a patient receiving anti-reflux surgery after a false GORD diagnosis PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VldG1hbjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2VldG1hbjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+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ADDIN EN.CITE.DATA (Sweetman, Ng & Kerrigan 2007; Taddio et al. 2011). Furthermore, patients with a false positive result would probably have a delay in treatment for their ‘real’ diagnosis, as they are misdiagnosed with GORD. Two studies on infants have been identified regarding delayed treatment after GORD misdiagnosis that confirmed the assumptions: infants with infantile spasms and a delayed diagnosis/treatment had a poorer outcome and a worse treatment response. Although these children never underwent pH monitoring and it is not known if they were eligible for the procedure, it shows that early diagnosis in children suspected of GORD can lead to better health outcomes.The body of evidence included in this assessment report was appraised according to the NHMRC’s methodological guidelines ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2008</Year><RecNum>132</RecNum><DisplayText>(NHMRC 2008)</DisplayText><record><rec-number>132</rec-number><ref-type name="Electronic Source">12</ref-type><contributors><authors><author>NHMRC</author></authors></contributors><titles><title>NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation.</title></titles><number>11/03/08</number><dates><year>2008</year></dates><publisher>National Health and Medical Research Council, Australian Government</publisher><work-type>Internet</work-type><urls><related-urls><url>.au/consult/index.htm</url></related-urls></urls></record></Cite></EndNote>(NHMRC 2008). This appraisal considered the evidence-base, consistency of the studies’ results, clinical relevance of the safety and effectiveness data, generalisability of the evidence to the population of interest, and applicability to the Australian healthcare system. REF _Ref363634333 \h \* MERGEFORMAT Table 67 presents the results of the assessment of the body of evidence for catheter-free monitoring in GORD.Table 67Body of evidence matrix ComponentABCDExcellentGoodSatisfactoryPoorEvidence-base aOne or two level III studies with a low risk of bias, or level I or II studies with a moderate risk of biasConsistency bMost studies consistent and inconsistency may be explainedClinical impactModerate (with regard to safety) Slight or restricted (with regard to change in management)GeneralisabilityPopulation(s) studied in body of evidence differ from target population for guideline but it is clinically sensible to apply this evidence to target population cApplicabilityApplicable to Australian healthcare context with few caveats Source: adapted from ADDIN EN.CITE <EndNote><Cite><Author>NHMRC</Author><Year>2008</Year><RecNum>132</RecNum><DisplayText>(NHMRC 2008)</DisplayText><record><rec-number>132</rec-number><ref-type name="Electronic Source">12</ref-type><contributors><authors><author>NHMRC</author></authors></contributors><titles><title>NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation.</title></titles><number>11/03/08</number><dates><year>2008</year></dates><publisher>National Health and Medical Research Council, Australian Government</publisher><work-type>Internet</work-type><urls><related-urls><url>.au/consult/index.htm</url></related-urls></urls></record></Cite></EndNote>NHMRC (2008)aLevel of evidence determined from the NHMRC evidence hierarchy (Table 9)bIf there is only one study, rank this component as ‘not applicable’. cFor example, results in adults that are clinically sensible to apply to children OR psychosocial outcomes for one cancer that may be applicable to patients with another cancer.Economic considerationsEstimated cost-effectivenessThe economic evaluation suggested that catheter-free (wireless) pH monitoring, while not cost-saving, was reasonably cost-effective vs no monitoring in patients who could not tolerate catheter-based monitoring (base-case ICER: $14,457/QALY). However, it was not cost-effective if patients could have used catheter-based monitoring as an alternative (ICER: Dominated—more costly and less effective). The economic evaluations required numerous assumptions and uncertain inputs. Where inputs could not be derived from the systematic review or published literature, expert opinion or plausible estimates were required, and a conservative approach, not favourable to a finding of cost-effectiveness, was employed. Most inputs, although uncertain, were not found to be drivers with respect to cost-effectiveness, but two key determinants of the cost-effectiveness were identified:The accuracy of the pH test in detecting acid-related conditions. If wireless monitoring is assumed to be of equivalent accuracy to a clinical trial of high-dose PPI treatment, and both are equivalent to catheter-based monitoring, the accuracy does not limit cost-effectiveness. However, where catheter-based pH monitoring is used as a perfect reference standard and the accuracy of wireless monitoring relative to this standard is considerably lower, wireless pH monitoring is dominated in all cost–utility analyses. Although catheter-based monitoring was the DAP-specified reference, the concerns with this approach are detailed in ‘Discussion – Effectiveness’.The extent to which patients who do not receive pH monitoring to ascertain a refinement of their diagnosis would remain on high-dose PPIs, even in cases where they are not effective. If 100% of patients who do not obtain pH monitoring received active follow-up and review of their treatment and empirical investigations for alternative diagnoses, the economic analysis suggests that wireless monitoring would not be cost-effective; however, if even as few as 1 in 10 patients do not receive follow-up and inappropriately remain on high-dose PPI treatment, as assumed in the base-case, the option of wireless monitoring to assist in diagnosis becomes relatively cost-effective.The proposed listing is for use of wireless pH monitoring only in patients that cannot tolerate or that fail catheter-based pH monitoring; however, the classification of patients as such may be subjective, and some patients may have a preference toward wireless monitoring. There is then a risk that, following a listing, some patients would receive wireless monitoring when they would otherwise have had a catheter-based pH test. This economic analysis suggests that this is not cost-effective, and were it to occur in any more than one in five patients who could otherwise undergo catheter-based monitoring, the overall cost-effectiveness of the proposed listing may be compromised. The extent to which leakage would occur in practice is highly uncertain. Estimated financial impactShould the listing proceed, it is estimated that, over the next few years, approximately 400–500 patients would be eligible for the procedure each year. This represents 10% of the number of patients who receive catheter-based monitoring, as this is the estimated catheter-intolerance rate. An annual growth rate in eligibility of 4%–8% is estimated, which is consistent with recent growth rates of catheter-based monitoring.It is assumed that each episode represents a single patient; however, it is possible that some degree of repeat monitoring is undertaken such that the number of patients receiving monitoring in a year may be fewer than the number of tests, e.g. if on-medication and off-medication tests are required. The extent of this is not explored as it is not expected to change the overall financial impacts significantly.If the estimate of intolerance to catheter-based monitoring is an underestimate, or if patients who could tolerate catheter-based monitoring ‘leak’ into the market for wireless monitoring, the number of patients could increase by approximately 10-fold. It is noted that some patients will have a preference for wireless monitoring PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA (Hirano 2006; Mearin et al. 1998), and the proposed fee structure incentivises doctors to provide the wireless service rather than the catheter-based one. Therefore, a degree of leakage is anticipated, although a realistic estimate of the extent to which this may occur is difficult to predict.In addition to the cost directly associated with the MBS item listing, each wireless pH-test episode is associated with:anaesthesia (MBS items 17610, 20740, 23010) to the value of $161.80, plus an average of $5.94/patient (1 in 10 patients) to allow for additional anaesthesia costs associated with age and complication (MBS Items 25015, 23021)admission to a hospital/day-centre (AR-DRG Z40Z; average cost $607).While the standard patient MBS co-contribution of 25% (for in-patients) of the MBS fees—the proposed listing and MBS anaesthetic fees—can be estimated, the extent to which doctors’ bills will include an additional ‘gap’ charge payable by the patient is unknown. It is expected that hospital/day-facility fees will generally be paid for by private insurance companies but in some cases this may represent an additional out-of-pocket expense for the patient. Where wireless monitoring is undertaken in patients who would not have tolerated catheter-based monitoring, there are no cost offsets to be considered. Where wireless monitoring leaks into the market for patients who would have otherwise undergone catheter-based monitoring, the cost of catheter-based monitoring (MBS item 11810; $174.75) is offset from the cost implications of the wireless test.A summary of the overall financial impacts associated with the listing, in the scenarios of restricted use in the proposed population and allowing for a high level of leakage in patients who would have undergone catheter-based monitoring, are presented in Table 68 and Table 69.Table SEQ Table \* ARABIC 68Financial impact on the MBS, patients and private health insurers, assuming use is strictly limited to patients who cannot tolerate catheter-based monitoring2014–152015–162016–17Number of patients eligible for wireless test (restricted) ( REF _Ref379468075 \h \* MERGEFORMAT Table 61)388404420MBS cost of the proposed item number ($913.64/patient) a$354,761$368,952$383,710Total MBS costs associated with listing (no leakage)$419,218$435,987$453,426MBS benefits payable (75%)$314,643$327,228$340,318Patient co-payments $104,575$108,758$113,109Hospital costs associated with test ($607/patient) (Table 63)$235,695$245,122$254,927Total healthcare costs (no leakage)$654,913$681,109$708,353aMBS Benefits payable per patient round up to $810.32, which results in a total benefits calculation slightly higher than 75% of the total fee. MBS = Medicare Benefits ScheduleTable SEQ Table \* ARABIC 69Financial impact on the MBS, patients and private health insurers, assuming extensive use of wireless monitoring in patients who would otherwise have a catheter-based pH test2014–152015–162016–17Number of patients taking up wireless test including upper limit of plausible leakage (Table 60)3,8834,0384,200Total MBS costs associated with listing (with leakage)$4,192,242$4,359,586$4,533,970Cost-offset associated with replaced catheter-based test (Table 61)–$666,846–$693,367–$721,102Net change in total MBS costs (Table 62)$3,525,396$3,666,219$3,812,868Net change in MBS benefits $2,605,412$2,709,492$2,817,872Net change in patient contributions$919,985$956,726$994,996Hospital costs associated with test ($607/patient) (Table 64)$2,356,981$2,451,066$2,549,109Total healthcare costs with high level of leakage$5,882,377$6,117,285$6,361,977MBS = Medicare Benefits ScheduleWhile the leakage of wireless monitoring beyond the proposed population as presented in Table 69 is extreme and unlikely to occur to such an extent, it is clear that the level of leakage that may occur would have a very significant impact on the overall financial impacts of the proposed listing. While a strictly observed restriction would have a relatively low healthcare system cost (less than $1?million/year), even a modest amount of leakage is likely to increase this impact substantially. Conclusions Is catheter-free monitoring safe? Adverse effects may occur from catheter-free monitoring as a result of the capsule being attached to the oesophageal wall. One study reported that chest pain was significantly more likely to occur in those undergoing catheter-free monitoring than in those undergoing no pH monitoring. Rare reported complications regarding the capsule include dislodgement and/or aspiration, retention somewhere in the gastrointestinal tract, and oesophageal perforation or tearing caused by capsule placement. Twelve comparative studies reported complications of catheter-free monitoring compared with catheter-based monitoring. No deaths or life-threatening events were reported. In general, catheter-free monitoring causes less overall discomfort than catheter-based monitoring and has less impact on normal daily activities and work attendance. Nose and throat pain, dysphagia, eating and drinking difficulties, and headache were more prevalent in catheter-based monitoring. However, chest pain and foreign-body sensation were more likely to occur with catheter-free monitoring, compared with catheter-based monitoring. In conclusion, catheter-free monitoring is usually better tolerated than catheter-based monitoring. Most reported complications are mild and do not require medical therapy but some (rare) complications could become severe when they are left untreated (e.g. mucosal tears).Is catheter-free monitoring effective?Direct evidence on the health impact of catheter-free monitoring versus no monitoring in the selected study population was not available. However, there was limited evidence that the health effects of catheter-free monitoring are similar to catheter-based monitoring: one study reported disappearance of the principal symptom in 73% of patients in the catheter-free monitoring group and 69% in the catheter-based monitoring group. On the other hand, catheter-free monitoring faced more technical problems compared with catheter-based monitoring according to a meta-analysis based on eight studies (RR=3.3, 95%CI 1.47 – 5.62). The most commonly reported technical failures that caused problems in catheter-free monitoring were early capsule detachments (i.e. in the wrong place in the oesophagus or where the capsule fails to attach to the oesophageal mucosa), causing incomplete data capture and errors in placement of the system.Sensitivity and specificity could be calculated from eight studies—three used catheter-based monitoring as a reference standard, and in five the reference standard was clinical diagnosis. Sensitivity and specificity in the latter five studies varied from 67% to 100% and from 66% to 100%, respectively, versus around 86.4% and 77.8%, respectively, in the first three studies. However, these accuracy values are likely to be biased. First, as arbitrary cut-off points were used in these studies, the threshold for a positive/negative test result changes the characteristics of the index test. It has to be determined which cut-off value leads to optimal accuracy. Second, there is currently no consensus on how the cut-off values lead to a positive test result (i.e. worst day analysis, positive value on both days or reflux symptom correlations). Third, the optimal position of the capsule in the oesophagus should be determined to maximise accuracy results. Finally, the catheter-free monitoring period is 48?hours instead of only 24?hours, as with catheter-based monitoring. This increased monitoring period leads to an incremental diagnostic yield of 2.0%–15.6%, as reported in six studies. Catheter-based monitoring was used as a reference standard for diagnostic accuracy in the assessment; however, as there is an incremental diagnostic yield with catheter-free monitoring, the validity of this reference standard should be questioned. As a result of these uncertainties, no conclusion can be drawn regarding the accuracy of catheter-free monitoring compared with catheter-based monitoring. Consensus has first to be reached on a cut-off value, the use of a cut-off value, the position of the capsule and an appropriate reference standard.There was no available evidence that met the population inclusion criteria on change in management; however, change occurred in around 60% of patients who could potentially tolerate catheter-based monitoring, and management changed in 88% of child patients after a pH test. Patients with an abnormal study result were more likely to get a change in management than patients with a normal result.The evidence on whether a change in management leads to improved health outcomes was limited. Two systematic reviews and two RCTs on true positives were included to answer the question whether anti-reflux surgery for GORD leads to better health outcomes compared with medical treatment in patients with GORD (and a positive pH-test result). Anti-reflux surgery led to better health outcomes and had a higher decrease in symptoms, compared with medical management. Two RCTs published 5-year follow-up results; most patients achieved and remained in remission at 5?years with anti-reflux surgery, and fundoplication continued to give better pain relief than medical management. However, these results cannot be generalised to patients who are refractory to PPI therapy, as these trials were conducted in patients who responded to PPI therapy. Furthermore, two studies on GORD misdiagnosis in small infants were included, to provide evidence on false positive results. A small percentage (7% and 17%) of infants with infantile spasms initially received a GORD diagnosis, which led to a delay in (true) diagnosis and treatment. Treatment delay was associated with a poor outcome 2?years after diagnosis and low treatment response. In conclusion, false GORD diagnosis could lead to a delay in correct treatment and suboptimal health outcomes. However, it is not known whether this patient population is eligible for oesophageal pH monitoring. In summary, using catheter-free monitoring for GORD appears likely to be effective at benefiting the health of patients, compared with no monitoring; however, due to applicability concerns regarding the patient populations used in the studies, there is a large amount of uncertainty surrounding this conclusion. Is catheter-free monitoring cost-effective?Economic modelling suggests that catheter-free pH monitoring appears to be reasonably cost-effective in a patient population who have PPI-refractory, endoscopic negative GORD symptoms who cannot tolerate catheter-based pH monitoring, as it may result in improved diagnosis and management of symptoms, albeit at some additional cost—a base-case ICER of $14,457/QALY.However, this conclusion only holds if the accuracy of catheter-free monitoring is assumed to be close to equivalent or better than catheter-based pH monitoring, and this assumption is uncertain given the lack of evidence in using an appropriate alternative reference standard.Furthermore, the proposed listing may be used beyond the intended population in patients who would otherwise have had catheter-based monitoring; where this occurs, cost-effectiveness is substantially reduced.CostingThe expected uptake of catheter-free pH monitoring in the intended catheter-intolerant population is estimated at approximately 400 tests annually. However, if monitoring occurs in a broader population, as many as 4,000 tests could be undertaken annually. The total cost to the MBS for catheter-free pH monitoring in the intended catheter-intolerant population is estimated to be approximately $500,000 annually. This would increase to $3.6?million if the test is used in the broader population requiring pH monitoring.The total cost to the Australian healthcare system including the MBS for catheter-free pH monitoring in the intended catheter-intolerant population is estimated to be $700,000 annually, increasing to over $6?million if the test is used in the broader population requiring pH monitoring.Appendix AHealth Expert Standing Panel and Assessment GroupHealth Expert Standing Panel (HESP)MemberExpertise or affiliationProf. Robert FraserGastroenterologist, Flinders University Department of Gastroenterology, Adelaide, AustraliaProf. Robert BateyGastroenterologist, Addiction Medicine, Central Clinical School, Royal Prince Alfred Hospital, the University of Sydney, Sydney, AustraliaAssessment groupAHTA, University of Adelaide, South AustraliaNamePositionMs Sharon KesselsResearch Officer Ms Camille SchubertSenior Health EconomistMs Skye NewtonTeam leader (Medical HTA)Assoc. Prof. Tracy MerlinManaging DirectorNoted conflicts of interestThere were no conflicts of interest.Appendix BSearch strategiesAUSTRALIAAustralian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S) for Clinical Effectiveness, Monash University for Health Economics, Monash University of Technology Assessment / HTA unit d’Evaluation des Technologies et des Modes d’Intervention en Santé (AETMIS) Heritage Foundation for Medical Research (AHFMR) Institute of Health Economics Canadian Agency for Drugs And Technologies in Health (CADTH) Health Economics Research Association (CHERA/ACRES) – Cabot database Centre for Health Economics and Policy Analysis (CHEPA), McMaster University for Health Services and Policy Research (CHSPR), University of British Columbia Utilities Index (HUI) for Clinical and Evaluative Studies (ICES) Health Quality Council (Canada) Centre for Evaluation and Health Technology Assessment (DACEHTA) Institute for Health Services Research (DSI) Office for Health Technology Assessment (FINOHTA) ’Agence Nationale d’Accréditation et d’Evaluation en Santé (ANAES) Institute for Medical Documentation and Information (DIMDI) / HTA for Quality and Efficiency in Health Care (IQWiG) NETHERLANDSHealth Council of the Netherlands Gezondheidsraad for Medical Technology Assessment (Netherlands) ZEALANDNew Zealand Health Technology Assessment (NZHTA) Knowledge Centre for the Health Services de Evaluación de Tecnologias Sanitarias, Instituto de Salud “Carlos III”I/Health Technology Assessment Agency (AETS) Agency for Health Technology Assessment (Spain) Agency for Health Technology Assessment (CAHTA) for Medical Health Technology Assessment Council on Technology Assessment in Health Care (SBU) Network on Health Technology Assessment (SNHTA) KINGDOMNational Health Service Health Technology Assessment (UK) / National Coordinating Centre for Health Technology Assessment (NCCHTA) Quality Improvement Scotland Institute for Clinical Excellence (NICE) European Information Network on New and Changing Health Technologies of York NHS Centre for Reviews and Dissemination (NHS CRD) STATESAgency for Healthcare Research and Quality (AHRQ) School of Public Health for Clinical and Economic Review (ICER) for Clinical Systems Improvement (ICSI) Department of Health (US) Information Centre of Health Services Research and Health Care Technology (US) Health Resources Commission (US) of Health Technology Assessment Archive (US). Blue Cross/ Blue Shield Association Technology Evaluation Center (Tec)’s Affairs Research and Development Technology Assessment Program (US) databasesElectronic databaseTime periodCochrane Library – including, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials (CENTRAL), the Health Technology Assessment Database, the NHS Economic Evaluation Database2001 – 9/2013Current Contents 2001 – 9/2013Embase 2001 – 9/2013PubMed2001 – 9/2013Web of Science – Science Citation Index Expanded2001 – 9/2013Cinahl2001 – 9/2013Econlit2001 – 9/2013Scopus2001 – 9/2013Additional sources of literatureSourceLocation InternetNHMRC- National Health and Medical Research Council (Australia) Department of Health and Human Services (reports and publications) York Academy of Medicine Grey Literature Report database Controlled Trials metaRegister Library of Medicine Health Services/Technology Assessment Text. National Research Register Scholar and New Zealand Clinical Trials Registry included articles will have their reference lists searched for additional relevant source materialGuidelines search (last step linked evidence)Guidelines International Network (G-I-N) Clinical Guidelines Portal databases searched for economic evaluationsElectronic databaseCost-effectiveness Analysis (CEA) RegistryDatabase of Abstracts of Reviews of Effects or Reviews of Effects (DARE)Health Technology Assessment databaseNHS Economic Evaluation Database (NHS EED)European Network of Health Economics Evaluation Databases (EURONHEED)Specialty websitesInternational Foundation for Functional Gastrointestinal Disorders Gastroenterological Association college of Gastroenterology Society of Australia CStudies included in the review Study profiles of included studies on safetyStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / Exclusion criteriaDiagnostic testsSafety outcomes assessedAgrawal, Akerman & Rich PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWdyYXdhbDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWdyYXdhbDwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2009)Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USACase reportLevel: NA1 patient45 year old femaleIndication:Persistent heartburn despite maximal acid-suppressive therapyInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the SCJDuration: not statedMild epigastric painSevere retrosternal chest discomfortAhlawat et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWhsYXdhdDwvQXV0aG9yPjxZ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 EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWhsYXdhdDwvQXV0aG9yPjxZ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 EN.CITE.DATA (2006)Division of Gastroenterology, Department of Medicine, Georgetown University Hospital, Washington, DC, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P290 patients 48 males and 42 femalesAge range: 18–80 yearsIndications:Being intolerant to the conventional naso-oesophageal pH catheter placement or had normal 24-hour oesophageal pH monitoring despite symptomsInclusion:Not statedExclusion:Patients with bleeding diathesis, strictures, severe oesophagitis, varices, obstructions, pacemakers, implantable cardiac defibrillators, and surgical manipulations of the upper GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursComparator: NAChest painForeign-body sensationAndrews et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5kcmV3czwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5kcmV3czwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2012)Division of Gastroenterology, University of Calgary, CanadaDual centre, randomised, non-blinded trialLevel: IIQuality: 19/26CX P286 patients(40 in Calgary and 46 in Edmonton)61 females, 25 malesAge range 18–75 yearsIndications:Reflux symptomsChest painDysphagiaInclusion:Patients aged 18–75?years referred for ambulatory pH monitoring between August 2008 and August 2009Exclusion:Patients with previous oesophageal surgery or achalasiaIndex test:System: activated and calibrated Bravo? wireless capsule system, Medtronic Inc., Minneapolis, MNInsertion: transorally Placement: 5 cm above the proximal border of the LOSDuration: 24 (Calgary) or 48 (Edmonton) hoursComparator:Catheter: calibrated standard antimony-based pH catheter (Comfortec Plus catheter and ZepHR Sleuth recorder, Sandhill Scientific Inc., Highlands Ranch, CO)Insertion: transnasallyPlacement: 5 cm above the proximal border of the LOSDuration: 24 hoursManometry discomfort (nasal, throat, chest, overall) pH placement discomfort (nasal, throat, chest, overall) pH-test discomfort (nasal, throat, chest, overall)Eating and drinkingAbility to do usual daily activitiesAzzam et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2012)Sao Paulo University Medical School, Sao Paulo, BrazilCase seriesLevel: IV Quality: Q1CX (no comparator)P225 patients21 females, 4 malesMean age: 52.4 years (range 34–73)Indications:All patients had as predominant symptom the typical GORD complaints; 64% also had atypical complaints and 76% had associated extra oesophageal complaintsInclusion:Heartburn and/or regurgitation as the main clinical complaint; at least 18?years of age; recent upper GI endoscopy (within the past 2?months); interruption in the administration of PPIs for 7 days; and signature on the free and informed consent formExclusion:Oesophageal diverticula; strictures and varices; hiatal hernia greater than or equal to 3?cm; erosive oesophagitis Los Angeles grades C or D; Barrett’s oesophagus; neoplasms; obstructive diseases; previous surgery of the GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 3 cm above the superior border of the LOSDuration: 48 hoursComparator: NAChest pain (none)Belafsky et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVsYWZza3k8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVsYWZza3k8L0F1dGhvcj48
WWVhcj4yMDA0PC9ZZWFyPjxSZWNOdW0+MTk5PC9SZWNOdW0+PElEVGV4dD4yNi04PC9JRFRleHQ+
PERpc3BsYXlUZXh0PigyMDA0KTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4xOTk8
L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZkZmxk
ZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjE5OTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYt
dHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxh
dXRob3JzPjxhdXRob3I+QmVsYWZza3ksIFAuIEMuPC9hdXRob3I+PGF1dGhvcj5BbGxlbiwgSy48
L2F1dGhvcj48YXV0aG9yPkNhc3Ryby1EZWwgUm9zYXJpbywgTC48L2F1dGhvcj48YXV0aG9yPlJv
c2VtYW4sIEQuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+
U2NyaXBwcyBDZW50ZXIgZm9yIFZvaWNlIGFuZCBTd29sbG93aW5nLCBMYSBKb2xhLCBDQSA5MjAz
NywgVVNBLiBwY2JAc2FuLnJyLmNvbTwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPldpcmVs
ZXNzIHBIIHRlc3RpbmcgYXMgYW4gYWRqdW5jdCB0byB1bnNlZGF0ZWQgdHJhbnNuYXNhbCBlc29w
aGFnb3Njb3B5OiB0aGUgc2FmZXR5IGFuZCBlZmZpY2FjeSBvZiB0cmFuc25hc2FsIHRlbGVtZXRy
eSBjYXBzdWxlIHBsYWNlbWVudDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5PdG9sYXJ5bmdvbCBI
ZWFkIE5lY2sgU3VyZzwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+T3RvbGFyeW5nb2xvZ3kt
LWhlYWQgYW5kIG5lY2sgc3VyZ2VyeSA6IG9mZmljaWFsIGpvdXJuYWwgb2YgQW1lcmljYW4gQWNh
ZGVteSBvZiBPdG9sYXJ5bmdvbG9neS1IZWFkIGFuZCBOZWNrIFN1cmdlcnk8L2FsdC10aXRsZT48
L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5PdG9sYXJ5bmdvbCBIZWFkIE5lY2sgU3Vy
ZzwvZnVsbC10aXRsZT48YWJici0xPk90b2xhcnluZ29sb2d5LS1oZWFkIGFuZCBuZWNrIHN1cmdl
cnkgOiBvZmZpY2lhbCBqb3VybmFsIG9mIEFtZXJpY2FuIEFjYWRlbXkgb2YgT3RvbGFyeW5nb2xv
Z3ktSGVhZCBhbmQgTmVjayBTdXJnZXJ5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9k
aWNhbD48ZnVsbC10aXRsZT5PdG9sYXJ5bmdvbCBIZWFkIE5lY2sgU3VyZzwvZnVsbC10aXRsZT48
YWJici0xPk90b2xhcnluZ29sb2d5LS1oZWFkIGFuZCBuZWNrIHN1cmdlcnkgOiBvZmZpY2lhbCBq
b3VybmFsIG9mIEFtZXJpY2FuIEFjYWRlbXkgb2YgT3RvbGFyeW5nb2xvZ3ktSGVhZCBhbmQgTmVj
ayBTdXJnZXJ5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjYtODwvcGFnZXM+PHZv
bHVtZT4xMzE8L3ZvbHVtZT48bnVtYmVyPjE8L251bWJlcj48ZWRpdGlvbj4yMDA0LzA3LzEwPC9l
ZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5DYXBzdWxlczwva2V5d29yZD48a2V5d29yZD5DaHJv
bmljIERpc2Vhc2U8L2tleXdvcmQ+PGtleXdvcmQ+Q291Z2gvIGV0aW9sb2d5PC9rZXl3b3JkPjxr
ZXl3b3JkPkVzb3BoYWdvc2NvcHkvIG1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9r
ZXl3b3JkPjxrZXl3b3JkPkdhc3RyaWMgQWNpZGl0eSBEZXRlcm1pbmF0aW9uL2luc3RydW1lbnRh
dGlvbjwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC8gZXRpb2xvZ3k8
L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkh5ZHJvZ2VuLUlvbiBD
b25jZW50cmF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlk
ZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TW9uaXRvcmluZywgUGh5c2lvbG9naWMvIGluc3Ry
dW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5Qcm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3Jk
PjxrZXl3b3JkPlRyZWF0bWVudCBPdXRjb21lPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5
ZWFyPjIwMDQ8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5KdWw8L2RhdGU+PC9wdWItZGF0ZXM+PC9k
YXRlcz48aXNibj4wMTk0LTU5OTggKFByaW50KSYjeEQ7MDE5NC01OTk4IChMaW5raW5nKTwvaXNi
bj48YWNjZXNzaW9uLW51bT4xNTI0MzU1MzwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11
cmxzPjx1cmw+aHR0cDovL290by5zYWdlcHViLmNvbS9jb250ZW50LzEzMS8xLzI2LmZ1bGwucGRm
PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4x
MDE2L2oub3RvaG5zLjIwMDQuMDEuMDE5PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3Rl
LWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFn
ZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE.DATA (2004)Scripps Center for Voice and Swallowing, La Jolla, California, USAProspective case seriesLevel: IVQuality: Q2CX (no comparator)P246 patients23 males and 23 femalesMean age: 52 yearsIndications: GORD, chronic cough, laryngopharyngeal reflux Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the manometric lower oesophageal high-pressure zone or 6?cm above the endoscopic SCJDuration: >36 hoursComparator: NASelf-limited epistaxisLaryngospasmVasovagal reactionBhat, McGrath & Bielefeldt PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2006)Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAProspective case seriesLevel: IVQuality: Q2CX (no comparator)P2217 patients140 females, 77 malesMean age: 51 years (range 42–58)Indications:Preoperative workup for fundoplication, possible extra oesophageal manifestations of reflux disease, symptoms after fundoplication, refractory symptoms on medication, atypical symptomsInclusion:Adult patients undergoing endoscopy with wireless pH studies at the University of Pittsburgh Medical Center between 9 April 2004 and 31 March 2005Exclusion:Individuals unable to give informed consent, pregnant women, prisoners, patients with oesophageal varices, patients requiring continuing anticoagulation, patients with cardiac defibrillatorsIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NAChest discomfortRashBothwell, Phillips & Bauer PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Qm90aHdlbGw8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Qm90aHdlbGw8L0F1dGhvcj48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ADDIN EN.CITE.DATA (2004)Department of Otolaryngology, University of Missouri-Columbia, Columbia, Missouri, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P225 patientsMean age: 3 years (range 3 months – 11 years)Indications: Vomiting and dysphagia, ‘noisy breathing’, chronic cough, aspiration pneumonia, reactive airway disease, recurrent croup, known subglottic stenosis, nasal airway obstruction with rhinosinusitis, sleep apnoea, restrictive lung diseaseInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: just below the closed cricopharyngeal muscle in the upper oesophagusDuration: 48 hoursComparator: NAMucosal tearBradley et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QnJhZGxleTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QnJhZGxleTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USACohort studyLevel: III-2Quality: 15/26CXP2341 patients (248 patients underwent Bravo monitoring)62% females in the wireless group, 72% females in the catheter groupMean age: 58 years in wireless group, 57?years in catheter groupInclusion:Outpatients undergoing ambulatory pH-metry between October 2006 and October 2008Exclusion:Known history of oesophageal strictures, obstructions or surgical manipulations of the upper GI tract (e.g. anti-reflux surgery or oesophagectomy)Index test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJ or 5 cm above the upper border of the LOSDuration: 48 hoursComparator (MII-pH):System: Sandhill Scientific Inc., Highland Ranch, USAInsertion: transnasallyPlacement: proximal channel 5 cm above upper border of the LOSDuration: 24 hoursComparator (pH-metry):System: Alpine Biomed, Corp, Fountain Valley, USA Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursChest discomfortForeign-body sensationChest and abdominal painDifficulty swallowingPainful swallowingEating and drinkingNausea and vomitingCabrera et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FicmVyYTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FicmVyYTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana, USAProspective case seriesLevel: IVQuality: Q1CX (no comparator)P2289 patients (At least 1?day of data was obtained in 278 patients; 2 days were obtained in 274 patients)144 females, 145 malesAge: range 4–22 yearsIndications:Epigastric abdominal pain (59.9%), vomiting (33.9%), regurgitation (23.9%), heartburn (18.3%)Inclusion:Children who are at least 4?years of age and weigh at least 30?lbExclusion:Children with a history of oesophageal surgery, a documented anatomic abnormality, or a history of coagulopathy or a bleeding diathesisIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: at 87% of the distance from the incisors to the Z lineDuration: 48 hoursComparator: NAOesophageal mucosa tearCalabrese et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FsYWJyZXNlPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FsYWJyZXNlPC9BdXRob3I+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ADDIN EN.CITE.DATA (2008)Department of Clinical Medicine, University of Bologna, Bologna, ItalyCase seriesLevel: IVQuality: Q2CX (no comparator)P324 patients (12 males, 12 females)Mean age: 37.7 ± 11.9?yearsIndications: Typical symptoms of GORD (heartburn and/or regurgitation)Inclusion:The presence of clinical symptoms such as heartburn and/or regurgitation without erosive oesophagitis, symptoms occurred more than twice weekly for at least 6?months, treatment with acid suppression had results in complete symptom relief or in reduction of the symptoms by more than 50%Exclusion:Coagulopathy, severe oeosphagitis/strictures, erosive oesophagitis, portal hypertension, a history of upper Gl surgery, Helicobacter pylori infection, age <20 or >70?years, pacemakerIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 96 hoursComparator: NAOccasional retrosternal discomfort on swallowingCroffie et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2007)Section of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana, USARandomised controlled trialLevel: IIQuality:14.5/26CXP266 patients (children)(but 5 patients were excluded due to operative failure, failed recording etc.)32 males, 34 femalesMean age: 9.4 years (range 4–16.5)Indications:Persistent epigastric or substernal pain, persistent vomiting, heartburn, chronic nocturnal cough or wheezing, persistent throat clearance, dental abnormalities suspected to be caused by refluxInclusion:Children between the ages of 4 and 18?years and weighing at least 30?lb who were undergoing oesophagogastroduodenoscopy and oesophageal pH monitoring for symptoms suggestive of gastro-oesophageal reflux.Exclusion:Children younger than 4?years of age or weighing <30?lb, having anatomic abnormalities of the oesophagus, a history of surgical procedure of the oesophagus, stomach or duodenum, a history of coagulopathy or bleeding diathesis, presence of oesophageal varices, significant medical illnessIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: at 87% of the distance from the incisors to the Z lineDuration: 48 hoursComparator:System: not stated (catheter-based)Insertion: transnasallyPlacement: tip at 87% of the distance from the nostril to the GOJDuration: 24 hoursVomitingChest painThroat painOesophageal discomfortEating and drinkingActivitySatisfaction Crowell et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3Jvd2VsbDwvQXV0aG9yPjxZ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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3Jvd2VsbDwvQXV0aG9yPjxZ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==
ADDIN EN.CITE.DATA (2009)Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USACase seriesLevel: IVQuality: Q1CX (no comparator)P2157 patients, predominantly (>95%) Caucasian Indications: heartburn/regurgitation symptoms, chest pain, abdominal pain/discomfort Inclusion:Patients with GORD symptomsExclusion:History of bleeding diathesis, strictures, severe oesophagitis, varices, obstructions, pacemakers or implantable cardiac defibrillatorsIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the endoscopically determined GOJ or 5?cm above the manometrically determined upper margin of the LOS Duration: 48 hoursComparator: NAForeign-body sensationChest discomfortChest painDiminished appetitede Hoyos & Esparza (2010); de Hoyos, Esparza & Loredo (2009)Department of Gastroenterology, Angeles del Pedregal Hospital, Mexico City, MexicoProspective case seriesLevel: IVQuality: Q2CX (no comparator)P266 patients27 males, 39 femalesMean age: 41.7 years (range 11–73)Indications:Typical oesophageal reflux symptoms, atypical manifestations or a mixed symptomatologyInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm from the SCJDuration: 48 hoursComparator: NAIntolerable chest painDetachment failuredes Varannes et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE.DATA (2005)Department of Gastroenterology and Hepatology, Hopital Hotel Dieu, Nantes, FranceCase seriesLevel: IV Quality: Q1CX (no comparison)P240 patients(probe successfully attached in 36 patients)21 males, 19 femalesMean age: 50 yearsIndications:Heartburn (n=7), regurgitation (n=6) or both symptoms (n=26)Inclusion:Patients suggestive of GORD and referred to the functional laboratory of four French academic centres for pH monitoringExclusion:Severe oesophageal motility disorders, severe oesophagitis (Los Angeles grade C or above), pregnancy, women who were not using reliable contraceptionIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the Z lineDuration: 48 hoursComparator: NAEpistaxisDizzy spellsSleep disordersDysphagia for liquidsSwallowing discomfortThoracic discomfortDomingues, Moraes-Filho & Domingues PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE.DATA (2011)Motility laboratory (Gastro Resolucao Diagnostico, Laboratorio de Motilidade Digestive), Rio de Janeiro, BrazilRetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P2100 patients(probe successfully attached in 95 patients)39 female, 61 maleMean age: 53 years (range 18– 81)Indications:82% were referred to diagnose GORD, 18% were referred due to persistent symptoms despite PPI useInclusion:Patients referred to a GI motility laboratory to investigate GORD with typical or atypical symptoms, persistent GORD symptoms on medical therapy or recurrent GORD symptoms after surgical fundoplication, between 2004 and 2009Exclusion:<18 years of age, history of bleeding tendency or coagulopathy, significant concomitant medical co-morbidities, severe GI bleeding in the past 6?months, a history of upper GI surgery, medication with PPIs, presence of oesophageal varices, Barrett’s oesophagus, oesophageal stenosis, erosive oesophagitis, pacemaker or implantable cardiac defibrillator in situIndex test:System: Bravo? wireless capsule systemInsertion: 5 cm above the upper border of the LOS (manometry) or 6 cm above the LOS (endoscopy)Placement: transorallyDuration: 48 hoursComparator: NAForeign-body sensationChest painFajardo et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RmFqYXJkbzwvQXV0aG9yPjxZ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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RmFqYXJkbzwvQXV0aG9yPjxZ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==
ADDIN EN.CITE.DATA (2006)Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USACase reportLevel: NA1 patient76 year old womanIndication:Recurrent GORD, failing to respond to medical therapyInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: not statedDuration: NAComparator: NAMucosal tear with oesophageal perforationFrancis, DL ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Francis</Author><Year>2008</Year><RecNum>235</RecNum><IDText>2663</IDText><DisplayText>(2008)</DisplayText><record><rec-number>235</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">235</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francis, D. L.</author></authors></contributors><titles><title>Attachment disorder: a decline in the performance of the Bravo pH system</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>2663</pages><volume>103</volume><number>10</number><edition>2008/10/16</edition><keywords><keyword>Endoscopes, Gastrointestinal</keyword><keyword>Equipment Failure</keyword><keyword>Esophageal pH Monitoring/ instrumentation</keyword><keyword>Esophagus/ physiopathology</keyword><keyword>Gastroesophageal Reflux/ diagnosis/physiopathology</keyword><keyword>Humans</keyword><keyword>Peristalsis/ physiology</keyword><keyword>Retrospective Studies</keyword></keywords><dates><year>2008</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1572-0241 (Electronic)
0002-9270 (Linking)</isbn><accession-num>18855870</accession-num><urls><related-urls><url>;(2008)Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P276 patientsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NASevere chest painCapsule dislodgement in the pyriform sinusFrancis, DO et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Francis</Author><Year>2012</Year><RecNum>236</RecNum><IDText>91-97</IDText><DisplayText>(2012)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francis, D. O.</author><author>Sumner, E.</author><author>Goutte, M.</author><author>Slaughter, J. C.</author><author>Garrett, C. G.</author><author>Hagaman, D.</author><author>Vaezi, M. F.</author></authors></contributors><titles><title>Feasibility of Dual Wireless Esophageal pH Monitoring: Randomized Blinded Sham-Controlled Trial</title><secondary-title>Otolaryngology-Head and Neck Surgery</secondary-title></titles><periodical><full-title>Otolaryngology-Head and Neck Surgery</full-title></periodical><pages>91-97</pages><volume>147</volume><number>1</number><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0194-5998</isbn><accession-num>CCC:000314267600016</accession-num><urls><related-urls><url><Go to ISI>://CCC:000314267600016</url><url>;(2012)Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USARandomised, blinded controlled trialLevel: II Quality: 16/26C1P222 patients were included (13 males, 9 females)Indications:Cough, hoarseness, globus, heartburn, regurgitationInclusion:Patients >18 years of age, scheduled for planned oesophagogastroduodenoscopy and wireless pH monitoring for physiologic assessment of oesophageal acid exposure for typical GORD symptoms or for extraoesophageal reflux (EER) symptomsExclusion:History of upper oesophageal surgery, bleeding dyscrasia, recent cerebrovascular accident or transient ischemic attack, recent (<6?months) GI haemorrhage, oesophageal varices or significant medical illness, current pregnancyIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 16 cm above the SCJDuration: 48 hoursComparator:No monitoring (a sham capsule placement)Chest pain (adj OR)Odynophagia (adj OR)Dysphagia (adj OR)Garrean et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2008)Division of Gastroenterology, Northwestern University Freiberg School of Medicine, Chicago, Illinois, USACase series (prospective?)Level: IVQuality: Q2CX (no comparator)P260 patients (22 males and 38 females) Age: 19–80?years40 patients had complete 4-day data acquisitionIndications: acid reflux symptoms, chest pain, laryngeal symptoms that were poorly responsive to twice-daily PPI therapy for a minimum of 6?weeksInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJComparator: NABack painGlobus sensationChest painGillies et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2007)Departments of Upper Gastrointestinal Surgery and Gastrointestinal Physiology, Royal Berkshire hospital, Reading, UKNon-randomised controlled trialLevel: III-2 Quality: 13.5/26CXP2185 patients, but 200 oesophageal pH studies104 males, 81 femalesMean age: Catheter group: 46?years (range 16–71)Bravo group: 45?years (range 13–75)Indication: Symptoms suggestive of GORD or documenting the outcome of laparoscopic anti-reflux surgeryInclusion:See indicationExclusion:No specific exclusion criteria existIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursComparator:System: MedtronicInsertion: transnasallyPlacement: 5 cm above the proximal border of the LOSDuration: 24 hoursOverall discomfort (during insertion and monitoring)Nasal discomfortThroat discomfortOesophageal discomfortInterference with daily activitiesEatingSleepingWork attendanceGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2007)Gastroenterology, Department of Medical Sciences, University of Milan, Milan, ItalyPseudo-randomised controlled trialLevel: III-1Quality: 13.5/26CXP2133 patientsCatheter group: 78 patients, 46% males, aged 53 ± 2?yearsBravo group: 55 patients, 45% males, aged 44 ± 3?years)Indication: Suspected GORD, consecutively referred for oesophageal pH monitoringInclusion:See indicationExclusion:Previous GI surgery (excluding cholecystectomy and appendectomy) and known or suspected stricture of the GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach, or 5?cm above the upper margin of the LOS Duration: 24 hoursDiscomfort at placementOverall discomfortChest discomfortEating and drinkingInterference with daily activitiesGunnarsdottir, Stenstrom & Arnbjornsson PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE.DATA (2007, 2008)Department of Paediatric Surgery, Lund University Hospital, Lund, SwedenCase seriesLevel: IVQuality: Q1CX (no comparator)P258 children37 males, 21 females Mean age: 8 ± 4?yearsIndications:Vomiting, abdominal and chest pain, GORD control, GI bleeding, respiratory symptomsInclusion:Not statedExclusion: Oesophageal strictures, coagulopathy, any suspicion of intestinal stricturesIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: above the diaphragm valve at the width of two of the individual patient’s vertebral bodies as visualised on a perioperative X-rayDuration: 24 or 48?hours (23 children had 48-hour measurement)Comparator: NA Chest discomfortCoughingDysphagiaHakanson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2009)Department of Surgery, Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, SwedenCase-control study with in-subject simultaneous recordingLevel: III-2Quality: 14/26CXP253 volunteers and 55 patients (45 volunteers and 47 patients had enough data to be included)30 females and 15 males in volunteer group27 females and 20 males in patient groupMean age: Volunteers: 47?years (range 21–68)Patients: 50?years (range 23–69)Indication: Patients had symptoms including mainly heartburn, acid regurgitation, and chest or epigastric painInclusion:Patients: referred to the clinic for investigation of GORDExclusion:Volunteers: history of GORD or any other pathology of the upper GI tract, taking acid-suppressing agents or medication known to affect GI motilityIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJ Duration: 48 hoursComparator:System: Slimline, Medtronic, Skovlunde, DenmarkInsertion: transnasallyPlacement: 5 cm proximal to the upper border of the LOSDuration: 24 hoursComplications (none)Premature removal of the capsule (none)Hirano et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Hirano</Author><Year>2005</Year><RecNum>511</RecNum><IDText>1083-1088</IDText><DisplayText>(2005)</DisplayText><record><rec-number>511</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">511</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hirano, I.</author><author>Zhang, Q.</author><author>Pandolfino, J. E.</author><author>Kahrilas, P. J.</author></authors></contributors><titles><title>Four-day Bravo pH capsule monitoring with and without proton pump inhibitor therapy</title><secondary-title>Clinical Gastroenterology and Hepatology</secondary-title></titles><periodical><full-title>Clinical Gastroenterology and Hepatology</full-title></periodical><pages>1083-1088</pages><volume>3</volume><number>11</number><dates><year>2005</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>CCC:000234106100009</accession-num><urls><related-urls><url><Go to ISI>://CCC:000234106100009</url></related-urls></urls><electronic-resource-num>10.1016/s1542-3565(05)00529-x</electronic-resource-num></record></Cite></EndNote>(2005)Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USACase series (prospective)Level: IVQuality: Q2CX (no comparator)P218 patients (17 patients had enough data to be included)6 males, 12 femalesMedian age: 52 yearsIndications:Chest pain, refractory heartburn, laryngeal symptomsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the endoscopically determined SCJDuration: 4 days Comparator: NAChest pain (none)Dysphagia (none)Bleeding (none)Hochman and Favaloro-Sabatier PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9jaG1hbjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9jaG1hbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2005)Children’s Center for Digestive Health Care, Atlanta, Georgia, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P244 patients (children)27 males, 17 femalesMean age: 11.8?years (range 6–19)Inclusion: Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the proximal border of the LOSDuration: 48 hoursComparator: NAPatient discomfortHogan et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9nYW48L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9nYW48L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2009)Gastrointestinal Associates, Jackson, Mississippi, USACase report (letter to the editor)Level: NA1 patient72 year old maleIndication: Symptoms of gastro-oesophageal refluxInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: not statedDuration: not stated2-year retention of the capsule in a giant colonic diverticulumKaramanolis et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Karamanolis</Author><Year>2012</Year><RecNum>268</RecNum><IDText>169-73</IDText><DisplayText>(2012)</DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Karamanolis, G.</author><author>Triantafyllou, K.</author><author>Psatha, P.</author><author>Vlachogiannakos, I.</author><author>Gaglia, A.</author><author>Polymeros, D.</author><author>Fessatou, S.</author><author>Triantafyllou, M.</author><author>Papanikolaou, I. S.</author><author>Ladas, S. D.</author></authors></contributors><auth-address>Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University General Hospital, Athens Medical School, Athens, Greece.</auth-address><titles><title>Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors</title><secondary-title>J Neurogastroenterol Motil</secondary-title><alt-title>Journal of neurogastroenterology and motility</alt-title></titles><periodical><full-title>J Neurogastroenterol Motil</full-title><abbr-1>Journal of neurogastroenterology and motility</abbr-1></periodical><alt-periodical><full-title>Journal of Neurogastroenterology and Motility</full-title></alt-periodical><pages>169-73</pages><volume>18</volume><number>2</number><edition>2012/04/24</edition><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>2093-0887 (Electronic)
2093-0879 (Linking)</isbn><accession-num>22523725</accession-num><urls><related-urls><url>;(2012)2nd Department of Internal Medicine, Propaedeutic Attikon University General Hospital, Athens, GreeceCase series (prospective?)Level: IVQuality: Q1CX (no comparator)P232 patients18 males, 14 femalesMean age: 45.3 ± 12.5?yearsIndications:Three episodes of non-cardiac chest pain per weekInclusion:Patients with at least three episodes of chest pain per week and normal oesophageal manometry (in order to exclude the presence of any oesophageal motility disorder)Exclusion:Patients that were using aspirin or NSAIDs, a history of upper GI surgery, gastric or duodenal ulcer, connective tissue disease, or severe liver, lung, renal or haematological diseaseIndex test:System: Bravo? wireless capsule systemInsertion: transorally Placement: 6 cm proximal to the SCJDuration: 48 hoursComparator: NAThroat painBack painGlobus sensationKramer & Chokhavatia PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S3JhbWVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S3JhbWVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2012)Department of Medicine, the Mount Sinai Medical Center, New York, New York, USACase reportLevel: NA1 patient44 year old maleIndication:History of GORD symptoms, non-adherent to anti-reflux therapyInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the GOJComparator: NACapsule dislodging into the pyriform sinusLacy, Chehade & Crowell PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2011)Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USACase seriesLevel: IVQuality: Q1CX (no comparator)P2358 patients (257 females, 101 males)Mean age: 51 ±14?yearsPredominantly (97%) Caucasian Indications: Symptoms thought secondary to GORDInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the GOJ or 5?cm above the upper border of the LOSDuration: 48 hoursComparator: NAChest discomfortLee et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGVlPC9BdXRob3I+PFllYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGVlPC9BdXRob3I+PFllYXI+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ADDIN EN.CITE.DATA (2005)Department of Internal Medicine, Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanProspective case seriesLevel: IVQuality: Q3CX (no comparator)P240 patients (27 males and 13 females)Age: range 28–83 yearsIndications:Typical heartburn with unsatisfactory response to therapy (15), erosive oesophagitis and undergoing preoperative evaluation (25)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NARetrosternal discomfortMucosal lesionForeign-body sensationMarchese et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Marchese</Author><Year>2006</Year><RecNum>516</RecNum><IDText>813-818</IDText><DisplayText>(2006)</DisplayText><record><rec-number>516</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">516</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marchese, M.</author><author>Spada, C.</author><author>Iacopini, F.</author><author>Familiari, P.</author><author>Shah, S. G.</author><author>Tringali, A.</author><author>Costamagna, G.</author></authors></contributors><titles><title>Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: feasibility, safety, and efficacy of a manometry-guided procedure</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>813-818</pages><volume>38</volume><number>8</number><dates><year>2006</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0013-726X</isbn><accession-num>CCC:000240368800009</accession-num><urls><related-urls><url><Go to ISI>://CCC:000240368800009</url></related-urls></urls><electronic-resource-num>10.1055/s-2006-944526</electronic-resource-num></record></Cite></EndNote>(2006)Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Catholic University of Rome, Rome, ItalyProspective case seriesLevel: IVQuality: Q1CX (no comparator)P240 patients (36 patients had successful oesophageal placement of the capsule)23 males, 17 femalesMean age: 42.5 yearsIndications:Reflux symptoms that were refractory to PPI therapy Inclusion:Patients with reflux symptoms refractory to PPI therapy who had normal or equivocal endoscopic findingsExclusion:Patients with oesophageal varices, previous GI surgery, known coagulopathy or bleeding diathesis, cardiac pacemakers, defibrillators or other electromedical devices, significant comorbidity, pregnant women and patients <18?years of ageIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the upper margin of the LOSDuration: 24 or 48 hoursComparator: NAMild discomfortSevere chest pain(Endoscopic removal of the capsule)EpistaxisPharyngeal irritationNusrat, Roy & Bielefeldt PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TnVzcmF0PC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TnVzcmF0PC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2012)University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2356 patients (65% females)Mean age: 49.9 ± 0.8?yearsIndications:Evaluations of GORD, recurrent or persistent symptoms after fundoplication, chest pain, unexplained cough or other atypical symptomsInclusion:Not statedExclusion:Patients with pacemakers, implanted cardiac defibrillators, known oesophageal varices, bleeding disorders or ongoing anticoagulationIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the endoscopically localised SCJ or 5?cm above the manometrically determined upper border of the LOSDuration: 48 hoursComparator: NANo significant adverse effects during the studyPandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE.DATA (2003)Northwestern University Feinberg School of Medicine, Chicago, Illinois, USACohort studyLevel: III-2 Quality: 11.5/26CX P344 controls (13 males, 31 females, aged 23–53?years) 41 patients (26 males, 15 females, aged 32–72?years)Inclusion:Not statedExclusion:Controls: abdominal symptoms, use of antacids or antisecretory medication, abnormal endoscopyPatients: history of surgical manipulation of the upper GI tract, history of bleeding diathesis or coagulopathy, stroke or transient ischemic attack in the past 6?months, significant medical illness, oesophageal varicesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJComparator:System: not stated (catheter-based)Insertion: transnasallyPlacement: not statedDuration: 24 hoursForeign-body sensationChest painThroat discomfortLate detachmentOesophageal discomfortEating and drinkingActivitySleep patternsPandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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=
ADDIN EN.CITE.DATA (2006)Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USACase seriesLevel: IVQuality: Q2CX (no comparator)P310 normal control subjects (7 males and 3 females, aged 21–53?years) 10 patients with GORD (6 males and 4 females, aged 20–54?years)Inclusion:Controls: no history of heartburn, reflux, chest pain or atypical symptomsPatients: oesophagitis (3) or an abnormal 24-hour oesophageal pH study prior to this studyExclusion:History of surgical manipulation of the upper GI tract, anticoagulation therapy, significant medical diseaseControls: abdominal symptoms, use of antacids, abnormal upper endoscopyIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 1 cm proximal to SCJDuration: 24 hoursComparator: NAChest discomfortForeign-body sensationPrakash et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UHJha2FzaDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UHJha2FzaDwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2006)Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P28 patients (who required endoscopic dislodgement because of severe discomfort) out of 452 patients6 females, 2 malesMean age: 44.5 years (range 29–67)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: not statedDuration: not statedComparator: NASevere discomfortSevere chest pain and/or odynophagiaForeign-body sensationRemes-Troche et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVtZXMtVHJvY2hlPC9BdXRo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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVtZXMtVHJvY2hlPC9BdXRo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ADDIN EN.CITE.DATA (2005)Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, MexicoProspective case seriesLevel: IVQuality: Q1CX (no comparator)P284 patients (77 patients had enough data to be included)49 females, 35 malesMean age: 44 ± 12?years (range 19–73)Indications:Persistent GORD symptoms on PPI, preoperative evaluation before surgery, previous failed transnasal pH monitoring, extraoesophageal GORDInclusion:Consecutive patients with GORD symptoms with an indication for 24-hour pH monitoringExclusion:Patients with surgical manipulation of the upper GI tract, bleeding diathesis or coagulopathy, severe GI bleeding in the past 6?months, oesophageal varices, significant comorbiditiesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NAChest painForeign-body sensationNauseaRenteln et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVudGVsbjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVudGVsbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2008)Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, GermanyCase reportLevel: NA One 44 year old patientIndication: Evaluation of atypical GORD symptomsInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the upper margin of the LOSDuration: NAComparator: NARetchHeavy coughDropped oxygen saturationCapsule aspirationScarpulla et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE.DATA (2007)Gastroenterology Division, M. Raimondi Hospital, Can Cataldo, ItalyRetrospective case seriesLevel: IVQuality: Q2CX P283 patients (complete 4-day recordings were available for 34/83)44 females, 39 malesMedian age: 42 years (range 18–63)Indications:Typical reflux symptoms or atypical symptoms including chest pain and extra oesophageal complaintsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the Z lineDuration: 24, 48, 72 and/or 96 hoursComparator: NARetrosternal discomfortSchneider et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NobmVpZGVyPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NobmVpZGVyPC9BdXRob3I+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ADDIN EN.CITE.DATA (2007)Department of General, Visceral, and Transplant Surgery, University Hospital of Tubingen, Tubingen, GermanyNon-randomised controlled trialLevel: III-2Quality: 9/26CXP3123 patientsBravo group: 36 males and 32 females, mean age: 51?years (range 34–67)Catheter group: 29 males and 26 females, mean age 43?years (range 32–59)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 5 cm above the upper border of the LOSDuration: 48 hoursComparator:System: not statedInsertion: transnasallyPlacement: not statedDuration: 24 hoursThroat discomfortOesophageal discomfortLimitation in daily activitiesShahid & Fisher ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Shahid</Author><Year>2011</Year><RecNum>542</RecNum><IDText>S378-S379</IDText><DisplayText>(2011)</DisplayText><record><rec-number>542</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">542</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shahid, S.</author><author>Fisher, R.</author></authors></contributors><auth-address>Shahid, S., Gastroenterology, Temple University Hospital, PhiladelphiaUnited States</auth-address><titles><title>Left, right and out: Esophageal probe aspiration</title><secondary-title>American Journal of Gastroenterology</secondary-title></titles><periodical><full-title>American Journal of Gastroenterology</full-title></periodical><pages>S378-S379</pages><volume>106</volume><keywords><keyword>proton pump inhibitor</keyword><keyword>aspiration</keyword><keyword>gastroenterology</keyword><keyword>college</keyword><keyword>human</keyword><keyword>patient</keyword><keyword>pH</keyword><keyword>coughing</keyword><keyword>esophagus pH</keyword><keyword>bronchus</keyword><keyword>endoscopy</keyword><keyword>bronchoscopy</keyword><keyword>endoscope</keyword><keyword>esophagus mucosa</keyword><keyword>esophagus</keyword><keyword>stomach</keyword><keyword>dental anesthesia</keyword><keyword>vital sign</keyword><keyword>thorax</keyword><keyword>intensive care unit</keyword><keyword>thorax radiography</keyword><keyword>anesthesiology</keyword><keyword>heartburn</keyword><keyword>female</keyword><keyword>thorax pain</keyword><keyword>conscious sedation</keyword><keyword>duodenum</keyword></keywords><dates><year>2011</year></dates><isbn>0002-9270</isbn><urls><related-urls><url>;(2011)Gastroenterology, Section, Temple University Hospital, Philadelphia, Pennsylvania, USACase report1 patient 61 year old femaleIndication: History of heartburn, regurgitation and intermittent chest pain, unresponsive to PPI therapyInclusion:NAExclusion:NAIndex testSystem: Bravo? wireless capsule systemInsertion: transorallyPlacement: not statedComparator: NACapsule dislodgement in the left mainstem bronchusSofi et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Sofi</Author><Year>2011</Year><RecNum>540</RecNum><IDText>243-248</IDText><DisplayText>(2011)</DisplayText><record><rec-number>540</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">540</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sofi, A.</author><author>Filipiak, C.</author><author>Sodeman, T.</author><author>Ahmad, U.</author><author>Bawany, M.</author><author>Daboul, I.</author></authors></contributors><auth-address>Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States</auth-address><titles><title>Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method</title><secondary-title>Turkish Journal of Gastroenterology</secondary-title></titles><periodical><full-title>Turkish Journal of Gastroenterology</full-title></periodical><pages>243-248</pages><volume>22</volume><number>3</number><keywords><keyword>Bravo capsule</keyword><keyword>Direct/indirect</keyword><keyword>Technique</keyword></keywords><dates><year>2011</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(2011)Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USARetrospective case series58 patientsAge range: 26– 87?years17 males, 41 femalesInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the GOJComparator: NASevere chest painThroat painDysphagiaCoughWork attendanceSweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2009)Functional GI Disease Unit, Clinic for Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland Cohort study Level: III-2 Quality: 15/26CXP1134 patients Mean age: 60?years (range 18–76) 58 males, 76 females Compared with 110 consecutive catheter pH controlsMean age: 57?years (range 16–85) 44 males, 66 femalesIndications:Intolerance of catheter insertion, intolerance of catheter after intubation, or vomiting of catheter within 24?hours of the monitoring periodInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursComparator:System: Slimline, MedtronicInsertion: transnasallyPlacement: 5 cm above the lower oesophageal high-pressure zoneDuration: 24 hoursOverall satisfactionSweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Guy’s and St Thomas Hospitals, London, UKCase series Level: IVQuality: Q2CX P238 patients13 males, 25 femalesMedian age: 41.6?years (range 17–75)Indication: Reflux symptoms and no diagnosis of GORD on catheter-based pH monitoringInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 96 hoursComparator: NANo patient complained of severe symptomsTankurt et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGFua3VydDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGFua3VydDwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Kent Hospital, Department of Gastroenterology, Izmir, TurkeyCase seriesLevel: IVQuality: Q2CX (no comparator)P264 patients (37 males, 27 females)Mean age: 37.9?years (range 25–58)Indications: Preoperative evaluation (17), evaluation of atypical reflux symptoms (40) and ‘other’ (7)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NARetrosternal pain or discomfortTharavej et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGhhcmF2ZWo8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGhhcmF2ZWo8L0F1dGhvcj48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ADDIN EN.CITE.DATA (2006)Division of Thoracic and Foregut Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USACase seriesLevel: IVQuality:Q1CX (no comparator)P280 patients (40 in control group and 40 in study group)Study group:15 males and 25 females; mean age 45.5?years (range 40–53) Control group: 15 males and 25 females; mean age 49?years (range 44–63) Inclusion:Consecutive patients with gastro-oesophageal reflux symptomsExclusion:Patients with a history of achalasia, benign or malignant stricture, or a previous oesophageal or gastric surgeryIndex test:System: Bravo? wireless capsule systemInsertion: transorally (study group) or transnasally (control group)Placement: 6 cm above the upper limit of the rugal folds (study group) or 5?cm above the upper border of the LOSDuration: 48 hoursComparator: NAHigh distal oesophageal contraction amplitudeChest painHypertensive oesophageal contractionsTriester et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHJpZXN0ZXI8L0F1dGhvcj48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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHJpZXN0ZXI8L0F1dGhvcj48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=
ADDIN EN.CITE.DATA (2005)Division of Gastroenterology and Hepatology, Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USACase reportLevel: NA1 patient61 year old woman with a history of GORD and a laparoscopic Nissen fundoplicationIndication:Returning heartburn, regurgitation and sore throat, and intermittent dysphagiaInclusion:NAExclusion:NAIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the GOJDuration:Comparator: NAForeign-body sensationDysphagiaSharp substernal chest painTseng et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHNlbmc8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHNlbmc8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2005)Digestive Health Center, Department of Surgery and Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2190 procedures and 186 patients (some patients had the test performed twice) 72 males and 114 femalesMean age: 51 yearsIndications: Being evaluated for GORDInclusion:Patients older than 18?years of ageExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5– 6 cm above the LOS or 5–6?cm above the SCJ Duration: 48 hoursComparator:24-hour Bravo monitoringSevere gagging during placementForeign-body sensationChest painTu et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Tu</Author><Year>2004</Year><RecNum>527</RecNum><IDText>1586-1589</IDText><DisplayText>(2004)</DisplayText><record><rec-number>527</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">527</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tu, C. H.</author><author>Lee, Y. C.</author><author>Wang, H. P.</author><author>Wu, M. S.</author><author>Chiu, H. M.</author><author>Lin, J. T.</author></authors></contributors><titles><title>Ambulatory esophageal pH monitoring by using a wireless system: A pilot study in Taiwan</title><secondary-title>Hepato-Gastroenterology</secondary-title></titles><periodical><full-title>Hepatogastroenterology</full-title><abbr-1>Hepato-gastroenterology</abbr-1></periodical><pages>1586-1589</pages><volume>51</volume><number>60</number><dates><year>2004</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>0172-6390</isbn><accession-num>CCC:000224607400004</accession-num><urls><related-urls><url><Go to ISI>://CCC:000224607400004</url></related-urls></urls></record></Cite></EndNote>(2004)Department of Internal Medicine and Department of Emergency Medicine, National Taiwan University Hospital, Taipei, TaiwanProspective case seriesLevel: IVQuality: Q1CX (no comparator)P230 patients20 males, 10 femalesMean age: 57.6 ± 14.3?years (range 29–83)Indications: 24 patients with GORD were evaluated for drug effectiveness before surgery, 6 patients showed typical heartburn but their endoscopic findings were normal.Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the GOJDuration: 48 hoursComparator: NAMucosal abrasion and minor haemorrhageTurner et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Turner</Author><Year>2007</Year><RecNum>536</RecNum><IDText>737-741</IDText><DisplayText>(2007)</DisplayText><record><rec-number>536</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">536</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Turner, B. G.</author><author>Saltzman, J. R.</author><author>Hua, L.</author><author>Maurer, R.</author><author>Feldman, N.</author><author>Carr-Locke, D. L.</author><author>Burakoff, R.</author><author>Liu, J. J.</author></authors></contributors><titles><title>Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease</title><secondary-title>Canadian Journal of Gastroenterology</secondary-title></titles><periodical><full-title>Canadian Journal of Gastroenterology</full-title></periodical><pages>737-741</pages><volume>21</volume><number>11</number><dates><year>2007</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0835-7900</isbn><accession-num>CCC:000251481000008</accession-num><urls><related-urls><url><Go to ISI>://CCC:000251481000008</url><url>;(2007)Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, USACase seriesLevel: IVQuality: Q2CX (no comparator)P2198 pH studies (148 studies had enough data to be included)Off medical therapy: 115 patients, 76 females, 39 males; mean age: 50 ± 13?yearsOn medical therapy: 33 patients, 26 females, 7 males; mean age: 52 ± 14?yearsIndications: Typical and atypical symptoms of GORD or persistent GORD-related symptoms despite medical therapy. Patients with planned anti-reflux surgery were also evaluatedInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: (during endoscopy)Placement: 6 cm above the SCJDuration: 48 hoursComparator: NAChest pain requiring capsule removalWenner, Johnsson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll
YXI+MjAwNzwvWWVhcj48UmVjTnVtPjMzMjwvUmVjTnVtPjxJRFRleHQ+MjM5LTQ1PC9JRFRleHQ+
PERpc3BsYXlUZXh0PigyMDA3KTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4zMzI8
L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZkZmxk
ZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjMzMjwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYt
dHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxh
dXRob3JzPjxhdXRob3I+V2VubmVyLCBKLjwvYXV0aG9yPjxhdXRob3I+Sm9obnNzb24sIEYuPC9h
dXRob3I+PGF1dGhvcj5Kb2hhbnNzb24sIEouPC9hdXRob3I+PGF1dGhvcj5PYmVyZywgUy48L2F1
dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9m
IFN1cmdlcnksIEx1bmQgVW5pdmVyc2l0eSBIb3NwaXRhbCwgU0UtMjIxIDg1IEx1bmQsIFN3ZWRl
bi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5XaXJlbGVzcyBlc29waGFnZWFsIHBIIG1v
bml0b3JpbmcgaXMgYmV0dGVyIHRvbGVyYXRlZCB0aGFuIHRoZSBjYXRoZXRlci1iYXNlZCB0ZWNo
bmlxdWU6IHJlc3VsdHMgZnJvbSBhIHJhbmRvbWl6ZWQgY3Jvc3Mtb3ZlciB0cmlhbDwvdGl0bGU+
PHNlY29uZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0
LXRpdGxlPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRs
ZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1
bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5
PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdh
c3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBn
YXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjM5LTQ1PC9w
YWdlcz48dm9sdW1lPjEwMjwvdm9sdW1lPjxudW1iZXI+MjwvbnVtYmVyPjxlZGl0aW9uPjIwMDYv
MTEvMTU8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3Jk
PkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Q2F0aGV0ZXJpemF0aW9uPC9rZXl3b3JkPjxrZXl3b3Jk
PkNpcmNhZGlhbiBSaHl0aG0vcGh5c2lvbG9neTwva2V5d29yZD48a2V5d29yZD5Dcm9zcy1TZWN0
aW9uYWwgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIHBIIE1vbml0b3Jpbmc8
L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ3VzLyBtZXRhYm9saXNtPC9rZXl3b3JkPjxrZXl3b3Jk
PkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5Gb2xsb3ctVXAgU3R1ZGllczwva2V5d29yZD48a2V5
d29yZD5HYXN0cmljIEFjaWQvIG1ldGFib2xpc208L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNv
cGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npcy9tZXRhYm9saXNtPC9rZXl3b3JkPjxrZXl3b3JkPkh1
bWFuczwva2V5d29yZD48a2V5d29yZD5IeWRyb2dlbi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29y
ZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxr
ZXl3b3JkPlF1ZXN0aW9ubmFpcmVzPC9rZXl3b3JkPjxrZXl3b3JkPlJlcHJvZHVjaWJpbGl0eSBv
ZiBSZXN1bHRzPC9rZXl3b3JkPjxrZXl3b3JkPlJldHJvc3BlY3RpdmUgU3R1ZGllczwva2V5d29y
ZD48a2V5d29yZD5UZWxlbWV0cnkvIG1ldGhvZHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+
PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkZlYjwvZGF0ZT48L3B1Yi1kYXRlcz48
L2RhdGVzPjxpc2JuPjAwMDItOTI3MCAoUHJpbnQpJiN4RDswMDAyLTkyNzAgKExpbmtpbmcpPC9p
c2JuPjxhY2Nlc3Npb24tbnVtPjE3MTAwOTcxPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVk
LXVybHM+PHVybD5odHRwOi8vd3d3Lm5hdHVyZS5jb20vYWpnL2pvdXJuYWwvdjEwMi9uMi9wZGYv
YWpnMjAwNzQxYS5wZGY8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVz
b3VyY2UtbnVtPjEwLjExMTEvai4xNTcyLTAyNDEuMjAwNi4wMDkzOS54PC9lbGVjdHJvbmljLXJl
c291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNl
LXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5v
dGU+AG==
ADDIN EN.CITE.DATA (2007)Department of Surgery, Lund University Hospital, Lund, SwedenRandomised crossover trialLevel: IIQuality: 20/26CXP235 patients (31 patients had enough data to be included)15 males, 16 femalesMedian age: 52 yearsMedian BMI: 27 (range 24–28)Indications: Typical reflux symptoms (55%) and atypical reflux symptoms (45%)Inclusion:Patients referred for oesophageal pH monitoring Exclusion:Patients with coagulopathy, severe oesophagitis/stricture, portal hypertension, a pacemaker, age <20 or >70?years, previous gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline (Medtronic) Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursNose and/or throat symptomsSwallow-induced symptomsChest symptomsAll adverse symptomsNormal work activitiesPhysical activitiesEating and drinkingNormal daily lifeWong et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V29uZzwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V29uZzwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE.DATA (2005)The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona, USARandomised controlled trialLevel: IIQuality: 16.5/26CXP250 patients Mean age: 50.2?years (range 21–79)26 males and 24 femalesIndication: Failure in controlling symptoms while on PPI therapy or for evaluation before anti-reflux surgeryInclusion:Not statedExclusion:Patients with a history of bleeding tendency or coagulopathy, significant concomitant medical co-morbidity, severe GI bleeding within the past 6?months, a history of upper GI surgery, oesophageal varices, pacemaker, implantable cardiac defibrillator, being unable to complete the 24-hour pH monitoring, unable to report daily activityIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursComparator:System: Digitrapper Mark III (Medtronic)Insertion: transnasallyPlacement: 5 cm above the proximal margin of the LOS Duration: 24 hoursNose painRunny noseThroat painThroat discomfortCoughChest discomfortHeadacheNose bleedingWorkEating and drinkingDaily activitiesOverall experience with the testSatisfaction with the testStudy profiles of included studies on direct effectivenessDirect evidenceStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / Exclusion criteriaDiagnostic testsHealth outcomes assessedGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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==
ADDIN EN.CITE.DATA (2011)Department of Gastroenterology, Universita Degli Studi and Fondazione IRCCS Ca Granada, Ospedale Maggiore Policlinico, Milan, ItalyMatched-pairs retrospective cohort studyLevel: III-2 Quality: 16.5/26CXP2102 patientsCatheter group: 51 patients, 20 males, mean age 48?years (range 22–78) Bravo group: 51 patients, 22 males, mean age 48?years (range 23–82)Inclusion:All consecutive patients who underwent wireless 96-hour pH monitoring between January and December 2007 off PPI therapy, and patients undergoing traditional 24-hour pH monitoring in the same period, after matching for the most troublesome symptom potentially related to GORD, sex and ageExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJDuration: 48–96 hoursComparator:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach or 5?cm above the upper margin of the LOS Duration: 24 hoursOutcome of the principal symptom Sweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Guy’s and St Thomas Hospitals, London, UKCase series Level: IVQuality: Q2CX P238 patients13 males, 25 femalesMedian age: 41.6?years (range 17–75)Indication: Reflux symptoms and no diagnosis of GORD on catheter-based pH monitoringInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 96 hoursComparator:(24-, 48-, 72-hour Bravo pH monitoring)Improvement in symptoms / poor outcome (with 24-, 48-, 72-hour Bravo as a comparator)Technical efficacyStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / Exclusion criteriaDiagnostic testsTechnical efficacy outcomes assessedAhlawat et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWhsYXdhdDwvQXV0aG9yPjxZ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 EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWhsYXdhdDwvQXV0aG9yPjxZ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 EN.CITE.DATA (2006)Division of Gastroenterology, Department of Medicine, Georgetown University Hospital, Washington, DC, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P290 patients (82 patients had enough data to be included)48 males and 42 femalesAge range: 18–80 yearsIndications:Being intolerant to the conventional naso-oesophageal pH catheter placement or had normal 24-hour oesophageal pH monitoring despite symptomsInclusion:Not statedExclusion:Patients with bleeding diathesis, strictures, severe oesophagitis, varices, obstructions, pacemakers, implantable cardiac defibrillators, and surgical manipulations of the upper Gl tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursComparator: NATechnical efficacy:Technical failureDay-to-day variability (% time pH <4)Andrews et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5kcmV3czwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5kcmV3czwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2012)Division of Gastroenterology, University of Calgary, CanadaDual centre, randomised non-blinded trialLevel: IIQuality: 19/26CX P286 patients(40 in Calgary and 46 in Edmonton)61 females, 25 malesAged 18–75 yearsIndications:Reflux symptomsChest painDysphagia Inclusion:Patients aged 18–75 years referred for ambulatory pH monitoring between August 2008 and August 2009Exclusion:Patients with previous oesophageal surgery or achalasiaIndex test:System: activated and calibrated Bravo? wireless capsule system, Medtronic Inc., Minneapolis, MNInsertion: transorally Placement: 5 cm above the proximal border of the LESDuration: 24 (Calgary) or 48 (Edmonton) hoursComparator:Catheter: calibrated standard antimony-based pH catheter (Comfortec Plus catheter and ZepHR Sleuth recorder, Sandhill Scientific Inc., Highlands Ranch, CO)Insertion: transnasallyPlacement: 5 cm above the proximal border of the LOSDuration: 24 hoursTechnical efficacy:Equipment malfunctionCalibration failureEarly detachmentInsertion intolerance Ayazi et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXlhemk8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXlhemk8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Division of Thoracic Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, California, USACase seriesLevel: IVQuality: Q1CX (no comparator)P2310 patients (158 males and 152 females)Median age: 52?years (IQR=42–63)Inclusion:Patients with no history of foregut surgery who had the Bravo capsule placed transnasally without sedation and who were monitored while off acid-suppression therapyExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the manometrically determined border of the LOSDuration: 48 hoursComparator: NATechnical efficacy:Day-to-day variability (% time pH <4 and reflux events)Azzam et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2012)Sao Paulo University Medical School, Sao Paulo, BrazilIn-subject simultaneous recording studyLevel: II Quality: 17/26CX P225 patients21 females, 4 malesMean age: 52.4 years (range 34–73)Indications:All patients had as predominant symptom the typical GORD complaints; 64% also had atypical complaints and 76% had associated extra oesophageal complaintsInclusion:Heartburn and/or regurgitation as the main clinical complaint; at least 18?years of age; recent upper GI endoscopy (within the past 2?months); interruption in the administration of PPIs for 7?days; and signature on the free and informed consent formExclusion:Oesophageal diverticula; strictures and varices; hiatal hernia greater than or equal to 3?cm; erosive oesophagitis Los Angeles grades C or D; Barrett’s oesophagus; neoplasms; obstructive diseases; previous surgery of the GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 3 cm above the superior border of the LOSDuration: 48 hoursComparator:System: Alacer (Brazil) pH-monitor catheter with Medtronic/Synetics (USA) recording deviceInsertion: transnasallyPlacement: distal sensor was placed 3?cm above the superior border of the LOS, proximal sensor was positioned 5?cm above the superior border of the LOSDuration: 24 hoursTechnical efficacy:Early detachment Bansal et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll
YXI+MjAwOTwvWWVhcj48UmVjTnVtPjE5NjwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oMjAwOSk8L0Rp
c3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTk2PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtl
eXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZy
MHdyIj4xOTY8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRp
Y2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJhbnNhbCwg
QS48L2F1dGhvcj48YXV0aG9yPldhbmksIFMuPC9hdXRob3I+PGF1dGhvcj5SYXN0b2dpLCBBLjwv
YXV0aG9yPjxhdXRob3I+UmFzdG9naSwgSy48L2F1dGhvcj48YXV0aG9yPkdveWFsLCBBLjwvYXV0
aG9yPjxhdXRob3I+SGFsbCwgUy48L2F1dGhvcj48YXV0aG9yPlNpbmdoLCBWLjwvYXV0aG9yPjxh
dXRob3I+SGlnYmVlLCBBLjwvYXV0aG9yPjxhdXRob3I+U2hhcm1hLCBQLjwvYXV0aG9yPjwvYXV0
aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9ucyBvZiBHYXN0cm9lbnRl
cm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBVbml2ZXJzaXR5IG9mIEthbnNhcyBTY2hvb2wgb2YgTWVk
aWNpbmUgYW5kIFZldGVyYW5zIEFmZmFpcnMgTWVkaWNhbCBDZW50ZXIsIEthbnNhcyBDaXR5LCBN
aXNzb3VyaSA2NDEyOCwgVVNBLiBhYmFuc2FsQGt1bWMuZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxl
cz48dGl0bGU+SW1wYWN0IG9mIG1lYXN1cmVtZW50IG9mIGVzb3BoYWdlYWwgYWNpZCBleHBvc3Vy
ZSBjbG9zZSB0byB0aGUgZ2FzdHJvZXNvcGhhZ2VhbCBqdW5jdGlvbiBvbiBkaWFnbm9zdGljIGFj
Y3VyYWN5IGFuZCBldmVudC1zeW1wdG9tIGNvcnJlbGF0aW9uOiBhIHByb3NwZWN0aXZlIHN0dWR5
IHVzaW5nIHdpcmVsZXNzIGR1YWwgcEggbW9uaXRvcmluZzwvdGl0bGU+PHNlY29uZGFyeS10aXRs
ZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRoZSBBbWVy
aWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnIt
MT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJp
b2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1
bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5
PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjkxOC0yNTwvcGFnZXM+PHZvbHVtZT4x
MDQ8L3ZvbHVtZT48bnVtYmVyPjEyPC9udW1iZXI+PGVkaXRpb24+MjAwOS8wOS8xNzwvZWRpdGlv
bj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBwSCBNb25pdG9yaW5nLyBpbnN0cnVtZW50
YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9uPC9rZXl3b3Jk
PjxrZXl3b3JkPkVzb3BoYWdvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2Vh
bCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtl
eXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwv
a2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Qcm9zcGVjdGl2
ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlF1ZXN0aW9ubmFpcmVzPC9rZXl3b3JkPjxrZXl3
b3JkPlJPQyBDdXJ2ZTwva2V5d29yZD48a2V5d29yZD5TZW5zaXRpdml0eSBhbmQgU3BlY2lmaWNp
dHk8L2tleXdvcmQ+PGtleXdvcmQ+U3RhdGlzdGljcywgTm9ucGFyYW1ldHJpYzwva2V5d29yZD48
L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDA5PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RGVjPC9k
YXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTU3Mi0wMjQxIChFbGVjdHJvbmljKSYjeEQ7
MDAwMi05MjcwIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xOTc1NTk3NTwvYWNjZXNz
aW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2Fq
Zy9qb3VybmFsL3YxMDQvbjEyL3BkZi9hamcyMDA5NTA2YS5wZGY8L3VybD48L3JlbGF0ZWQtdXJs
cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMzgvYWpnLjIwMDkuNTA2PC9l
bGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVt
b3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv
Q2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE.DATA (2009)Divisions of Gastroenterology and Hepatology, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USACase seriesLevel: IVQuality: Q1 CXP248 patients (43 males, 5 females) and 22 controls (22 males)Mean age:Patients: 57 ± 13?yearsControls: 59 ± 9?yearsIndication: Patients: reflux symptomsInclusion:Patients: answering ‘yes’ to either heartburn or regurgitation, having a score of >2 on the RDQControls: answering ‘no’ to heartburn and regurgitation, having a score of 0 on the RDQExclusion:Patients: cancer or mass lesion in the oesophagus, advanced chronic liver disease, severe uncontrolled coagulopathy, history of oesophageal or gastric surgeryControls: use of acid suppression, evidence of erosive oesophagitisIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 1 cm above the GOJDuration: 24 hoursIndex test 2:System: Bravo? wireless capsule systemInsertion: NS Placement: 6 cm above the GOJ Duration: 24 hoursComparator: NATechnical efficacy:Early detachmentCardia placementLoss of dataBechtold et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVjaHRvbGQ8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVjaHRvbGQ8L0F1dGhvcj48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ADDIN EN.CITE.DATA (2007)Division of Gastroenterology, University of Missouri Hospital and Clinics, Columbia, Missouri, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P227 patients (26 patients had enough data to be included)6 males and 20 femalesMean age: 47.6 ± 12.2?years (range 15–67)Inclusion:Patients who underwent 48-hour Bravo ambulatory oesophageal pH monitoring for suspected GORD off any anti-reflux medicationsExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the GOJComparator: NATechnical efficacy:Early detachmentDay-to-day variability (time pH <4 (upright, supine, total), number of reflux episodes, long refluxes etc.)Belafsky et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVsYWZza3k8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmVsYWZza3k8L0F1dGhvcj48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ADDIN EN.CITE.DATA (2004)Scripps Center for Voice and Swallowing, La Jolla, California, USAProspective case seriesLevel: IVQuality: Q2CX (no comparator)P246 patients23 males and 23 femalesMean age: 52 yearsIndications: GORD, chronic cough, laryngopharyngeal reflux Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the manometric lower oesophageal high-pressure zone or 6?cm above the endoscopic SCJDuration: >36 hoursComparator: NATechnical efficacy:Failures due to tight nasal vaultEarly detachment rateDelivery system failure rateLost recorder rateBhat, McGrath & Bielefeldt PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2006)Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAProspective case seriesLevel: IVQuality: Q2CX (no comparator)P2217 patients(203 patients had enough data to be included)140 females, 77 malesMean age: 51?years (range 42–58)Indications:Preoperative workup for fundoplication, possible extra oesophageal manifestations of reflux disease, symptoms after fundoplication, refractory symptoms on medication, atypical symptomsInclusion:Adult patients undergoing endoscopy with wireless pH studies at the University of Pittsburgh Medical Center between 9 April 2004 and 31 March 2005Exclusion:Individuals unable to give informed consent, pregnant women, prisoners, patients with oesophageal varices, patients requiring continuing anticoagulation, patients with cardiac defibrillatorsIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Operative failure ratesEarly detachment rateDay-to-day variabilityBradley et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QnJhZGxleTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QnJhZGxleTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USACohort studyLevel: III-2Quality: 15/26CXP2341 patients (338 patients had enough data to be included, 248 patients underwent Bravo monitoring)62% females in the wireless group, 72% females in the catheter groupMean age: 58?years in wireless group, 57?years in catheter groupInclusion:Outpatients undergoing ambulatory pH-metry between October 2006 and October 2008Exclusion:Known history of oesophageal strictures, obstructions or surgical manipulations of the upper GI tract (e.g. anti-reflux surgery or oesophagectomy)Index test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJ or 5?cm above the upper border of the LOSDuration: 48 hoursComparator (MII-pH):System: Sandhill Scientific, Inc., Highland Ranch, USAInsertion: transnasallyPlacement: proximal channel 5?cm above upper border of the LOSDuration: 24 hoursComparator (pH-metry):System: Alpine Biomed, Corp, Fountain Valley, US Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursTechnical efficacy:Early detachmentInsertion intolerance Endoscopic removalCabrera et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FicmVyYTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2FicmVyYTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Division of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana, USAProspective case seriesLevel: IVQuality: Q1CX (no comparator)P2289 children (At least 1?day of data was obtained in 278 patients, 2?days were obtained in 274 patients)144 females, 145 males,Age: range 4–22 yearsMain indications:Epigastric abdominal pain (59.9%), vomiting (33.9%), regurgitation (23.9%), heartburn (18.3%)Inclusion:Children who are at least 4?years of age and weigh at least 30?lbExclusion:Children with a history of oesophageal surgery, a documented anatomic abnormality, or a history of coagulopathy or a bleeding diathesisIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: at 87% of the distance from the incisors to the Z lineDuration: 48 hoursComparator: NATechnical efficacy:Early detachmentOperative success/failureRecording failuresChander et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2hhbmRlcjwvQXV0aG9yPjxZ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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q2hhbmRlcjwvQXV0aG9yPjxZ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=
ADDIN EN.CITE.DATA (2012)Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2124 patients 87 females, 37 malesAge range: 24–68?yearsIndications: Heartburn, regurgitation, chest pain, belching or cough. And a previous negative EGD and symptoms despite PPI treatmentInclusion:See indicationsExclusion:Patients with a history of pacemakers, implantable defibrillators, oesophageal varices, severe oesophagitis, bleeding disorders, intestinal obstructionIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the GOJDuration: 48 hoursComparator: NA Technical efficacy:Day-to-day variability in acid exposure Croffie et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2007)Section of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana, USARandomised controlled trialLevel: IIQuality:14.5/26CXP266 children(but 5 patients were excluded due to operative failure, failed recording etc.)32 males, 34 femalesMean age: 9.4 years (range 4–16.5)Indications:Persistent epigastric or substernal pain, persistent vomiting, heartburn, chronic nocturnal cough or wheezing, persistent throat clearance, dental abnormalities suspected to be caused by refluxInclusion:Children between the ages of 4 and 18?years and weighing at least 30?lb who were undergoing oesophagogastroduodenoscopy and oesophageal pH monitoring for symptoms suggestive of gastro-oesophageal refluxExclusion:Children younger than 4?years of age or weighing <30?lb, having anatomic abnormalities of the oesophagus, a history of a surgical procedure of the oesophagus, stomach or duodenum, a history of coagulopathy or bleeding diathesis, presence of oesophageal varices, significant medical illnessIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: at 87% of the distance from the incisors to the Z lineDuration: 48 hoursComparator:System: not stated (catheter-based)Insertion: transnasallyPlacement: tip at 87% of the distance from the nostril to the GOJDuration: 24 hoursTechnical efficacy:Operative successRecording failuresEarly detachmentDay-to-day variability in acid exposureCrowell et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3Jvd2VsbDwvQXV0aG9yPjxZ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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3Jvd2VsbDwvQXV0aG9yPjxZ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==
ADDIN EN.CITE.DATA (2009)Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USACase seriesLevel: IVQuality: Q1CX (no comparator)P2157 (>95%) patients, predominantly Caucasian Indications: Heartburn/regurgitation symptoms, chest pain, abdominal pain/discomfort Inclusion:Patients with GORD symptomsExclusion:History of bleeding diathesis, strictures, severe oesophagitis, varices, obstructions, pacemakers or implantable cardiac defibrillatorsIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the endoscopically determined GOJ or 5?cm above the manometrically determined upper margin of the LOS Duration: 48 hoursComparator: NATechnical efficacy:Day-to-day variabilityEarly detachmentde Hoyos & Esparza (2010); de Hoyos, Esparza & Loredo (2009) Department of Gastroenterology, Angeles del Pedregal Hospital, Mexico City, MexicoProspective case seriesLevel: IVQuality: Q2CX (no comparator)P266 patients27 males, 39 femalesMean age: 41.7 years (range 11–73)Indications:Typical oesophageal reflux symptoms, atypical manifestations or a mixed symptomatologyInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm from the SCJDuration: 48 hoursComparator: NATechnical efficacy:Poor data receptionEarly detachmentTransmission failuredes Varannes et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE.DATA (2005)Department of Gastroenterology and Hepatology, Hopital Hotel Dieu, Nantes, FranceIn-subject simultaneous recording studyLevel: II Quality: 20/26CXP240 patients(probe successfully attached in 36 patients)21 males, 19 femalesMean age: 50 yearsIndications:Heartburn (n=7), regurgitation (n=6) or both symptoms (n=26)Inclusion:Patients suggestive of GORD and referred to the functional laboratory of four French academic centres for pH monitoringExclusion:Severe oesophageal motility disorders, severe oesophagitis (Los Angeles grade C or above), pregnancy, women who were not using reliable contraceptionIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the Z lineDuration: 48 hoursComparator:System: Mark III or Digitrapper pH, Medtronic, Stockholm, SwedenInsertion: transnasallyPlacement: adjusted to the same level as the index testDuration: 24 hoursTechnical efficacy:Insertion intoleranceOperative failureEarly detachmentDay-to-day variabilityDoma et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Doma</Author><Year>2010</Year><RecNum>225</RecNum><DisplayText>(2010)</DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">225</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Doma, S.</author><author>Paladugu, S.</author><author>Parkman, H. P.</author><author>Friedenberg, F. K.</author></authors></contributors><auth-address>Gastroenterology Section, Temple University School of Medicine, Philadelphia, PA 19140, USA.</auth-address><titles><title>Wireless capsules for esophageal pH monitoring: are we placing them correctly?</title><secondary-title>Digestion</secondary-title><alt-title>Digestion</alt-title></titles><periodical><full-title>Digestion</full-title></periodical><alt-periodical><full-title>Digestion</full-title></alt-periodical><pages>54-9</pages><volume>82</volume><number>1</number><edition>2010/03/11</edition><keywords><keyword>Analysis of Variance</keyword><keyword>Capsule Endoscopy</keyword><keyword>Chi-Square Distribution</keyword><keyword>Esophageal pH Monitoring/ instrumentation</keyword><keyword>Esophagus/ anatomy & histology</keyword><keyword>Female</keyword><keyword>Gastroesophageal Reflux/ physiopathology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Manometry</keyword><keyword>Medical Errors/ statistics & numerical data</keyword><keyword>Middle Aged</keyword><keyword>Monitoring, Ambulatory/ instrumentation</keyword><keyword>Retrospective Studies</keyword></keywords><dates><year>2010</year></dates><isbn>1421-9867 (Electronic)
0012-2823 (Linking)</isbn><accession-num>20215751</accession-num><urls><related-urls><url>;(2010)Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania, USACase series (prospective?)Level: IVQuality: Q1CX (no comparator)P2161 patients, but 147 patients had enough data to be included (44 males, 103 females)Age: 45.6 ± 16?yearsMost common indications: Heartburn (44.2%), chest pain (19.7%), cough (4.1%), regurgitation (8.8%) Inclusion:Not statedExclusion: Prior upper GI tract surgeryIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 6 cm above the SCJComparator: NATechnical efficacy:Inaccurate placement of the capsuleDomingues, Moraes-Filho & Domingues PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE.DATA (2011)Motility laboratory (Gastro Resolucao Diagnostico Laboratorio de Motilidade Digestive), Rio de Janeiro, BrazilRetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P2100 patients(probe successfully attached in 95 patients)39 female, 61 maleMean age: 53 years (range 18– 81)Indications:82% of patients referred to diagnose GORD, 18% referred due to persistent symptoms despite PPI useInclusion:Patients referred to a GI motility laboratory to investigate GORD with typical or atypical symptoms, persistent GORD symptoms on medical therapy or recurrent GORD symptoms after surgical fundoplication, between 2004 and 2009Exclusion:<18 years of age, a history of bleeding tendency or coagulopathy, significant concomitant medical co-morbidities, severe GI bleeding in the past 6?months, a history of upper GI surgery, medication with PPIs, presence of oesophageal varices, Barrett’s oesophagus, oesophageal stenosis, erosive oesophagitis, pacemaker or implantable cardiac defibrillator in situIndex test:System: Bravo? wireless capsule systemInsertion: 5 cm above the upper border of the LOS (manometry) or 6?cm above the LOS (endoscopy)Placement: transorallyDuration: 48 hoursComparator: NATechnical efficacy:Attachment failureTechnical flaws (recording failure, downloaded data lost etc.)Early detachmentDay-to-day variability in oesophageal acid exposureFrancis, DL ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Francis</Author><Year>2008</Year><RecNum>235</RecNum><IDText>2663</IDText><DisplayText>(2008)</DisplayText><record><rec-number>235</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">235</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francis, D. L.</author></authors></contributors><titles><title>Attachment disorder: a decline in the performance of the Bravo pH system</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>2663</pages><volume>103</volume><number>10</number><edition>2008/10/16</edition><keywords><keyword>Endoscopes, Gastrointestinal</keyword><keyword>Equipment Failure</keyword><keyword>Esophageal pH Monitoring/ instrumentation</keyword><keyword>Esophagus/ physiopathology</keyword><keyword>Gastroesophageal Reflux/ diagnosis/physiopathology</keyword><keyword>Humans</keyword><keyword>Peristalsis/ physiology</keyword><keyword>Retrospective Studies</keyword></keywords><dates><year>2008</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1572-0241 (Electronic)
0002-9270 (Linking)</isbn><accession-num>18855870</accession-num><urls><related-urls><url>;(2008)Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P276 patientsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Technical failure to capture all dataEarly detachmentAttachment failureFrancis, DO et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Francis</Author><Year>2012</Year><RecNum>236</RecNum><IDText>91-97</IDText><DisplayText>(2012)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Francis, D. O.</author><author>Sumner, E.</author><author>Goutte, M.</author><author>Slaughter, J. C.</author><author>Garrett, C. G.</author><author>Hagaman, D.</author><author>Vaezi, M. F.</author></authors></contributors><titles><title>Feasibility of Dual Wireless Esophageal pH Monitoring: Randomized Blinded Sham-Controlled Trial</title><secondary-title>Otolaryngology-Head and Neck Surgery</secondary-title></titles><periodical><full-title>Otolaryngology-Head and Neck Surgery</full-title></periodical><pages>91-97</pages><volume>147</volume><number>1</number><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0194-5998</isbn><accession-num>CCC:000314267600016</accession-num><urls><related-urls><url><Go to ISI>://CCC:000314267600016</url><url>;(2012)Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USARandomised blinded controlled trialLevel: II Quality: 16/26C1P222 patients were included (13 males, 9 females)Indications:Cough, hoarseness, globus, heartburn, regurgitationInclusion:Patients >18 years of age, scheduled for planned oesophagogastroduodenoscopy and wireless pH monitoring for physiologic assessment of oesophageal acid exposure for typical GORD symptoms or for extraoesophageal reflux (EER) symptomsExclusion:History of upper oesophageal surgery, bleeding dyscrasia, recent cerebrovascular accident or transient ischemic attack, recent GI haemorrhage <6?months, oesophageal varices or significant medical illness, current pregnancyIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 16 cm above the SCJDuration: 48 hoursComparator (other half of randomisation):No monitoring (a sham capsule placement)Comparator 2: Initial test (whole population):System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJDuration: 48 hoursTechnical efficacy:Operative successGarrean et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ
ZWFyPjIwMDg8L1llYXI+PFJlY051bT4yMzg8L1JlY051bT48SURUZXh0PjE2MzEtNzwvSURUZXh0
PjxEaXNwbGF5VGV4dD4oMjAwOCk8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM4
PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZs
ZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4yMzg8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVm
LXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48
YXV0aG9ycz48YXV0aG9yPkdhcnJlYW4sIEMuIFAuPC9hdXRob3I+PGF1dGhvcj5aaGFuZywgUS48
L2F1dGhvcj48YXV0aG9yPkdvbnNhbHZlcywgTi48L2F1dGhvcj48YXV0aG9yPkhpcmFubywgSS48
L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EaXZpc2lvbiBv
ZiBHYXN0cm9lbnRlcm9sb2d5LCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSBGZWluYmVyZyBTY2hv
b2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlub2lzIDYwNjExLCBVU0EuPC9hdXRoLWFkZHJl
c3M+PHRpdGxlcz48dGl0bGU+QWNpZCByZWZsdXggZGV0ZWN0aW9uIGFuZCBzeW1wdG9tLXJlZmx1
eCBhc3NvY2lhdGlvbiB1c2luZyA0LWRheSB3aXJlbGVzcyBwSCByZWNvcmRpbmcgY29tYmluaW5n
IDQ4LWhvdXIgcGVyaW9kcyBvZmYgYW5kIG9uIFBQSSB0aGVyYXB5PC90aXRsZT48c2Vjb25kYXJ5
LXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+VGhl
IEFtZXJpY2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWx0LXRpdGxlPjwvdGl0bGVz
PjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48
YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48
L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJv
bDwvZnVsbC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVy
b2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xNjMxLTc8L3BhZ2VzPjx2b2x1
bWU+MTAzPC92b2x1bWU+PG51bWJlcj43PC9udW1iZXI+PGVkaXRpb24+MjAwOC8wNi8xOTwvZWRp
dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+Mi1QeXJpZGlueWxtZXRoeWxzdWxmaW55bGJlbnppbWlk
YXpvbGVzL2FkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZTwva2V5d29yZD48a2V5d29yZD5BZHVs
dDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQsIDgwIGFuZCBv
dmVyPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgcEggTW9uaXRvcmluZzwva2V5d29yZD48
a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgv
ZHJ1ZyB0aGVyYXB5LyBwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9r
ZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdv
cmQ+PGtleXdvcmQ+T21lcHJhem9sZS9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2U8L2tleXdv
cmQ+PGtleXdvcmQ+UHJvdG9uIFB1bXAgSW5oaWJpdG9ycy8gYWRtaW5pc3RyYXRpb24gJmFtcDsg
ZG9zYWdlPC9rZXl3b3JkPjxrZXl3b3JkPlNlbnNpdGl2aXR5IGFuZCBTcGVjaWZpY2l0eTwva2V5
d29yZD48a2V5d29yZD5Tb2RpdW0gQmljYXJib25hdGUvYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9z
YWdlPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDg8L3llYXI+PHB1Yi1kYXRl
cz48ZGF0ZT5KdWw8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTcyLTAyNDEgKEVs
ZWN0cm9uaWMpJiN4RDswMDAyLTkyNzAgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE4
NTU3NzE0PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3
Lm5hdHVyZS5jb20vYWpnL2pvdXJuYWwvdjEwMy9uNy9wZGYvYWpnMjAwODMzOWEucGRmPC91cmw+
PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL2ou
MTU3Mi0wMjQxLjIwMDguMDE4MjkueDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1k
YXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+
ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2008)Division of Gastroenterology, Northwestern University Freiberg School of Medicine, Chicago, Illinois, USACase series (prospective?) Level: IVQuality: Q2CX (no comparator)P260 patients (22 males and 38 females) Age range: 19–80?years40 patients had complete 4-day data acquisitionIndications: Acid reflux symptoms, chest pain, laryngeal symptoms that were poorly responsive to twice-daily PPI therapy for a minimum of 6?weeksInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJComparator: NATechnical efficacy:Loss of data transmissionDay-to-day variabilityGillies et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ
ZWFyPjIwMDc8L1llYXI+PFJlY051bT4yNDE8L1JlY051bT48SURUZXh0PjU3LTYzPC9JRFRleHQ+
PERpc3BsYXlUZXh0PigyMDA3KTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yNDE8
L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZkZmxk
ZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjI0MTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYt
dHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxh
dXRob3JzPjxhdXRob3I+R2lsbGllcywgUi4gUy48L2F1dGhvcj48YXV0aG9yPlN0cmF0Zm9yZCwg
Si4gTS48L2F1dGhvcj48YXV0aG9yPkJvb3RoLCBNLiBJLjwvYXV0aG9yPjxhdXRob3I+RGVobiwg
VC4gQy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBh
cnRtZW50IG9mIFVwcGVyIEdhc3Ryb2ludGVzdGluYWwgU3VyZ2VyeSwgUm95YWwgQmVya3NoaXJl
IEhvc3BpdGFsLCBSZWFkaW5nLCBVSy4gcmdpbGxpZXNAZG9jdG9ycy5vcmcudWs8L2F1dGgtYWRk
cmVzcz48dGl0bGVzPjx0aXRsZT5PZXNvcGhhZ2VhbCBwSCBtb25pdG9yaW5nIHVzaW5nIHRoZSBC
cmF2byBjYXRoZXRlci1mcmVlIHJhZGlvIGNhcHN1bGU8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+
RXVyIEogR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5F
dXJvcGVhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgaGVwYXRvbG9neTwvYWx0
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkV1ciBKIEdhc3Ryb2VudGVy
b2wgSGVwYXRvbDwvZnVsbC10aXRsZT48YWJici0xPkV1cm9wZWFuIGpvdXJuYWwgb2YgZ2FzdHJv
ZW50ZXJvbG9neSAmYW1wOyBoZXBhdG9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5FdXIgSiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L2Z1bGwtdGl0
bGU+PGFiYnItMT5FdXJvcGVhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgaGVw
YXRvbG9neTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PHBhZ2VzPjU3LTYzPC9wYWdlcz48dm9s
dW1lPjE5PC92b2x1bWU+PG51bWJlcj4xPC9udW1iZXI+PGVkaXRpb24+MjAwNy8wMS8wOTwvZWRp
dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWN0aXZpdGllcyBvZiBEYWlseSBMaXZpbmc8L2tleXdv
cmQ+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48
a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgcEggTW9uaXRvcmluZy9h
ZHZlcnNlIGVmZmVjdHMvIGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5Fc29waGFn
b3Njb3B5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9l
c29waGFnZWFsIFJlZmx1eC8gZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5
d29yZD48a2V5d29yZD5IeWRyb2dlbi1Jb24gQ29uY2VudHJhdGlvbjwva2V5d29yZD48a2V5d29y
ZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk1v
bml0b3JpbmcsIEFtYnVsYXRvcnkvYWR2ZXJzZSBlZmZlY3RzL2luc3RydW1lbnRhdGlvbi9tZXRo
b2RzPC9rZXl3b3JkPjxrZXl3b3JkPlBhaW4vZXRpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+VGVs
ZW1ldHJ5L2FkdmVyc2UgZWZmZWN0cy8gaW5zdHJ1bWVudGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+
PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkphbjwv
ZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjA5NTQtNjkxWCAoUHJpbnQpJiN4RDswOTU0
LTY5MVggKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE3MjA2MDc4PC9hY2Nlc3Npb24t
bnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vZ3JhcGhpY3MudHgub3ZpZC5jb20v
b3ZmdHBkZnMvRlBERE5DRkJGQkVQSUcwMC9mczA0Ni9vdmZ0L2xpdmUvZ3YwMjMvMDAwNDI3Mzcv
MDAwNDI3MzctMjAwNzAxMDAwLTAwMDA5LnBkZjwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48
ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA5Ny9NRUcuMGIwMTNlMzI4MDExNmVlYzwvZWxl
Y3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90
ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0Np
dGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA (2007)Departments of Upper Gastrointestinal Surgery and Gastrointestinal Physiology, Royal Berkshire hospital, Reading, UKNon-randomised Controlled trialLevel: III-2 Quality: 13.5/26CXP2185 patients, but 200 oesophageal pH studies104 males, 81 femalesMean age: Catheter group: 46?years (range 16–71)Bravo group: 45?years (range 13–75)Indication: Symptoms suggestive of GORD or documenting the outcome of laparoscopic anti-reflux surgeryInclusion:See indicationExclusion:No specific exclusion criteria existIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursComparator:System: MedtronicInsertion: transnasallyPlacement: 5 cm above the proximal border of the LOSDuration: 24 hoursTechnical efficacy:Attachment failuresTechnical failures (recording failures etc.)Early detachmentDay-to-day variabilityGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2007)Gastroenterology, Department of Medical Sciences, University of Milan, Milan, ItalyPseudo-randomised controlled trialLevel: III-1Quality: 13.5/26CXP2133 patientsCatheter group: 78 patients, 46% males, aged 53 ± 2?yearsBravo group: 55 patients, 45% males, aged 44 ± 3?years)Indication: Suspected GORD, consecutively referred for oesophageal pH monitoringInclusion:See indicationExclusion:Previous GI surgery (excluding cholecystectomy and appendectomy) and known or suspected stricture of the GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach, or 5?cm above the upper margin of the LOS Duration: 24 hoursTechnical efficacy:Early detachmentTechnical failureRecording timeDay-to-day variabilityGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2011)Department of Gastroenterology, Universita Degli Studi and Fondazione IRCCS Ca Granada, Ospedale Maggiore Policlinico, Milan, ItalyOne arm of matched pairs retrospective cohort studyLevel: IV Quality: Q2CX (no comparator)P2Bravo group: 57 patients, of which 51 had enough data to be included 22 males, mean age 48?years (range 23–82)Inclusion:All consecutive patients who underwent wireless 96-hour pH monitoring between January and December 2007 off PPI therapy, and patients undergoing traditional 24-hour pH monitoring in the same period, after matching for the most troublesome symptom potentially related to GORD, sex and ageExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJDuration: 48–96 hoursComparator:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach, or 5?cm above the upper margin of the LOS Duration: 24 hoursTechnical efficacy:Early detachmentIncomplete data capture Gunnarsdottir, Stenstrom & Arnbjornsson PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE.DATA (2007, 2008)Department of Paediatric Surgery, Lund University Hospital, Lund, SwedenCase seriesLevel: IVQuality: Q1CX (no comparator)P258 children37 males, 21 females Mean age: 8 ± 4?yearsIndications:Vomiting, abdominal and chest pain, GORD control, GI bleeding, respiratory symptomsInclusion:Not statedExclusion: Oesophageal strictures, coagulopathy, any suspicion of intestinal stricturesIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: above the diaphragm valve at the width of two of the individual patient’s vertebral bodies as visualised on a perioperative X-rayDuration: 24 or 48 hours (23 children had 48-hour measurement)Comparator: NA Technical efficacy:Attachment failureTechnical failureDay-to-day variability in oesophageal acid exposureHakanson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2009)Department of Surgery, Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, SwedenCase-control study with in-subject simultaneous recordingLevel: III-2Quality: 14/26CXP253 volunteers and 55 patients (45 volunteers and 47 patients had enough data to be included)30 females and 15 males in volunteer group27 females and 20 males in patient groupMean age: Volunteers: 47?years (range 21–68)Patients: 50?years (range 23–69)Indication: Patients had symptoms including mainly heartburn, acid regurgitation, and chest or epigastric painInclusion:Patients: referred to the clinic for investigation of GORDExclusion:Volunteers: history of GORD or any other pathology of the upper GI tract, taking acid-suppressing agents or medication known to affect GI motilityIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJ Duration: 48 hoursComparator:System: Slimline, Medtronic, Skovlunde, DenmarkInsertion: transnasallyPlacement: 5 cm proximal to the upper border of the LOSDuration: 24 hoursTechnical efficacy:Attachment failureEarly detachmentTechnical failure (recording failures etc.)Day-to-day variability in oesophageal acid exposureHochman and Favaloro-Sabatier PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9jaG1hbjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SG9jaG1hbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2005)Children’s Center for Digestive Health Care, Atlanta, Georgia, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P250 patients (44 patients had enough data to be included)27 males, 17 femalesMean age: 11.8?years (range 6–19)Inclusion: Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the proximal border of the LOSDuration: 48 hoursComparator: NATechnical efficacy:Early detachmentAttachment failureDay-to-day variability in oesophageal acid exposureIqbal et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SXFiYWw8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SXFiYWw8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2007)Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2100 patients58 females, 42 malesMean age:Women: 40 ± 14 yearsMen: 42 ± 16 yearsInclusion:Consecutive patients with GORD symptoms and undergoing Bravo pH monitoring over a 1-year periodExclusion:Patients with surgical history of the upper GI tract, bleeding diathesis or coagulopathy, oesophageal strictures, severe GI bleeding in the past 3?months, advanced cirrhosis or significant comorbiditiesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJComparator: NATechnical efficacy:Early detachmentKorrapati et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S29ycmFwYXRpPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S29ycmFwYXRpPC9BdXRob3I+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ADDIN EN.CITE.DATA (2011)Department of Gastroenterology and Hepatology, Winthrop University Hospital, Mineola, New York, USARetrospective case seriesLevel: IVQuality: Q2CX (no comparator)P2108 patients (47 male, 61 female)Mean age: 54.74 ± 14.67?yearsIndications: Heartburn (58%), chest pain (30%), chronic cough (8%), laryngitis (21%), bloating (35%)Inclusion:Not statedExclusion: Patients on anti-reflux medicationIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the GOJDuration: 48 hoursComparator: NATechnical efficacy:Day-to-day variability (% time pH <4)Lacy et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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ADDIN EN.CITE.DATA (2009)Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USAProspective case seriesLevel: IVQuality: Q1CX (no comparator)P251 patients (50 patients had enough data to be included)24 males, 26 femalesMean age: 13 years (range: 5–17)Indications: Heartburn, regurgitation, abdominal pain, nausea and/or vomiting, chest painInclusion:Not statedExclusion:Prior surgery to the oesophagus or stomach, known intestinal obstruction or oesophageal varices, achalasia, inability to understand the procedure, inability to undergo oesophageal manometry or sedationIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Day-to-day variability in oesophageal acid exposureLacy, Chehade & Crowell PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2011)Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USACase seriesLevel: IVQuality: Q1CX (no comparator)P2358 patients (257 females, 101 males)Mean age: 51 ± 14?yearsPredominantly (97%) Caucasian Indications: Symptoms thought secondary to GORDInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the GOJ or 5 cm above the upper border of the LOSDuration: 48 hoursComparator: NATechnical efficacy:Early detachmentLoss of signalLee et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGVlPC9BdXRob3I+PFllYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGVlPC9BdXRob3I+PFllYXI+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ADDIN EN.CITE.DATA (2005)Department of Internal Medicine, Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanProspective case seriesLevel: IVQuality: Q3CX (no comparator)P240 patients (27 males and 13 females)Age: range 28–83 yearsIndications:Typical heartburn with unsatisfactory response to therapy (15), erosive oesophagitis and undergoing preoperative evaluation (25)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Attachment failureEarly detachmentMarchese et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Marchese</Author><Year>2006</Year><RecNum>516</RecNum><IDText>813-818</IDText><DisplayText>(2006)</DisplayText><record><rec-number>516</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">516</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marchese, M.</author><author>Spada, C.</author><author>Iacopini, F.</author><author>Familiari, P.</author><author>Shah, S. G.</author><author>Tringali, A.</author><author>Costamagna, G.</author></authors></contributors><titles><title>Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: feasibility, safety, and efficacy of a manometry-guided procedure</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>813-818</pages><volume>38</volume><number>8</number><dates><year>2006</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0013-726X</isbn><accession-num>CCC:000240368800009</accession-num><urls><related-urls><url><Go to ISI>://CCC:000240368800009</url></related-urls></urls><electronic-resource-num>10.1055/s-2006-944526</electronic-resource-num></record></Cite></EndNote>(2006)Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Catholic University of Rome, Rome, ItalyProspective case seriesLevel: IVQuality: Q1CX (no comparator)P240 patients (36 patients had successful oesophageal placement of the capsule)23 males, 17 femalesMean age: 42.5?yearsIndications:Reflux symptoms that were refractory to PPI therapy Inclusion:Patients with reflux symptoms refractory to PPI therapy who had normal or equivocal endoscopic findingsExclusion:Patients with oesophageal varices, previous GI surgery, known coagulopathy or bleeding diathesis, cardiac pacemakers, defibrillators or other electromedical devices, significant comorbidity, pregnant women and patients <18?years of ageIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the upper margin of the LOSDuration: 24 or 48 hoursComparator: NATechnical efficacy:Technical failure Capsule displacementMartinez de Haro et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE.DATA (2008)Servicio de Cirugia General, Hospital Universitario Virgen de la Arrixaca, Murcia, SpainOne arm of non-randomised controlled trialLevel: IV Quality: Q2CXP240 patientsGroup 2 standard pH monitoring: mean age 45?years (range 17–73); 9 males and 6 femalesGroup 2 Bravo monitoring: mean age 37?years (range 21–59); 8 males and 7 femalesGroup 3 (both): mean age, 36.5?years (range 18–56); 7 males and 3 femalesInclusion:General criteria: >18 years of age, informed consent of the risks, benefits and alternative tests, committed to completing follow-upControl group: less than 2 episodes of pyrosis or regurgitation per month, no dysphagia or atypical reflux symptoms, no oesophageal motility disorders, not taken medication for acid reflux, no evidence of hiatal hernia or oesophagitisPatient group: typical reflux symptoms requiring treatment, inflammatory lesions due to reflux in the oesophageal mucosa in group 2Exclusion:<18 years of age, oesophageal stenosis, oesophageal varix, lesion affecting the nostrils, severe oesophageal motor disorders, high anaesthetic risk, history of coagulopathy, haemorrhage, intake of anticoagulants or platelet antiaggregates, myocardial infarction or CVA in the past 6?months, pregnancy, history of radiotherapy in the thoracic region, digestive haemorrhage in the past 6?months, any known medical disorder that could alter the data, unable to accept study protocols Index test:System: Bravo? wireless capsule systemInsertion: transnasally (n=25) and transorally (n=10)Placement: 5 cm above the LOSDuration: 48 hoursComparator:System: Digitrapper Mark III pH monitoring (Synetics, Stockholm, Sweden)Insertion: transnasallyPlacement: 5 cm above the LOS Duration: 24 hoursTechnical efficacy:Incorrect placementEarly detachmentImmediate detachmentNusrat, Roy & Bielefeldt PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TnVzcmF0PC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TnVzcmF0PC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2012)University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2356 patients (65% females)Mean age: 49.9 ± 0.8?yearsIndications: Evaluations of GORD, recurrent or persistent symptoms after fundoplication, chest pain, unexplained cough or other atypical symptomsInclusion:Not statedExclusion:Patients with pacemakers, implanted cardiac defibrillators, known oesophageal varices, bleeding disorders or ongoing anticoagulationIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the endoscopically localized SCJ or 5 cm above the manometrically determined upper border of the LOSDuration: 48 hoursComparator: NATechnical efficacy:Early capsule detachmentPandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE.DATA (2003)Northwestern University Feinberg School of Medicine, Chicago, Illinois, USACase-control studyLevel: IVQuality: Q1CX (no comparator)P344 controls (13 males, 31 females, aged 23–53?years) 41 patients (26 males, 15 females, aged 32–72?years)Inclusion:Not statedExclusion:Controls: abdominal symptoms, use of antacids or antisecretory medication, abnormal endoscopyPatients: history of surgical manipulation of the upper GI tract, history of bleeding diathesis or coagulopathy, stroke or transient ischemic attack in the past 6?months, significant medical illness, oesophageal varicesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJComparator: NATechnical efficacy:Early detachmentAttachment failureDay-to-day variability in oesophageal acid refluxPandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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=
ADDIN EN.CITE.DATA (2006)Division of Gastroenterology, Department of Medicine, the Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USACase-control studyLevel: IV Quality: Q2CX (no comparator)P310 normal control subjects (7 males and 3 females, aged 21–53?years) 10 patients with GORD (6 males and 4 females, aged 20–54?years)Inclusion:Controls: no history of heartburn, reflux, chest pain or atypical symptomsPatients: oesophagitis (3) or an abnormal 24-hour oesophageal pH study prior to this studyExclusion:History of surgical manipulation of the upper Gl tract, anticoagulation therapy, significant medical disease Controls: abdominal symptoms, use of antacids, abnormal upper endoscopyIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 1 cm proximal to SCJDuration: 24 hoursComparator: NATechnical efficacy:Operative successEarly detachmentConcordance capsule 1?cm vs 6?cm proximal to SCJPark et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Park</Author><Year>2013</Year><RecNum>611</RecNum><IDText>1-7</IDText><DisplayText>(2013)</DisplayText><record><rec-number>611</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">611</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Park, E. Y.</author><author>Choi, M. G.</author><author>Baeg, M.</author><author>Lim, C. H.</author><author>Kim, J.</author><author>Cho, Y.</author><author>Park, J.</author><author>Lee, I.</author><author>Kim, S.</author><author>Choi, K.</author></authors></contributors><auth-address>Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, Seoul, 137-040, South Korea</auth-address><titles><title>The Value of Early Wireless Esophageal pH Monitoring in Diagnosing Functional Heartburn in Refractory Gastroesophageal Reflux Disease</title><secondary-title>Digestive Diseases and Sciences</secondary-title></titles><periodical><full-title>Dig Dis Sci</full-title><abbr-1>Digestive diseases and sciences</abbr-1></periodical><pages>1-7</pages><keywords><keyword>Esophageal pH monitoring</keyword><keyword>Gastroesophageal reflux</keyword><keyword>Heartburn</keyword><keyword>Proton pump inhibitors</keyword></keywords><dates><year>2013</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(2013)Divisions of Gastroenterology, Department of internal Medicine, Seoul; St Mary’s Hospital, the Catholic University of Korea, Seoul, KoreaCase seriesLevel: IVQuality: Q1CX (no comparator)P2230 patients (101 males, 129 females)Mean age: 49.7 ± 12.4?yearsIndication: suspected GORDInclusion:≥18 years of ageExclusion: Previous oesophageal, gastric or duodenal surgery, GI organic disease, significant comorbidity or GI bleedingIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to SCJDuration: 48 hoursComparator: NATechnical efficacy:Operative successAttachment failureEarly detachmentRecording failurePrakash & Clouse PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UHJha2FzaDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UHJha2FzaDwvQXV0aG9yPjxZ
ZWFyPjIwMDY8L1llYXI+PFJlY051bT4zMDE8L1JlY051bT48SURUZXh0PjQ0Ni01MjwvSURUZXh0
PjxEaXNwbGF5VGV4dD4oMjAwNik8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MzAx
PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZs
ZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4zMDE8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVm
LXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48
YXV0aG9ycz48YXV0aG9yPlByYWthc2gsIEMuPC9hdXRob3I+PGF1dGhvcj5DbG91c2UsIFIuIEUu
PC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24g
b2YgR2FzdHJvZW50ZXJvbG9neSwgV2FzaGluZ3RvbiBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRp
Y2luZSwgNjYwIFMuIEV1Y2xpZCBBdmVudWUsIENCIDgxMjQsIFN0LiBMb3VpcywgTU8gNjMxMTAs
IFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5XaXJlbGVzcyBwSCBtb25pdG9yaW5n
IGluIHBhdGllbnRzIHdpdGggbm9uLWNhcmRpYWMgY2hlc3QgcGFpbjwvdGl0bGU+PHNlY29uZGFy
eS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRo
ZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxl
cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+
PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+
PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVy
b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRl
cm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NDQ2LTUyPC9wYWdlcz48dm9s
dW1lPjEwMTwvdm9sdW1lPjxudW1iZXI+MzwvbnVtYmVyPjxlZGl0aW9uPjIwMDYvMDMvMTg8L2Vk
aXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFudGktVWxj
ZXIgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5DaGVzdCBQYWluLyBl
dGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Njb3Blczwva2V5d29yZD48a2V5d29y
ZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJpYyBBY2lkaXR5IERldGVybWluYXRpb24v
IGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1
eC8gZGlhZ25vc2lzL2RydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdv
cmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48
a2V5d29yZD5NaW5pYXR1cml6YXRpb24vIGluc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29y
ZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5LyBpbnN0cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdv
cmQ+UHJvdG9uIFB1bXBzL2FudGFnb25pc3RzICZhbXA7IGluaGliaXRvcnM8L2tleXdvcmQ+PGtl
eXdvcmQ+UmVwcm9kdWNpYmlsaXR5IG9mIFJlc3VsdHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0
ZXM+PHllYXI+MjAwNjwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1hcjwvZGF0ZT48L3B1Yi1kYXRl
cz48L2RhdGVzPjxpc2JuPjAwMDItOTI3MCAoUHJpbnQpJiN4RDswMDAyLTkyNzAgKExpbmtpbmcp
PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE2NTQyMjc5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxh
dGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5hdHVyZS5jb20vYWpnL2pvdXJuYWwvdjEwMS9uMy9w
ZGYvYWpnMjAwNjkyYS5wZGY8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMt
cmVzb3VyY2UtbnVtPjEwLjExMTEvai4xNTcyLTAyNDEuMjAwNi4wMDQyNS54PC9lbGVjdHJvbmlj
LXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFi
YXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0Vu
ZE5vdGU+AG==
ADDIN EN.CITE.DATA (2006)Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USACase seriesLevel: IVQuality: Q1CX (no comparator)P262 patients (41 females, 21 males)Mean age: 47 ± 2?yearsInclusion:Not statedExclusion:Oesophagitis, prior anti-reflux surgery, failure to maintain a complete diary of activities and symptoms, having <14?hours of good-quality tracings on each of the study daysIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJComparator: NATechnical efficacy:Day-to-day variabilityRemes-Troche et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVtZXMtVHJvY2hlPC9BdXRo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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UmVtZXMtVHJvY2hlPC9BdXRo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ADDIN EN.CITE.DATA (2005)Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, MexicoProspective case seriesLevel: IVQuality: Q1CX (no comparator)P284 patients (77 patients had enough data to be included)49 females, 35 malesMean age: 44 ± 12?years (range 19–73)Indications:Persistent GORD symptoms on PPI, preoperative evaluation before surgery, previous failed transnasal pH monitoring, extraoesophageal GORDInclusion:Consecutive patients with GORD symptoms with an indication for 24-hour pH monitoringExclusion:Patients with surgical manipulation of the upper GI tract, bleeding diathesis or coagulopathy, severe GI bleeding in the past 6?months, oesophageal varices, significant comorbiditiesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Attachment failureEarly detachmentDay-to-day variability in acid exposureScarpulla et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE.DATA (2007)Gastroenterology Division, M. Raimondi Hospital, Can Cataldo, ItalyRetrospective case seriesLevel: IVQuality: Q2CX P283 patients (complete 4-day recordings were available for 34/83)44 females, 39 malesMedian age 42?years (range 18–63)Indications:Typical reflux symptoms or atypical symptoms including chest pain and extra oesophageal complaintsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the Z lineDuration: 24, 48, 72 and/or 96?hoursComparator: NATechnical efficacy:Early detachmentTechnical failureSofi et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Sofi</Author><Year>2011</Year><RecNum>540</RecNum><IDText>243-248</IDText><DisplayText>(2011)</DisplayText><record><rec-number>540</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">540</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sofi, A.</author><author>Filipiak, C.</author><author>Sodeman, T.</author><author>Ahmad, U.</author><author>Bawany, M.</author><author>Daboul, I.</author></authors></contributors><auth-address>Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States</auth-address><titles><title>Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method</title><secondary-title>Turkish Journal of Gastroenterology</secondary-title></titles><periodical><full-title>Turkish Journal of Gastroenterology</full-title></periodical><pages>243-248</pages><volume>22</volume><number>3</number><keywords><keyword>Bravo capsule</keyword><keyword>Direct/indirect</keyword><keyword>Technique</keyword></keywords><dates><year>2011</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(2011)Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USARetrospective case series58 patientsAge range: 26–87?years17 males, 41 femalesInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the GOJComparator: NATechnical efficacy:Early detachment (none)Device malfunctionRecording failureTankurt et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGFua3VydDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VGFua3VydDwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Kent Hospital, Department of Gastroenterology, Izmir, TurkeyCase seriesLevel: IVQuality: Q2CX (no comparator)P264 patients (37 males, 27 females)Mean age: 37.9 years (range 25–58)Indications: Preoperative evaluation (17), evaluation of atypical reflux symptoms (40) and ‘other’ (7)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Early detachmentTseng et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHNlbmc8L0F1dGhvcj48WWVh
cj4yMDA1PC9ZZWFyPjxSZWNOdW0+MzI0PC9SZWNOdW0+PElEVGV4dD4xMDQzLTUxOyBkaXNjdXNz
aW9uIDEwNTEtMjwvSURUZXh0PjxEaXNwbGF5VGV4dD4oMjAwNSk8L0Rpc3BsYXlUZXh0PjxyZWNv
cmQ+PHJlYy1udW1iZXI+MzI0PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVO
IiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdyIj4zMjQ8L2tleT48
L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5
cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlRzZW5nLCBELjwvYXV0aG9yPjxhdXRo
b3I+Uml6dmksIEEuIFouPC9hdXRob3I+PGF1dGhvcj5GZW5uZXJ0eSwgTS4gQi48L2F1dGhvcj48
YXV0aG9yPkpvYmUsIEIuIEEuPC9hdXRob3I+PGF1dGhvcj5EaWdncywgQi4gUy48L2F1dGhvcj48
YXV0aG9yPlNoZXBwYXJkLCBCLiBDLjwvYXV0aG9yPjxhdXRob3I+R3Jvc3MsIFMuIEMuPC9hdXRo
b3I+PGF1dGhvcj5Td2Fuc3Ryb20sIEwuIEwuPC9hdXRob3I+PGF1dGhvcj5XaGl0ZSwgTi4gQi48
L2F1dGhvcj48YXV0aG9yPkF5ZSwgUi4gVy48L2F1dGhvcj48YXV0aG9yPkh1bnRlciwgSi4gRy48
L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EaWdlc3RpdmUg
SGVhbHRoIENlbnRlciwgRGVwYXJ0bWVudCBvZiBTdXJnZXJ5IGFuZCBEaXZpc2lvbiBvZiBHYXN0
cm9lbnRlcm9sb2d5LCBPcmVnb24gSGVhbHRoIGFuZCBTY2llbmNlIFVuaXZlcnNpdHksIE9SIDk3
MjM5LTMwOTgsIFVTQS4gdHNlbmdkQG9oc3UuZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0
bGU+Rm9ydHktZWlnaHQtaG91ciBwSCBtb25pdG9yaW5nIGluY3JlYXNlcyBzZW5zaXRpdml0eSBp
biBkZXRlY3RpbmcgYWJub3JtYWwgZXNvcGhhZ2VhbCBhY2lkIGV4cG9zdXJlPC90aXRsZT48c2Vj
b25kYXJ5LXRpdGxlPkogR2FzdHJvaW50ZXN0IFN1cmc8L3NlY29uZGFyeS10aXRsZT48YWx0LXRp
dGxlPkpvdXJuYWwgb2YgZ2FzdHJvaW50ZXN0aW5hbCBzdXJnZXJ5IDogb2ZmaWNpYWwgam91cm5h
bCBvZiB0aGUgU29jaWV0eSBmb3IgU3VyZ2VyeSBvZiB0aGUgQWxpbWVudGFyeSBUcmFjdDwvYWx0
LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogR2FzdHJvaW50ZXN0IFN1
cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2ludGVzdGluYWwgc3VyZ2Vy
eSA6IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIFNvY2lldHkgZm9yIFN1cmdlcnkgb2YgdGhlIEFs
aW1lbnRhcnkgVHJhY3Q8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPkogR2FzdHJvaW50ZXN0IFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9m
IGdhc3Ryb2ludGVzdGluYWwgc3VyZ2VyeSA6IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIFNvY2ll
dHkgZm9yIFN1cmdlcnkgb2YgdGhlIEFsaW1lbnRhcnkgVHJhY3Q8L2FiYnItMT48L2FsdC1wZXJp
b2RpY2FsPjxwYWdlcz4xMDQzLTUxOyBkaXNjdXNzaW9uIDEwNTEtMjwvcGFnZXM+PHZvbHVtZT45
PC92b2x1bWU+PG51bWJlcj44PC9udW1iZXI+PGVkaXRpb24+MjAwNS8xMS8wNTwvZWRpdGlvbj48
a2V5d29yZHM+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3RyaWMgQWNpZGl0
eSBEZXRlcm1pbmF0aW9uLyBpbnN0cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJv
ZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl
eXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdv
cmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5N
b25pdG9yaW5nLCBBbWJ1bGF0b3J5LyBpbnN0cnVtZW50YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+
UmV0cm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlNlbnNpdGl2aXR5IGFuZCBT
cGVjaWZpY2l0eTwva2V5d29yZD48a2V5d29yZD5TdGF0aXN0aWNzLCBOb25wYXJhbWV0cmljPC9r
ZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDU8L3llYXI+PHB1Yi1kYXRlcz48ZGF0
ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xMDkxLTI1NVggKFByaW50KSYj
eEQ7MTA5MS0yNTVYIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xNjI2OTM3NDwvYWNj
ZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL2xpbmsuc3ByaW5nZXIu
Y29tLnByb3h5LmxpYnJhcnkuYWRlbGFpZGUuZWR1LmF1L2NvbnRlbnQvcGRmLzEwLjEwMTYlMkZq
Lmdhc3N1ci4yMDA1LjA3LjAxMS5wZGY8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0
cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5nYXNzdXIuMjAwNS4wNy4wMTE8L2VsZWN0cm9u
aWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0
YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwv
RW5kTm90ZT4A
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+VHNlbmc8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2005)Digestive Health Center, Department of Surgery and Division of Gastroenterology, Oregon health and Science University, Portland, Oregon, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2190 procedures and 186 patients (some had the test performed twice) 72 males and 114 femalesMean age: 51?yearsIndication: Being evaluated for GORDInclusion:Patients older than 18 yearsExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5–6cm above the LOS or 5–6?m above the SCJ Duration: 48 hoursComparator:24-hour Bravo monitoringTechnical efficacy:Loss of signal/dataEarly detachmentDay-to-day variabilityTu et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Tu</Author><Year>2004</Year><RecNum>527</RecNum><IDText>1586-1589</IDText><DisplayText>(2004)</DisplayText><record><rec-number>527</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">527</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tu, C. H.</author><author>Lee, Y. C.</author><author>Wang, H. P.</author><author>Wu, M. S.</author><author>Chiu, H. M.</author><author>Lin, J. T.</author></authors></contributors><titles><title>Ambulatory esophageal pH monitoring by using a wireless system: A pilot study in Taiwan</title><secondary-title>Hepato-Gastroenterology</secondary-title></titles><periodical><full-title>Hepatogastroenterology</full-title><abbr-1>Hepato-gastroenterology</abbr-1></periodical><pages>1586-1589</pages><volume>51</volume><number>60</number><dates><year>2004</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>0172-6390</isbn><accession-num>CCC:000224607400004</accession-num><urls><related-urls><url><Go to ISI>://CCC:000224607400004</url></related-urls></urls></record></Cite></EndNote>(2004)Department of Internal Medicine and Department of Emergency Medicine, National Taiwan University Hospital, Taipei, TaiwanProspective case seriesLevel: IVQuality: Q1CX (no comparator)P230 patients20 males, 10 femalesMean age: 57.6 ± 14.3?years (range 29–83)Indications: 24 patients with GORD were evaluated for drug effectiveness before surgery, 6 patients showed typical heartburn but their endoscopic findings were normalInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the GOJDuration: 48 hoursComparator: NATechnical efficacy:Attachment failureTurner et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Turner</Author><Year>2007</Year><RecNum>536</RecNum><IDText>737-741</IDText><DisplayText>(2007)</DisplayText><record><rec-number>536</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">536</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Turner, B. G.</author><author>Saltzman, J. R.</author><author>Hua, L.</author><author>Maurer, R.</author><author>Feldman, N.</author><author>Carr-Locke, D. L.</author><author>Burakoff, R.</author><author>Liu, J. J.</author></authors></contributors><titles><title>Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease</title><secondary-title>Canadian Journal of Gastroenterology</secondary-title></titles><periodical><full-title>Canadian Journal of Gastroenterology</full-title></periodical><pages>737-741</pages><volume>21</volume><number>11</number><dates><year>2007</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0835-7900</isbn><accession-num>CCC:000251481000008</accession-num><urls><related-urls><url><Go to ISI>://CCC:000251481000008</url><url>;(2007)Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, USACase seriesLevel: IVQuality: Q2CX (no comparator)P2198 pH studies (148 studies had enough data to be included)Off medical therapy: 115 patients, 76 females, 39 males. Mean age: 50 ± 13?yearsOn medical therapy: 33 patients, 26 females, 7 males. Mean age: 52 ± 14?yearsIndications: Typical and atypical symptoms of GORD or persistent GORD-related symptoms despite medical therapy. Patients with planned anti-reflux surgery were also evaluatedInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: (during endoscopy)Placement: 6 cm above the SCJDuration: 48 hoursComparator:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: Duration: 24 hoursTechnical efficacyEarly detachmentInsufficient data captureDay-to-day variability in oesophageal acid exposureWard et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2FyZDwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2FyZDwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE.DATA (2004)Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USACase seriesLevel: IVQuality: Q2CX (no comparator)P260 patients (58 patients had enough data to be included)26 males, 34 femalesMean age: 54 years (range 27–82)Indications:Document GORD before surgery, possible GORD with negative PPI trial, evaluate response to PPI, possible supra-oesophageal GORD, non-cardiac chest pain, evaluate response to Stretta procedure, previous failed pH testInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NATechnical efficacy:Attachment failureHardware malfunctionWenner, Johnsson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2007)Department of Surgery, Lund University Hospital, Lund, SwedenRandomised crossover trialLevel: IIQuality: 20/26CXP235 patients (31 patients had enough data to be included)15 males, 16 femalesMedian age: 52 yearsMedian BMI: 27 (range 24–28)Indications: Typical reflux symptoms (55%) and atypical reflux symptoms (45%)Inclusion:Patients referred for oesophageal pH monitoring Exclusion:Patients with coagulopathy, severe oesophagitis/stricture, portal hypertension, a pacemaker, age <20 or >70?years, previous gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline (Medtronic) Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursTechnical efficacy:Technical problemsWenner et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll
YXI+MjAwNzwvWWVhcj48UmVjTnVtPjMzMTwvUmVjTnVtPjxJRFRleHQ+MTg2Mi05PC9JRFRleHQ+
PERpc3BsYXlUZXh0PigyMDA4OyAyMDA3KTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJl
cj4zMzE8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1
ZWZkZmxkZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjMzMTwva2V5PjwvZm9yZWlnbi1rZXlz
PjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0
b3JzPjxhdXRob3JzPjxhdXRob3I+V2VubmVyLCBKLjwvYXV0aG9yPjxhdXRob3I+Sm9oYW5zc29u
LCBKLjwvYXV0aG9yPjxhdXRob3I+Sm9obnNzb24sIEYuPC9hdXRob3I+PGF1dGhvcj5PYmVyZywg
Uy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRt
ZW50IG9mIFN1cmdlcnksIEx1bmQgVW5pdmVyc2l0eSBIb3NwaXRhbCwgU0UtMjIxIDg1IEx1bmQs
IFN3ZWRlbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5PcHRpbWFsIHRocmVzaG9sZHMg
YW5kIGRpc2NyaW1pbmF0b3J5IHBvd2VyIG9mIDQ4LWggd2lyZWxlc3MgZXNvcGhhZ2VhbCBwSCBt
b25pdG9yaW5nIGluIHRoZSBkaWFnbm9zaXNvZiBHRVJEPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxl
PkFtIEogR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+VGhlIEFtZXJp
Y2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJp
b2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0x
PlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L3Blcmlv
ZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVs
bC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8
L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xODYyLTk8L3BhZ2VzPjx2b2x1bWU+MTAy
PC92b2x1bWU+PG51bWJlcj45PC9udW1iZXI+PGVkaXRpb24+MjAwNy8wNS8xOTwvZWRpdGlvbj48
a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBwSCBN
b25pdG9yaW5nL2luc3RydW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdv
cmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29yZD48
a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5N
aWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5L2luc3Ry
dW1lbnRhdGlvbjwva2V5d29yZD48a2V5d29yZD5ST0MgQ3VydmU8L2tleXdvcmQ+PGtleXdvcmQ+
U2Vuc2l0aXZpdHkgYW5kIFNwZWNpZmljaXR5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5
ZWFyPjIwMDc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5TZXA8L2RhdGU+PC9wdWItZGF0ZXM+PC9k
YXRlcz48aXNibj4wMDAyLTkyNzAgKFByaW50KSYjeEQ7MDAwMi05MjcwIChMaW5raW5nKTwvaXNi
bj48YWNjZXNzaW9uLW51bT4xNzUwOTAzNDwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11
cmxzPjx1cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2FqZy9qb3VybmFsL3YxMDIvbjkvcGRmL2Fq
ZzIwMDczNjdhLnBkZjwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNv
dXJjZS1udW0+MTAuMTExMS9qLjE1NzItMDI0MS4yMDA3LjAxMjY5Lng8L2VsZWN0cm9uaWMtcmVz
b3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2Ut
cHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlIEV4
Y2x1ZGVBdXRoPSIxIj48QXV0aG9yPldlbm5lcjwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl
Y051bT4zMzA8L1JlY051bT48SURUZXh0PjI5NzctODU8L0lEVGV4dD48cmVjb3JkPjxyZWMtbnVt
YmVyPjMzMDwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6
dzVlZmRmbGRkejVhZTJ4MDM1cnAyZnoyMnNld3J2cjB3ciI+MzMwPC9rZXk+PC9mb3JlaWduLWtl
eXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmli
dXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5XZW5uZXIsIEouPC9hdXRob3I+PGF1dGhvcj5IYWxsLCBN
LjwvYXV0aG9yPjxhdXRob3I+SG9nbHVuZCwgUC48L2F1dGhvcj48YXV0aG9yPkpvaGFuc3Nvbiwg
Si48L2F1dGhvcj48YXV0aG9yPkpvaG5zc29uLCBGLjwvYXV0aG9yPjxhdXRob3I+T2JlcmcsIFMu
PC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVu
dCBvZiBTdXJnZXJ5LCBMdW5kIFVuaXZlcnNpdHkgSG9zcGl0YWwsIEx1bmQsIFN3ZWRlbi48L2F1
dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5XaXJlbGVzcyBwSCByZWNvcmRpbmcgaW1tZWRpYXRl
bHkgYWJvdmUgdGhlIHNxdWFtb2NvbHVtbmFyIGp1bmN0aW9uIGltcHJvdmVzIHRoZSBkaWFnbm9z
dGljIHBlcmZvcm1hbmNlIG9mIGVzb3BoYWdlYWwgcEggc3R1ZGllczwvdGl0bGU+PHNlY29uZGFy
eS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRo
ZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxl
cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+
PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+
PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVy
b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRl
cm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+Mjk3Ny04NTwvcGFnZXM+PHZv
bHVtZT4xMDM8L3ZvbHVtZT48bnVtYmVyPjEyPC9udW1iZXI+PGVkaXRpb24+MjAwOC8wOS8xMzwv
ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwv
a2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIHBIIE1vbml0b3Jpbmc8L2tleXdvcmQ+PGtleXdv
cmQ+RXNvcGhhZ3VzLyBwYXRob2xvZ3kvIHBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29y
ZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvZGlhZ25v
c2lzLyBwYXRob2xvZ3kvIHBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8
L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtl
eXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48L2tleXdv
cmRzPjxkYXRlcz48eWVhcj4yMDA4PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RGVjPC9kYXRlPjwv
cHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTU3Mi0wMjQxIChFbGVjdHJvbmljKSYjeEQ7MDAwMi05
MjcwIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xODc4NjExMjwvYWNjZXNzaW9uLW51
bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2FqZy9qb3Vy
bmFsL3YxMDMvbjEyL3BkZi9hamcyMDA4NjA4YS5wZGY8L3VybD48L3JlbGF0ZWQtdXJscz48L3Vy
bHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvai4xNTcyLTAyNDEuMjAwOC4wMjE3
NC54PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5M
TTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVj
b3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE.DATA (2008); Wenner. Johansson et al. (2007)Department of Surgery, Lund University Hospital, Lund, SwedenCase-control studyLevel: IV Quality: Q2CXP370 patients, but 64 had enough data to be included (39 males, 25 females) and 55 controls (27 males and 28 females) Not all patients are included in the distal capsule outcomesIndications: Patients with typical reflux symptomsInclusion:Patients: presence of typical reflux symptoms such as heartburn and regurgitation. Symptoms had to occur more than twice weekly. Treatment with medical acid suppression had to result in complete symptom relief or a more than 50% reduction of the symptoms Exclusion:Coagulopathy, severe oesophagitis/stricture, portal hypertension, pacemaker, <20 or >70?years of age, history of gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJTechnical efficacy:Early detachmentCapsule unable to pass through oesophagusTransmission failure / loss of signalIncorrect capsule placementStudy profiles of included studies on linked evidenceDiagnostic accuracyStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / Exclusion criteriaDiagnostic testsDiagnostic accuracy outcome assessedAyazi et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Ayazi</Author><Year>2009</Year><RecNum>497</RecNum><DisplayText>(2009)</DisplayText><record><rec-number>497</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">497</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayazi, S.</author><author>Lipham, J. C.</author><author>Portale, G.</author><author>Peyre, C. G.</author><author>Streets, C. G.</author><author>Leers, J. M.</author><author>Demeester, S. R.</author><author>Banki, F.</author><author>Chan, L. S.</author><author>Hagen, J. A.</author><author>Demeester, T. R.</author></authors></contributors><titles><title>Bravo Catheter-Free pH Monitoring: Normal Values, Concordance, Optimal Diagnostic Thresholds, and Accuracy</title><secondary-title>Clinical Gastroenterology and Hepatology</secondary-title></titles><periodical><full-title>Clinical Gastroenterology and Hepatology</full-title></periodical><pages>60-67</pages><volume>7</volume><number>1</number><dates><year>2009</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>CCC:000262822000012</accession-num><urls><related-urls><url><Go to ISI>://CCC:000262822000012</url></related-urls></urls><electronic-resource-num>10.1016/j.cgh.2008.08.020</electronic-resource-num></record></Cite></EndNote>(2009)Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USADiagnostic case-control studyLevel: III-3Quality:Patient selection: ?Index test: ?Reference standard: Flow and timing: ?CX P325 asymptomatic subjects and 25 patientsIndications: Patients had heartburn and were responsive to PPI therapy. All had hiatal herniaInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule system, Medtronic Inc. Minneapolis MinnesotaInsertion: transnasallyPlacement: 5 cm above the LOSDuration: 48 hoursComparator: NAReference standard:Clinical diagnosis (heartburn, responsive to PPI therapy and evidence of a hiatal hernia)SensitivitySpecificityAccuracyAyazi et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Ayazi</Author><Year>2009</Year><RecNum>497</RecNum><DisplayText>(2009)</DisplayText><record><rec-number>497</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">497</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayazi, S.</author><author>Lipham, J. C.</author><author>Portale, G.</author><author>Peyre, C. G.</author><author>Streets, C. G.</author><author>Leers, J. M.</author><author>Demeester, S. R.</author><author>Banki, F.</author><author>Chan, L. S.</author><author>Hagen, J. A.</author><author>Demeester, T. R.</author></authors></contributors><titles><title>Bravo Catheter-Free pH Monitoring: Normal Values, Concordance, Optimal Diagnostic Thresholds, and Accuracy</title><secondary-title>Clinical Gastroenterology and Hepatology</secondary-title></titles><periodical><full-title>Clinical Gastroenterology and Hepatology</full-title></periodical><pages>60-67</pages><volume>7</volume><number>1</number><dates><year>2009</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>CCC:000262822000012</accession-num><urls><related-urls><url><Go to ISI>://CCC:000262822000012</url></related-urls></urls><electronic-resource-num>10.1016/j.cgh.2008.08.020</electronic-resource-num></record></Cite></EndNote>(2009)11Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USADiagnostic case-control studyLevel: III-3Quality:Patient selection: Index test: ?Reference standard: Flow and timing: CXP3115 symptomatic patients who were tested for GORD (28 patients with strong clinical evidence, 77 with intermediate evidence, and 10 with minimal evidence, of GORDInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule system, Medtronic Inc. Minneapolis MinnesotaInsertion: transnasallyPlacement: 5 cm above the LOSDuration: 48 hoursComparator:NAReference standard:Clinical diagnosis (primary symptoms of heartburn and/or regurgitation, response to PPI therapy >50%, hiatal hernia >2?cm, oesophageal mucosal injury)SensitivitySpecificityPPV NPVAccuracyBansal et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll
YXI+MjAwOTwvWWVhcj48UmVjTnVtPjE5NjwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oMjAwOSk8L0Rp
c3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTk2PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtl
eXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZy
MHdyIj4xOTY8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRp
Y2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJhbnNhbCwg
QS48L2F1dGhvcj48YXV0aG9yPldhbmksIFMuPC9hdXRob3I+PGF1dGhvcj5SYXN0b2dpLCBBLjwv
YXV0aG9yPjxhdXRob3I+UmFzdG9naSwgSy48L2F1dGhvcj48YXV0aG9yPkdveWFsLCBBLjwvYXV0
aG9yPjxhdXRob3I+SGFsbCwgUy48L2F1dGhvcj48YXV0aG9yPlNpbmdoLCBWLjwvYXV0aG9yPjxh
dXRob3I+SGlnYmVlLCBBLjwvYXV0aG9yPjxhdXRob3I+U2hhcm1hLCBQLjwvYXV0aG9yPjwvYXV0
aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9ucyBvZiBHYXN0cm9lbnRl
cm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBVbml2ZXJzaXR5IG9mIEthbnNhcyBTY2hvb2wgb2YgTWVk
aWNpbmUgYW5kIFZldGVyYW5zIEFmZmFpcnMgTWVkaWNhbCBDZW50ZXIsIEthbnNhcyBDaXR5LCBN
aXNzb3VyaSA2NDEyOCwgVVNBLiBhYmFuc2FsQGt1bWMuZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxl
cz48dGl0bGU+SW1wYWN0IG9mIG1lYXN1cmVtZW50IG9mIGVzb3BoYWdlYWwgYWNpZCBleHBvc3Vy
ZSBjbG9zZSB0byB0aGUgZ2FzdHJvZXNvcGhhZ2VhbCBqdW5jdGlvbiBvbiBkaWFnbm9zdGljIGFj
Y3VyYWN5IGFuZCBldmVudC1zeW1wdG9tIGNvcnJlbGF0aW9uOiBhIHByb3NwZWN0aXZlIHN0dWR5
IHVzaW5nIHdpcmVsZXNzIGR1YWwgcEggbW9uaXRvcmluZzwvdGl0bGU+PHNlY29uZGFyeS10aXRs
ZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRoZSBBbWVy
aWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnIt
MT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJp
b2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1
bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5
PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjkxOC0yNTwvcGFnZXM+PHZvbHVtZT4x
MDQ8L3ZvbHVtZT48bnVtYmVyPjEyPC9udW1iZXI+PGVkaXRpb24+MjAwOS8wOS8xNzwvZWRpdGlv
bj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBwSCBNb25pdG9yaW5nLyBpbnN0cnVtZW50
YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9uPC9rZXl3b3Jk
PjxrZXl3b3JkPkVzb3BoYWdvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2Vh
bCBSZWZsdXgvIGRpYWdub3Npczwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtl
eXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwv
a2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Qcm9zcGVjdGl2
ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlF1ZXN0aW9ubmFpcmVzPC9rZXl3b3JkPjxrZXl3
b3JkPlJPQyBDdXJ2ZTwva2V5d29yZD48a2V5d29yZD5TZW5zaXRpdml0eSBhbmQgU3BlY2lmaWNp
dHk8L2tleXdvcmQ+PGtleXdvcmQ+U3RhdGlzdGljcywgTm9ucGFyYW1ldHJpYzwva2V5d29yZD48
L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDA5PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RGVjPC9k
YXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTU3Mi0wMjQxIChFbGVjdHJvbmljKSYjeEQ7
MDAwMi05MjcwIChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xOTc1NTk3NTwvYWNjZXNz
aW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2Fq
Zy9qb3VybmFsL3YxMDQvbjEyL3BkZi9hamcyMDA5NTA2YS5wZGY8L3VybD48L3JlbGF0ZWQtdXJs
cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMzgvYWpnLjIwMDkuNTA2PC9l
bGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVt
b3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv
Q2l0ZT48L0VuZE5vdGU+
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2009)Divisions of Gastroenterology and Hepatology, University of Kansas, School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USADiagnostic case-control study Level: III-3 Quality: Patient selection: Index test: ?Reference standard: Flow and timing:?C1 P248 patients (43 males, 5 females) 22 controls (22 males)Mean age:Patients: 57 ± 13?yearsControls: 59 ± 9?yearsIndication: Reflux symptomsInclusion:Patients: answering ‘yes’ to either heartburn or regurgitation, having a score of >2 on the RDQControls: answering ‘no’ to heartburn and regurgitation, having a score of 0 on the RDQExclusion:Patients: cancer or mass lesion in the oesophagus, advanced chronic liver disease, severe uncontrolled coagulopathy, history of oesophageal or gastric surgeryControls: use of acid suppression, evidence of erosive oesophagitisIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 1 cm above the GOJDuration: 24 hoursIndex test 2:System: Bravo? wireless capsule systemInsertion: NS placement: 6 cm above the GOJ Duration: 24 hoursReference standard (clinical diagnosis):Answering ‘yes’ to either heartburn or regurgitation and having a score of at least 2 on the RDQSensitivitySpecificitydes Varannes et al.PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE.DATA (2005)Department of Gastroenterology and Hepatology, Hopital Hotel Dieu, Nantes, FranceIn-subject simultaneous recording studyLevel: II Quality: Patient selection: ?Index test: Reference standard: ?Flow and timing: C1 P240 patients(probe successfully attached in 36 patients)21 males, 19 femalesMean age: 50 yearsIndications:Heartburn (n=7), regurgitation (n=6) or both symptoms (n=26)Inclusion:Patients suggestive of GORD and referred to the functional laboratory of four French academic centres for pH monitoringExclusion:Severe oesophageal motility disorders, severe oesophagitis (Los Angeles grade C or above), pregnancy, women who were not using reliable contraceptionIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the Z lineDuration: 48 hoursComparator:System: Mark III or Digitrapper pH, Medtronic, Stockholm, SwedenInsertion: transnasallyPlacement: adjusted to the same level as the index testDuration: 24 hoursSensitivitySpecificityPPV NPVLR+LR–Hakanson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2009)Department of Surgery, Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, SwedenCase-control study with in-subject simultaneous recordingLevel: III-3 Quality: Patient selection: ?Index test: Reference standard: ?Flow and timing: C1 P253 volunteers and 55 patients (45 volunteers and 47 patients had enough data to be included)30 females and 15 males in volunteer group27 females and 20 males in patient groupMean age: Volunteers: 47?years (range 21–68)Patients: 50?years (range 23–69)Indication: Patients had symptoms including mainly heartburn, acid regurgitation, and chest or epigastric painInclusion:Patients: referred to the clinic for investigation of GORDExclusion:Volunteers: history of GORD or any other pathology of the upper GI tract, taking acid-suppressing agents or medication known to affect GI motilityIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJ Duration: 48 hoursComparator:System: Slimline, Medtronic, Skovlunde, DenmarkInsertion: transnasallyPlacement: 5 cm proximal to the upper border of the LOSDuration: 24 hoursSensitivitySpecificityPPV NPVLR+LR–Pandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y
PjxZZWFyPjIwMDM8L1llYXI+PFJlY051bT4yOTU8L1JlY051bT48SURUZXh0Pjc0MC05PC9JRFRl
eHQ+PERpc3BsYXlUZXh0PigyMDAzKTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4y
OTU8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4enc1ZWZk
ZmxkZHo1YWUyeDAzNXJwMmZ6MjJzZXdydnIwd3IiPjI5NTwva2V5PjwvZm9yZWlnbi1rZXlzPjxy
ZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3Jz
PjxhdXRob3JzPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48YXV0aG9yPlJpY2h0
ZXIsIEouIEUuPC9hdXRob3I+PGF1dGhvcj5PdXJzLCBULjwvYXV0aG9yPjxhdXRob3I+R3VhcmRp
bm8sIEouIE0uPC9hdXRob3I+PGF1dGhvcj5DaGFwbWFuLCBKLjwvYXV0aG9yPjxhdXRob3I+S2Fo
cmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl
c3M+Tm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBD
aGljYWdvLCBJbGxpbm9pcyA2MDYxMS0zMDA4LCBVU0EuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48
dGl0bGU+QW1idWxhdG9yeSBlc29waGFnZWFsIHBIIG1vbml0b3JpbmcgdXNpbmcgYSB3aXJlbGVz
cyBzeXN0ZW08L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9zZWNv
bmRhcnktdGl0bGU+PGFsdC10aXRsZT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRl
cm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QW0gSiBH
YXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2Yg
Z2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1
bGwtdGl0bGU+QW0gSiBHYXN0cm9lbnRlcm9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhlIEFtZXJp
Y2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+
PHBhZ2VzPjc0MC05PC9wYWdlcz48dm9sdW1lPjk4PC92b2x1bWU+PG51bWJlcj40PC9udW1iZXI+
PGVkaXRpb24+MjAwMy8wNS8xMDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tl
eXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DYXBzdWxlcy9hZHZlcnNlIGVm
ZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+RXF1aXBtZW50IERlc2lnbjwva2V5d29yZD48a2V5d29y
ZD5Fc29waGFndXMvIHBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tl
eXdvcmQ+PGtleXdvcmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvIHBoeXNpb3BhdGhvbG9neTwv
a2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENv
bmNlbnRyYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NaWRk
bGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Nb25pdG9yaW5nLCBBbWJ1bGF0b3J5L2FkdmVyc2Ug
ZWZmZWN0cy8gaW5zdHJ1bWVudGF0aW9uLyBtZXRob2RzPC9rZXl3b3JkPjxrZXl3b3JkPlJlcHJv
ZHVjaWJpbGl0eSBvZiBSZXN1bHRzPC9rZXl3b3JkPjxrZXl3b3JkPlNlbnNpdGl2aXR5IGFuZCBT
cGVjaWZpY2l0eTwva2V5d29yZD48a2V5d29yZD5UZWxlbWV0cnkvYWR2ZXJzZSBlZmZlY3RzL2lu
c3RydW1lbnRhdGlvbi9tZXRob2RzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIw
MDM8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BcHI8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48
aXNibj4wMDAyLTkyNzAgKFByaW50KSYjeEQ7MDAwMi05MjcwIChMaW5raW5nKTwvaXNibj48YWNj
ZXNzaW9uLW51bT4xMjczODQ1MDwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1
cmw+aHR0cDovL3d3dy5uYXR1cmUuY29tL2FqZy9qb3VybmFsL3Y5OC9uNC9wZGYvYWpnMjAwMzE4
NGEucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51
bT4xMC4xMTExL2ouMTU3Mi0wMjQxLjIwMDMuMDczOTgueDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1u
dW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRl
cj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE.DATA (2003)Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADiagnostic case-control studyLevel: III-3Quality: Patient selection: Index test: ?Reference standard: ?Flow and timing: Q1CX (clinical diagnosis)P344 controls (13 males, 31 females, aged 23–53?years) 41 patients (26 males, 15 females, aged 32–72?years)Inclusion:Not statedExclusion:Controls: abdominal symptoms, use of antacids or antisecretory medication, abnormal endoscopyPatients: history of surgical manipulation of the upper GI tract, history of bleeding diathesis or coagulopathy, stroke or transient ischemic attack in the past 6?months, significant medical illness, oesophageal varicesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJComparator: NAReference standard (diagnosis of patients in study population):25 patients had erosive oesophagitis, 6 had an abnormal 24-hour pH study, 10 were diagnosed clinically with typical GORD symptoms that resolved with PPI therapySensitivitySpecificityPPVNPVLR+LR–Wenner, Johnsson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2007)Department of Surgery, Lund University Hospital, Lund, SwedenRandomised crossover trialLevel: IIQuality: Patient selection: Index test: Reference standard: ?Flow and timing: C1 P235 patients (31 patients had enough data to be included)15 males, 16 femalesMedian age: 52 yearsMedian BMI: 27 (range 24–28)Indications: Typical reflux symptoms (55%) and atypical reflux symptoms (45%)Inclusion:Patients referred for oesophageal pH monitoring Exclusion:Patients with coagulopathy, severe oesophagitis/stricture, portal hypertension, a pacemaker, age <20 or >70?years, previous gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline (Medtronic) Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursSensitivitySpecificityPPVNPVLR+LR–Wenner et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2008); Wenner, Johansson et al. (2007)Department of Surgery, Lund University Hospital, Lund, SwedenDiagnostic case-control studyLevel: III-3 Quality: Patient selection: Index test: ?Reference standard: Flow and timing: ?CXP370 patients, but 64 had enough data to be included (39 males, 25 females) 55 controls (27 males and 28 females) Not all patients are included in the distal capsule outcomesIndications: Patients with typical reflux symptomsInclusion:Patients: presence of typical reflux symptoms such as heartburn and regurgitation. Symptoms had to occur more than twice weekly. Treatment with medical acid suppression had to result in complete symptom relief or a more than 50% reduction of the symptoms Exclusion:Coagulopathy, severe oesophagitis/stricture, portal hypertension, pacemaker, <20 or >70 years of age, history of gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJReference standard (for sensitivity and specificity):Clinical diagnosis: symptoms suggestive of GORD and responding to acid suppressionSensitivitySpecificityLR+LR–Other accuracy—(incremental) diagnostic yield and concordance outcomesStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / Exclusion criteriaDiagnostic testsDiagnostic accuracy outcome assessedAng et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5nPC9BdXRob3I+PFllYXI+
MjAxMDwvWWVhcj48UmVjTnVtPjE5MDwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oMjAxMCk8L0Rpc3Bs
YXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MTkwPC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+
PGtleSBhcHA9IkVOIiBkYi1pZD0ieHp3NWVmZGZsZGR6NWFlMngwMzVycDJmejIyc2V3cnZyMHdy
Ij4xOTA8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xl
Ij4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkFuZywgRC48L2F1
dGhvcj48YXV0aG9yPlRlbywgRS4gSy48L2F1dGhvcj48YXV0aG9yPkFuZywgVC4gTC48L2F1dGhv
cj48YXV0aG9yPk9uZywgSi48L2F1dGhvcj48YXV0aG9yPlBvaCwgQy4gSC48L2F1dGhvcj48YXV0
aG9yPlRhbiwgSi48L2F1dGhvcj48YXV0aG9yPkZvY2ssIEsuIE0uPC9hdXRob3I+PC9hdXRob3Jz
PjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9n
eSwgRGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgQ2hhbmdpIEdlbmVyYWwgSG9zcGl0YWwsIFNpbmdh
cG9yZS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UbyBCcmF2byBvciBub3Q/IEEgY29t
cGFyaXNvbiBvZiB3aXJlbGVzcyBlc29waGFnZWFsIHBIIG1vbml0b3JpbmcgYW5kIGNvbnZlbnRp
b25hbCBwSCBjYXRoZXRlciB0byBldmFsdWF0ZSBub24tZXJvc2l2ZSBnYXN0cm9lc29waGFnZWFs
IHJlZmx1eCBkaXNlYXNlIGluIGEgbXVsdGlyYWNpYWwgQXNpYW4gY29ob3J0PC90aXRsZT48c2Vj
b25kYXJ5LXRpdGxlPkogRGlnIERpczwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Sm91cm5h
bCBvZiBkaWdlc3RpdmUgZGlzZWFzZXM8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48
ZnVsbC10aXRsZT5KIERpZyBEaXM8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIGRpZ2Vz
dGl2ZSBkaXNlYXNlczwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwt
dGl0bGU+SiBEaWcgRGlzPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiBkaWdlc3RpdmUg
ZGlzZWFzZXM8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xOS0yNzwvcGFnZXM+PHZv
bHVtZT4xMTwvdm9sdW1lPjxudW1iZXI+MTwvbnVtYmVyPjxlZGl0aW9uPjIwMTAvMDIvMDY8L2Vk
aXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFzaWFuIENv
bnRpbmVudGFsIEFuY2VzdHJ5IEdyb3VwPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgcEgg
TW9uaXRvcmluZy8gaW5zdHJ1bWVudGF0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5
d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC8gZGlhZ25vc2lzL2V0aG5vbG9n
eTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29y
ZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5SZXRyb3NwZWN0aXZlIFN0
dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+U2Vuc2l0aXZpdHkgYW5kIFNwZWNpZmljaXR5PC9rZXl3
b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTA8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5G
ZWI8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNzUxLTI5ODAgKEVsZWN0cm9uaWMp
JiN4RDsxNzUxLTI5NzIgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIwMTMyNDI3PC9h
Y2Nlc3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vb25saW5lbGlicmFy
eS53aWxleS5jb20vc3RvcmUvMTAuMTExMS9qLjE3NTEtMjk4MC4yMDA5LjAwNDA5LngvYXNzZXQv
ai4xNzUxLTI5ODAuMjAwOS4wMDQwOS54LnBkZj92PTEmYW1wO3Q9aGg5cHBlc2YmYW1wO3M9YmQx
MDVhY2E2MjEzMGVmYTY5YjJlMjFhNmNmNmI0OGFiZDZmMDIxMzwvdXJsPjwvcmVsYXRlZC11cmxz
PjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTExMS9qLjE3NTEtMjk4MC4yMDA5
LjAwNDA5Lng8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlk
ZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+
PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QW5nPC9BdXRob3I+PFllYXI+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ADDIN EN.CITE.DATA (2010)Division of Gastroenterology, Department of Medicine, Changi General Hospital, SingaporeComparative diagnostic yield studyLevel: III-2 Quality: 14/26C1P2125 patients(only 66 with catheter-free monitoring and 51 with catheter-based monitoring were analysed, 4 were unable to complete the catheter study due to intolerance)51 males and 70 femalesMean age: 45.14?years (range 22–82)Race:76.9% Chinese5.8% Malay10.7% Indian7.4% OtherIndication:Typical or atypical reflux symptoms in the absence of endoscopic features of reflux oesophagitisInclusion:Patients who were referred for investigation of persistent reflux-like symptoms suspected to be related to NERD despite the presence of a normal gastroscopy over a 50-month period from January 2004 to February 2009Exclusion:A history of bleeding tendency, coagulopathy, peptic ulcer disease, previous oesophageal or gastric surgery, known oesophageal or fundic varices, active GI bleeding, endoscopic features of oesophagitis based on Los Angeles classification, Barrett’s oesophagus, peptic strictures, herpetic or Candida oesophagitis, Zollinger-Ellison syndrome, progressive systemic sclerosis, oesophageal or upper small intestinal Chrohn’s disease, active solid tumor neoplastic tissue, pregnancy, presence of a pacemaker or implantable cardiac defibrillator, a history of severe cardiopulmonary disease or symptoms suggestive of oesophageal motor disorders Index test:System: Bravo? wireless capsule system, Medtronic Inc. Minneapolis, MinnesotaInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:Catheter: calibrated antimony pH electrode (Slimline, Medtronic, Shoreview, Minnesota, USA)Insertion: transnasallyPlacement: 5 cm above the proximal border of the LOSDuration: 24 hoursAccuracy:Comparative diagnostic yield Concordance (acid exposure time and reflux events)Ayazi et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXlhemk8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXlhemk8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Division of Thoracic Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, California, USADiagnostic yield studyLevel: IV310 patients (158 males and 152 females)Median age: 52 years (IQR=42–63)Inclusion:Patients with no history of foregut surgery who had the Bravo capsule placed transnasally without sedation and who were monitored while off acid suppression therapyExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transnasallyPlacement: 5 cm above the manometrically determined border of the LOSDuration: 48 hoursAccuracy:Diagnostic yieldAzzam et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXp6YW08L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2012)Sao Paulo University Medical School, Sao Paulo, BrazilIn-subject simultaneous recording studyLevel: II Quality: 17/26C1 P225 patients21 females, 4 malesMean age: 52.4 years (range 34–73)Indications:All patients had as predominant symptom the typical GORD complaints, 64% had atypical complaints and 76% had associated extraoesophageal complaintsInclusion:Heartburn and/or regurgitation as the main clinical complaint; at least 18?years of age, recent upper GI endoscopy (within the past 2?months), interruption in the administration of PPIs for 7?days and signature on the free and informed consent formExclusion:Oesophageal diverticula; strictures and varices; hiatal hernia greater than or equal to 3?cm; erosive oesophagitis Los Angeles grades C or D; Barrett’s oesophagus; neoplasms; obstructive diseases; previous surgery of the GI tractIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 3 cm above the superior border of the LOSDuration: 48 hoursComparator:System: Alacer (Brazil) pH-monitor catheter with Medtronic/Synetics (USA) recording deviceInsertion: transnasallyPlacement: Distal sensor was placed 3?cm above the superior border of the LOS, proximal sensor was positioned 5?cm above the superior border of the LOSDuration: 24 hoursAccuracy:Concordance (acid exposure time) Comparative diagnostic yieldBansal et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmFuc2FsPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2009)Divisions of Gastroenterology and Hepatology, University of Kansas, School of Medicine and Veterans affairs Medical Center, Kansas City, Missouri, USADiagnostic yield study Level: IV48 patients (43 males, 5 females) 22 controls (22 males)Mean age:Patients: 57 ± 13?yearsControls: 59 ± 9?yearsIndication: Patients: reflux symptomsInclusion:Patients: answering ‘yes’ to either heartburn or regurgitation, having a score of >2 on the RDQControls: answering ‘no’ to heartburn and regurgitation, having a score of 0 on the RDQExclusion:Patients: cancer or mass lesion in the oesophagus, advanced chronic liver disease, severe uncontrolled coagulopathy, history of oesophageal or gastric surgeryControls: use of acid suppression, evidence of erosive oesophagitisIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 1 cm above the GOJDuration: 24 hoursAccuracy:Diagnostic yieldBhat, McGrath & Bielefeldt PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QmhhdDwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2006)Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USADiagnostic yield studyLevel: IV217 patients (203 patients had enough data to be included)140 females, 77 malesMean age: 51 years (range 42–58)Indications:Preoperative workup for fundoplication, possible extra oesophageal manifestations of reflux disease, symptoms after fundoplication, refractory symptoms on medication, atypical symptomsInclusion:Adult patients undergoing endoscopy with wireless pH studies at the University of Pittsburgh Medical Center between 9 April 2004 and 31 March 2005Exclusion:Individuals unable to give informed consent, pregnant women, prisoners, patients with oesophageal varices, patients requiring continuing anticoagulation, patients with cardiac defibrillatorsIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursAccuracy:Diagnostic yield Croffie et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+Q3JvZmZpZTwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2007)Section of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, Indiana, USARandomised controlled trialLevel: IIQuality:14.5/26C1P266 patients (but 5 patients were excluded due to operative failure, failed recording etc.)32 males, 34 femalesMean age: 9.4 years (range 4–16.5)Indications:Persistent epigastric or substernal pain, persistent vomiting, heartburn, chronic nocturnal cough or wheezing, persistent throat clearance, dental abnormalities suspected to be caused by refluxInclusion:Children between the ages of 4 and 18?years and weighing at least 30?lb who were undergoing oesophagogastroduodenoscopy and oesophageal pH monitoring for symptoms suggestive of gastro-oesophageal refluxExclusion:Children younger than 4?years of age or weighing <30?lb, having anatomic abnormalities of the oesophagus, a history of a surgical procedure of the oesophagus, stomach or duodenum, a history of coagulopathy or bleeding diathesis, presence of oesophageal varices, significant medical illnessIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: at 87% of the distance from the incisors to the Z lineDuration: 48 hoursComparator:System: not stated (catheter-based)Insertion: transnasallyPlacement: tip at 87% of the distance from the nostril to the GOJDuration: 24 hoursAccuracy:Concordance (acid exposure time)des Varannes et al.PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+ZGVzIFZhcmFubmVzPC9BdXRo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==
ADDIN EN.CITE.DATA (2005)Department of Gastroenterology and Hepatology, Hopital Hotel Dieu, Nantes, FranceIn-subject simultaneous recording studyLevel: II Quality: 20/26C1P240 patients(probe successfully attached in 36 patients)21 males, 19 femalesMean age: 50 yearsIndications:Heartburn (n=7), regurgitation (n=6) or both symptoms (n=26)Inclusion:Patients suggestive of GORD and referred to the functional laboratory of four French academic centres for pH monitoringExclusion:Severe oesophageal motility disorders, severe oesophagitis (Los Angeles grade C or above), pregnancy, women who were not using reliable contraceptionIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the Z lineDuration: 48 hoursComparator:System: Mark III or Digitrapper pH, Medtronic, Stockholm, SwedenInsertion: transnasallyPlacement: adjusted to the same level as the index testDuration: 24 hoursAccuracy:Concordance (acid exposure time and reflux events)Domingues, Moraes-Filho & Domingues PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+RG9taW5ndWVzPC9BdXRob3I+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ADDIN EN.CITE.DATA (2011)Motility laboratory (Gastro Resolucao Diagnostico, Laboratorio de Motilidade Digestive), Rio de Janeiro, BrazilDiagnostic yield studyLevel: IV100 patients(probe successfully attached in 95 patients)39 female, 61 maleMean age: 53 years (range 18 –81)Indications:82% of patients referred to diagnose GORD, 18% referred due to persistent symptoms despite PPI useInclusion:Patients referred to a GI motility laboratory to investigate GORD with typical or atypical symptoms, persistent GORD symptoms on medical therapy or recurrent GORD symptoms after surgical fundoplication, between 2004 and 2009Exclusion:<18?years of age, history of bleeding tendency or coagulopathy, significant concomitant medical co-morbidities, severe GI bleeding in the past 6?months, a history of upper GI surgery, medication with PPIs, presence of oesophageal varices, Barrett’s oesophagus, oesophageal stenosis, erosive oesophagitis, pacemaker or implantable cardiac defibrillator in situIndex test:System: Bravo? wireless capsule systemInsertion: 5 cm above the upper border of the LOS (manometry) or 6?cm above the LOS (endoscopy)Placement: transorallyDuration: 48 hoursAccuracy:Diagnostic yieldGarrean et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FycmVhbjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2008)Division of Gastroenterology, Northwestern University Freiberg School of Medicine, Chicago, Illinois, USADiagnostic yield studyLevel: IV60 patients (22 males and 38 females) Age: 19–80?years40 patients had complete 4-day data acquisitionIndications: Acid reflux symptoms, chest pain, laryngeal symptoms that were poorly responsive to twice-daily PPI therapy for a minimum of 6?weeksInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: 6 cm above the SCJComparator: NAAccuracy:Diagnostic yieldIncremental diagnostic yieldGillies et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lsbGllczwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2007)Departments of Upper Gastrointestinal Surgery and Gastrointestinal Physiology, Royal Berkshire Hospital, Reading, UKDiagnostic yield studyLevel: IV95 patientsIndication: Symptoms suggestive of GORD or documenting the outcome of laparoscopic anti-reflux surgeryInclusion:See indicationExclusion:No specific exclusion criteria existIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursAccuracy:Diagnostic yieldGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2011)Department of Gastroenterology, Universita Degli Studi and Fondazione IRCCS Ca Granada, Ospedale Maggiore Policlinico, Milan, ItalyMatched-pairs retrospective cohort studyLevel: III-2 Quality: 16.5/26C1 P2102 patientsCatheter group: 51 patients, 20 males, mean age 48?years (range 22–78) Bravo group: 51 patients, 22 males, mean age 48?years (range 23–82)Inclusion:All consecutive patients who underwent wireless 96-hour pH monitoring between January and December 2007 off PPI therapy, and patients undergoing traditional 24-hour pH monitoring in the same period, after matching for the most troublesome symptom potentially related to GORD, sex and ageExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJDuration: 48–96 hoursComparator for concordance:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach, or 5?cm above the upper margin of the LOS Duration: 24 hoursAccuracy:Diagnostic yieldConcordance (acid exposure time)Incremental diagnostic yield (of prolonged monitoring) Gunnarsdottir, Stenstrom & Arnbjornsson PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3VubmFyc2RvdHRpcjwvQXV0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ADDIN EN.CITE.DATA (2007, 2008)Department of Paediatric Surgery, Lund University Hospital, Lund, SwedenDiagnostic yield studyLevel: IV58 children37 males, 21 females Mean age: 8 ± 4?yearsIndications:Vomiting, abdominal and chest pain, GORD control, GI bleeding, respiratory symptomsInclusion:Not statedExclusion: Oesophageal strictures, coagulopathy, any suspicion of intestinal stricturesIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: above the diaphragm valve at the width of two of the individual patient’s vertebral bodies as visualised on a perioperative X-rayDuration: 24 or 48?hours (23 children had 48-hour measurement)Comparator: NA Accuracy:Diagnostic yield (based on DeMeester score)Hakanson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+SGFrYW5zb248L0F1dGhvcj48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ADDIN EN.CITE.DATA (2009)Department of Surgery, Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, SwedenCase-control study with in-subject simultaneous recordingLevel: II Quality: 14/26C1P253 volunteers and 55 patients (45 volunteers and 47 patients had enough data to be included)30 females and 15 males in volunteer group27 females and 20 males in patient groupMean age: Volunteers: 47?years (range 21–68)Patients: 50?years (range 23–69)Indication: Patients had symptoms including mainly heartburn, acid regurgitation, and chest or epigastric painInclusion:Patients: referred to the clinic for investigation of GORDExclusion:Volunteers: history of GORD or any other pathology of the upper Gl tract, taking acid-suppressing agents or medication known to affect GI motilityIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJ Duration: 48 hoursComparator:System: Slimline, Medtronic, Skovlunde, DenmarkInsertion: transnasallyPlacement: 5 cm proximal to the upper border of the LOSDuration: 24 hoursAccuracy:Concordance (acid exposure time)Comparative diagnostic yieldKaramanolis et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Karamanolis</Author><Year>2012</Year><RecNum>268</RecNum><IDText>169-73</IDText><DisplayText>(2012)</DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Karamanolis, G.</author><author>Triantafyllou, K.</author><author>Psatha, P.</author><author>Vlachogiannakos, I.</author><author>Gaglia, A.</author><author>Polymeros, D.</author><author>Fessatou, S.</author><author>Triantafyllou, M.</author><author>Papanikolaou, I. S.</author><author>Ladas, S. D.</author></authors></contributors><auth-address>Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University General Hospital, Athens Medical School, Athens, Greece.</auth-address><titles><title>Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors</title><secondary-title>J Neurogastroenterol Motil</secondary-title><alt-title>Journal of neurogastroenterology and motility</alt-title></titles><periodical><full-title>J Neurogastroenterol Motil</full-title><abbr-1>Journal of neurogastroenterology and motility</abbr-1></periodical><alt-periodical><full-title>Journal of Neurogastroenterology and Motility</full-title></alt-periodical><pages>169-73</pages><volume>18</volume><number>2</number><edition>2012/04/24</edition><dates><year>2012</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>2093-0887 (Electronic)
2093-0879 (Linking)</isbn><accession-num>22523725</accession-num><urls><related-urls><url>;(2012)2nd Department of Internal Medicine, Propaedeutic Attikon University General Hospital, Athens, GreeceDiagnostic yield studyLevel: IV32 patients18 males, 14 femalesMean age: 45.3 ± 12.5?yearsIndications:3 episodes of non-cardiac chest pain per weekInclusion:Patients with at least 3 episodes of chest pain per week and normal oesophageal manometry (in order to exclude the presence of any oesophageal motility disorder)Exclusion:Patients that were using aspirin or NSAIDs, a history of upper GI surgery, gastric or duodenal ulcer, connective tissue disease and severe liver, lung, renal or haematological diseaseIndex test:System: Bravo? wireless capsule systemInsertion: transorally Placement: 6 cm proximal to the SCJDuration: 48 hoursComparator:(24-hour Bravo pH monitoring)Accuracy:Incremental diagnostic yield (of prolonged monitoring)Kushnir, Sayuk & Gyawali PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S3VzaG5pcjwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+S3VzaG5pcjwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2011)Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USAComparative study of diagnostic yieldLevel: IVQuality: 13.5/26C1P2462 patients (286 females and 176 males) in the wireless group 1,605 patients (1,092 females and 513 males) in the catheter groupInclusion:Adult patients referred for ambulatory pH monitoring for all indications at the medical centre over a 7-year periodExclusion:Subjects who had undergone prior anti-reflux procedures or oesophageal surgery, incomplete studies with <14?hours of interpretable data, studies contaminated by artefactIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: NSDuration: 28 hoursComparator:System: NS (catheter-based)Insertion: NSPlacement: NSDuration: 24 hoursAccuracy:Comparative diagnostic yieldLacy, Chehade & Crowell PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE.DATA (2011)Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USADiagnostic yield studyLevel: IVQuality: Q1CX (no comparator)P2358 patients (257 females, 101 males)Mean age: 51 ± 14?yearsPredominantly (97%) Caucasian Indications: Symptoms thought secondary to GORDInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the GOJ or 5?cm above the upper border of the LOSDuration: 48 hoursComparator: NAAccuracy:Diagnostic yieldMartinez de Haro et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE.DATA (2008)Servicio de Cirugia General, Hospital Universitario Virgen de la Arrixaca, Murcia, SpainNon-randomised controlled trial Level: III-2 Quality: 11/26C1P240 patientsGroup 2 standard pH monitoring: mean age 45?years (range 17–73) 9 males and 6 femalesGroup 2 Bravo monitoring: mean age 37?years (range 21–59), 8 males and 7 femalesGroup 3 (both): mean age 36.5?years (range 18–56), 7 males and 3 femalesInclusion:General criteria: >18?years of age, informed consent of the risks, benefits and alternative tests, committed to completing follow-upControl group: less than 2 episodes of pyrosis or regurgitation per month, no dysphagia or atypical reflux symptoms, no oesophageal motility disorders, not taken medication for acid reflux, no evidence of hiatal hernia or oesophagitisPatient group: typical reflux symptoms requiring treatment, inflammatory lesions due to reflux in the oesophageal mucosa in group 2.Exclusion:<18 years of age, oesophageal stenosis, oesophageal varix, lesion affecting the nostrils, severe oesophageal motor disorders, high anaesthetic risk, history of coagulopathy, haemorrhage, intake of anticoagulants or platelet antiaggregates, myocardial infarction or CVA in the past 6?months, pregnancy, history of radiotherapy in the thoracic region, digestive haemorrhage in the past 6?months, any known medical disorder that could alter the data, unable to accept study protocols Index test:System: Bravo? wireless capsule systemInsertion: transnasally (n=25) and transorally (n=10)Placement: 5 cm above the LOSDuration: 48 hoursComparator:System: Digitrapper Mark III pH monitoring (Synetics, Stockholm, Sweden)Insertion: transnasallyPlacement: 5 cm above the LOS Duration: 24 hoursAccuracy:Concordance (acid exposure time) Martinez de Haro et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TWFydGluZXogZGUgSGFybzwv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ADDIN EN.CITE.DATA (2008)Servicio de Cirugia General, Hospital Universitario Virgen de la Arrixaca, Murcia, SpainDiagnostic yield studyLevel: IVCX (no comparison)P240 patientsGroup 2 standard pH monitoring: mean age 45?years (range 17–73) 9 males and 6 femalesGroup 2 Bravo monitoring: mean age 37?years (range 21–59), 8 males and 7 femalesGroup 3 (both): mean age 36.5?years (range 18–56), 7 males and 3 femalesInclusion:General criteria: >18?years of age, informed consent of the risks, benefits and alternative tests, committed to completing follow-upControl group: less than 2 episodes of pyrosis or regurgitation per month, no dysphagia or atypical reflux symptoms, no oesophageal motility disorders, not taken medication for acid reflux, no evidence of hiatal hernia or oesophagitisPatient group: typical reflux symptoms requiring treatment, inflammatory lesions due to reflux in the oesophageal mucosa in group 2.Exclusion:<18?years of age, oesophageal stenosis, oesophageal varix, lesion affecting the nostrils, severe oesophageal motor disorders, high anaesthetic risk, history of coagulopathy, haemorrhage, intake of anticoagulants or platelet antiaggregates, myocardial infarction or CVA in the past 6?months, pregnancy, history of radiotherapy in the thoracic region, digestive haemorrhage in the past 6?months, any known medical disorder that could alter the data, unable to accept study protocols Index test:System: Bravo? wireless capsule systemInsertion: transnasally (n=25) and transorally (n=10)Placement: 5 cm above the LOSDuration: 48 hoursAccuracy:Concordance (acid exposure time) Pandolfino et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9y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==
ADDIN EN.CITE.DATA (2003)Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADiagnostic yield studyLevel: IV44 controls (13 males, 31 females, age range 23–53?years) 41 patients (26 males, 15 females, age range 32–72?years)Inclusion:Not statedExclusion:Controls: abdominal symptoms, use of antacids or antisecretory medication, abnormal endoscopyPatients: history of surgical manipulation of the upper GI tract, history of bleeding diathesis or coagulopathy, stroke or transient ischemic attack in the past 6?months, significant medical illness, oesophageal varicesIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJAccuracy:Incremental diagnostic yield (of prolonged monitoring)Diagnostic yieldPark et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Park</Author><Year>2013</Year><RecNum>611</RecNum><IDText>1-7</IDText><DisplayText>(2013)</DisplayText><record><rec-number>611</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">611</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Park, E. Y.</author><author>Choi, M. G.</author><author>Baeg, M.</author><author>Lim, C. H.</author><author>Kim, J.</author><author>Cho, Y.</author><author>Park, J.</author><author>Lee, I.</author><author>Kim, S.</author><author>Choi, K.</author></authors></contributors><auth-address>Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, Seoul, 137-040, South Korea</auth-address><titles><title>The Value of Early Wireless Esophageal pH Monitoring in Diagnosing Functional Heartburn in Refractory Gastroesophageal Reflux Disease</title><secondary-title>Digestive Diseases and Sciences</secondary-title></titles><periodical><full-title>Dig Dis Sci</full-title><abbr-1>Digestive diseases and sciences</abbr-1></periodical><pages>1-7</pages><keywords><keyword>Esophageal pH monitoring</keyword><keyword>Gastroesophageal reflux</keyword><keyword>Heartburn</keyword><keyword>Proton pump inhibitors</keyword></keywords><dates><year>2013</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(2013)Divisions of Gastroenterology, Department of Internal Medicine, Seoul; St Mary’s Hospital, the Catholic University of Korea, Seoul, KoreaDiagnostic yield studyLevel: IV230 patients (101 males, 129 females)Mean age: 49.7 ± 12.4?yearsIndication: Suspected GORDInclusion:≥18?years of ageExclusion: Previous oesophageal, gastric or duodenal surgery, GI organic disease, significant comorbidity, or GI bleedingIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to SCJDuration: 48 hoursAccuracy:Diagnostic yieldPrakash & Clouse ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Prakash</Author><Year>2005</Year><RecNum>522</RecNum><DisplayText>(2005)</DisplayText><record><rec-number>522</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">522</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prakash, C.</author><author>Clouse, R. E.</author></authors></contributors><titles><title>Value of extended recording time with wireless pH monitoring in evaluating gastroesophageal reflux disease</title><secondary-title>Clinical Gastroenterology and Hepatology</secondary-title></titles><periodical><full-title>Clinical Gastroenterology and Hepatology</full-title></periodical><pages>329-334</pages><volume>3</volume><number>4</number><dates><year>2005</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>CCC:000234105200006</accession-num><urls><related-urls><url><Go to ISI>://CCC:000234105200006</url></related-urls></urls><electronic-resource-num>10.1016/s1542-3565(05)00021-2</electronic-resource-num></record></Cite></EndNote>(2005)Division of Gastroenterology, Washington University, School of Medicine, St Louis, Missouri, USADiagnostic yield studyLevel: IV157 patients (100 females, 57 males)Mean age: 47 ± 1?years121 subjects were off therapy, 36 subjects were on therapyIndications: Typical reflux symptoms (55.4%) or atypical symptoms potentially attributable to GORD (44.6%)Inclusion:Patients who had been referred for pH monitoring to evaluate a predefined, suspected reflux symptom and who recorded this symptom at least once during the 2-day monitoring period were identifiedExclusion:OesophagitisIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJAccuracy:Incremental diagnostic yield (of prolonged monitoring)Scarpulla et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NhcnB1bGxhPC9BdXRob3I+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 EN.CITE.DATA (2007)Gastroenterology Division, M. Raimondi Hospital, Can Cataldo, ItalyStudy of diagnostic yieldLevel: IV83 patients (complete 4-day recordings were available for 34/83)44 females, 39 malesMedian age 42?years (range 18–63)Indications:Typical reflux symptoms or atypical symptoms including chest pain and extra oesophageal complaintsInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the Z lineDuration: 24, 48, 72 and/or 96?hoursAccuracy:Diagnostic yieldIncremental diagnostic yieldSchneider et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NobmVpZGVyPC9BdXRob3I+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U2NobmVpZGVyPC9BdXRob3I+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ADDIN EN.CITE.DATA (2007)Department of General, Visceral, and Transplant Surgery, University Hospital of Tubingen, Tubingen, GermanyNon-randomised controlled trialLevel: III-2Quality: 9/26CXP3123 patientsBravo group: 36 males and 32 females, mean age 51?years (range 34–67)Catheter group: 29 males and 26 females, mean age 43?years (range 32–59)Inclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 5 cm above the upper border of the LESDuration: 48 hoursComparator:System: not statedInsertion: transnasallyPlacement: not statedDuration: 24 hoursAccuracy:Concordance (acid exposure, number of reflux episodes)Sweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2009)Functional GI Disease Unit, Clinic for Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland Diagnostic yield studyLevel: IV134 patients Mean age: 60?years (range 18–76) 58 males, 76 females Compared with 110 consecutive catheter pH controlsMean age: 57?years (range 16–85) 44 males, 66 femalesIndications Patients:Intolerance of catheter insertion, intolerance of catheter after intubation, or vomiting of catheter within 24?hours of the monitoring periodInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 48 hoursAccuracy:Diagnostic yieldSweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Guy’s and St Thomas Hospitals, London, UKDiagnostic yield studyLevel: IV38 patients13 males, 25 femalesMedian age: 41.6?years (range 17–75)Indication: Reflux symptoms and no diagnosis of GORD on catheter-based pH monitoringInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 96 hoursComparator:24-, 48-, 72-hour Bravo pH monitoringAccuracy:Incremental diagnostic yield (of prolonged monitoring)Ward et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2FyZDwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2FyZDwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE.DATA (2004)Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USADiagnostic yield studyLevel: IVQuality: Q2CX (no comparator)P260 patients (58 patients had enough data to be included)26 males, 34 femalesMean age 54?years (range 27–82)Indications:Document GORD before surgery, possible GORD with negative PPI trial, evaluate response to PPI, possible supra-oesophageal GORD, non-cardiac chest pain, evaluate response to Stretta procedure, previous failed pH testInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursAccuracyDiagnostic yieldWenner, Johnsson et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2007)Department of Surgery, Lund University Hospital, Lund, SwedenRandomised crossover trialLevel: IIQuality: 20/2635 patients (31 patients had enough data to be included)15 males, 16 femalesMedian age: 52 yearsMedian BMI: 27 (range 24–28)Indications: Typical reflux symptoms (55%) and atypical reflux symptoms (45%)Inclusion:Patients referred for oesophageal pH monitoring Exclusion:Patients with coagulopathy, severe oesophagitis/stricture, portal hypertension, a pacemaker, age <20 or >70?years of age, previous gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJDuration: 48 hoursComparator:System: Slimline (Medtronic) Insertion: transnasallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursAccuracy:Concordance in acid exposure timeComparative diagnostic yieldWenner et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V2VubmVyPC9BdXRob3I+PFll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ADDIN EN.CITE.DATA (2008); Wenner & Johansson et al. (2007)Department of Surgery, Lund University Hospital, Lund, SwedenComparative diagnostic yield studyLevel: III-2 Quality: 11.5/26CXP370 patients, but 64 had enough data to be included (39 males, 25 females) 55 controls (27 males and 28 females).Not all patients are included in the distal capsule outcomesIndications: Patients with typical reflux symptomsInclusion:Patients: presence of typical reflux symptoms such as heartburn and regurgitation. Symptoms had to occur more than twice weekly. Treatment with medical acid suppression had to result in complete symptom relief or a more than 50% reduction of the symptoms Exclusion:Coagulopathy, severe oesophagitis/stricture, portal hypertension, pacemaker, <20 or >70?years of age, history of gastro-oesophageal surgery, severe cardiopulmonary disease, symptoms suggestive of oesophageal motor disordersIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm above the SCJReference standard (for sensitivity and specificity):Clinical diagnosis: symptoms suggestive of GORD and responding to acid suppressionAccuracy:Comparative diagnostic yieldWong et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V29uZzwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+V29uZzwvQXV0aG9yPjxZZWFy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=
ADDIN EN.CITE.DATA (2005)The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Department of Medicine, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona, USARandomised controlled trialLevel: IIQuality: 16.5/2650 patients Mean age: 50.2?years (range 21–79)26 males and 24 femalesIndication: Failure in controlling symptoms while on PPI therapy or for evaluation before anti-reflux surgeryInclusion:Not statedExclusion:Patients with a history of bleeding tendency or coagulopathy, significant concomitant medical co-morbidity, severe GI bleeding within the past 6?months, a history of upper GI surgery, oesophageal varices, pacemaker, implantable cardiac defibrillator, being unable to complete the 24-hour pH monitoring, unable to report daily activityIndex test:System: Bravo? wireless capsule systemInsertion: transnasally or transorallyPlacement: 5 cm above the upper border of the LOSDuration: 24 hoursComparator:System: Digitrapper Mark III (Medtronic)Insertion: transnasallyPlacement: 5 cm above the proximal margin of the LOS Duration: 24 hoursAccuracyConcordance (acid exposure time)Change in managementStudy settingStudy design / Quality appraisalStudy populationInclusion criteria / exclusion criteriaDiagnostic testsChange in management outcome assessedGawron et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2F3cm9uPC9BdXRob3I+PFll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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2F3cm9uPC9BdXRob3I+PFll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==
ADDIN EN.CITE.DATA (2012)Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USARetrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2The final sample consisted of 90 patients with a negative test, 66 Bravo monitoring and 24 impedance (75.6% female)Mean age: 48.4?yearsInclusion:Patients who had undergone Bravo monitoring from January 2006 to January 2010 while withholding PPI therapy, had total acid exposure <5% and a negative symptom index on both days Exclusion:Being on PPI therapy at the time of the test, prior surgery, Barrett’s oesophagus, oesinophilic oesophagitisIndex test:System: Bravo? wireless capsule systemInsertion: NSPlacement: NSDuration: 48 hoursComparator: NAManagement: % of patients who use PPIsGrigolon et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JpZ29sb248L0F1dGhvcj48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==
ADDIN EN.CITE.DATA (2011)Department of Gastroenterology, Universita Degli Studi and Fondazione IRCCS Ca Granada, Ospedale Maggiore Policlinico, Milan, ItalyMatched-pairs retrospective cohort studyLevel: III-2 Quality: 16.5/26CXP2102 patientsCatheter group: 51 patients, 20 males, mean age 48?years (range 22–78) Bravo group: 51 patients, 22 males, mean age 48?years (range 23–82)Inclusion:All consecutive patients who underwent wireless 96-hour pH monitoring between January and December 2007 off PPI therapy, and patients undergoing traditional 24-hour pH monitoring in the same period, after matching for the most troublesome symptom potentially related to GORD, sex and ageExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: NAPlacement: 6 cm above the SCJDuration: 48–96 hoursComparator:System: Slimline mod 901P3001, Medtronic, DenmarkInsertion: transnasallyPlacement: 6 cm above the point of sudden change in pH from acid to neutral as detected by means of continuous rapid withdrawal from the stomach, or 5 cm above the upper margin of the LOS Duration: 24 hoursManagement:Concordance between results of the test and treatmentLacy et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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ADDIN EN.CITE.DATA (2009)Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USAProspective case seriesLevel: IVQuality: Q1CX (no comparator)P251 patients (50 patients had enough data to be included)24 males, 26 femalesMean age: 13?years (range 5–17)Indications: Heartburn, regurgitation, abdominal pain, nausea and/or vomiting, chest painInclusion:Not statedExclusion:Prior surgery to the oesophagus or stomach, known intestinal obstruction or oesophageal varices, achalasia, inability to understand the procedure, inability to undergo oesophageal manometry or sedationIndex test:System: Bravo? wireless capsule systemInsertion: not statedPlacement: 6 cm above the SCJDuration: 48 hoursComparator: NAManagement:Change in management (%)Lacy, Chehade & Crowell PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+TGFjeTwvQXV0aG9yPjxZZWFy
PjIwMTE8L1llYXI+PFJlY051bT4yNzU8L1JlY051bT48SURUZXh0PjE2MDQtMTE8L0lEVGV4dD48
RGlzcGxheVRleHQ+KDIwMTEpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjI3NTwv
cmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Inh6dzVlZmRmbGRk
ejVhZTJ4MDM1cnAyZnoyMnNld3J2cjB3ciI+Mjc1PC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10
eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1
dGhvcnM+PGF1dGhvcj5MYWN5LCBCLiBFLjwvYXV0aG9yPjxhdXRob3I+Q2hlaGFkZSwgUi48L2F1
dGhvcj48YXV0aG9yPkNyb3dlbGwsIE0uIEQuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0
b3JzPjxhdXRoLWFkZHJlc3M+U2VjdGlvbiBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9s
b2d5LCBEYXJ0bW91dGgtSGl0Y2hjb2NrIE1lZGljYWwgQ2VudGVyLCBMZWJhbm9uLCBOZXcgSGFt
cHNoaXJlIDAzNzU2LCBVU0EuIEJyaWFuLkUuTGFjeUBIaXRjaGNvY2suT1JHPC9hdXRoLWFkZHJl
c3M+PHRpdGxlcz48dGl0bGU+QSBwcm9zcGVjdGl2ZSBzdHVkeSB0byBjb21wYXJlIGEgc3ltcHRv
bS1iYXNlZCByZWZsdXggZGlzZWFzZSBxdWVzdGlvbm5haXJlIHRvIDQ4LWggd2lyZWxlc3MgcEgg
bW9uaXRvcmluZyBmb3IgdGhlIGlkZW50aWZpY2F0aW9uIG9mIGdhc3Ryb2Vzb3BoYWdlYWwgcmVm
bHV4IChyZXZpc2VkIDItMjYtMTEpPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFtIEogR2FzdHJv
ZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+VGhlIEFtZXJpY2FuIGpvdXJuYWwg
b2YgZ2FzdHJvZW50ZXJvbG9neTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNh
biBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1w
ZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJi
ci0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L2Fs
dC1wZXJpb2RpY2FsPjxwYWdlcz4xNjA0LTExPC9wYWdlcz48dm9sdW1lPjEwNjwvdm9sdW1lPjxu
dW1iZXI+OTwvbnVtYmVyPjxlZGl0aW9uPjIwMTEvMDYvMjI8L2VkaXRpb24+PGtleXdvcmRzPjxr
ZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+QXJl
YSBVbmRlciBDdXJ2ZTwva2V5d29yZD48a2V5d29yZD5Fc29waGFndXMvIGNoZW1pc3RyeS9wYXRo
b2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkdhc3Ryb2Vz
b3BoYWdlYWwgUmVmbHV4LyBkaWFnbm9zaXMvZHJ1ZyB0aGVyYXB5L3BhdGhvbG9neTwva2V5d29y
ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlkcm9nZW4tSW9uIENvbmNlbnRy
YXRpb24vZHJ1ZyBlZmZlY3RzPC9rZXl3b3JkPjxrZXl3b3JkPkxvZ2lzdGljIE1vZGVsczwva2V5
d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3Jk
PjxrZXl3b3JkPk1vbml0b3JpbmcsIEFtYnVsYXRvcnk8L2tleXdvcmQ+PGtleXdvcmQ+UHJvc3Bl
Y3RpdmUgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5Qcm90b24gUHVtcCBJbmhpYml0b3JzL3Bo
YXJtYWNvbG9neS90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+UXVlc3Rpb25uYWly
ZXM8L2tleXdvcmQ+PGtleXdvcmQ+Uk9DIEN1cnZlPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVz
Pjx5ZWFyPjIwMTE8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5TZXA8L2RhdGU+PC9wdWItZGF0ZXM+
PC9kYXRlcz48aXNibj4xNTcyLTAyNDEgKEVsZWN0cm9uaWMpJiN4RDswMDAyLTkyNzAgKExpbmtp
bmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIxNjkxMzQyPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjxy
ZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5hdHVyZS5jb20vYWpnL2pvdXJuYWwvdjEwNi9u
OS9wZGYvYWpnMjAxMTE4MGEucGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJv
bmljLXJlc291cmNlLW51bT4xMC4xMDM4L2FqZy4yMDExLjE4MDwvZWxlY3Ryb25pYy1yZXNvdXJj
ZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92
aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE.DATA (2011)Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USAProspective case seriesLevel: IVQuality: Q2CX (no comparator)P2309 patientsMean age: 48 ± 15?years107 males, 202 femalesIndications:Symptoms of acid reflux, evaluation of chest pain, preoperative testing, chronic cough, ENT symptomsInclusion:Adult patients (>18?years of age) referred for wireless pH-monitoring from October 2005 to December 2006Exclusion:Women who were pregnant, history of major facial or nasal trauma, presence of any serious medical condition that would prevent safe deployment of the wireless capsuleIndex test:System: Bravo? wireless capsule systemInsertion: transorally or transnasallyPlacement: 6 cm above the SCJ (orally) or 5 cm above the upper border of the LOS (nasally)Duration: 48 hoursComparator: NAManagement:Change in diagnosis (%)Change in management (%)Sweis et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+U3dlaXM8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2011)Guy’s and St Thomas Hospitals, London, UKCase series Level: IVQuality: Q2CX (no comparator)P238 patients13 males, 25 femalesMedian age: 41.6?years (range 17–75)Indication: Reflux symptoms and no diagnosis of GORD on catheter-based pH monitoringInclusion:Not statedExclusion:Not statedIndex test:System: Bravo? wireless capsule systemInsertion: transorallyPlacement: 6 cm proximal to the SCJDuration: 96 hoursComparator: NAManagement Change in treatment Does management change health outcomes?True positivesStudy settingStudy design / Quality appraisalStudy population / Included studiesInclusion criteria / exclusion criteriaIntervention and comparatorHealth outcomes assessedAllgood & Bachmann PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWxsZ29vZDwvQXV0aG9yPjxZ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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QWxsZ29vZDwvQXV0aG9yPjxZ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ADDIN EN.CITE.DATA (2000)Department of Social Medicine, MRC Health Services Research Collaboration, University of Bristol, Bristol, UKSystematic reviewLevel: III-2Quality: 14/27Six randomised controlled trials and three cohort studies that compared medical and surgical management of GORD were included, study population ranged from 15 to 155 patients per arm, 7/9 studies had fewer than 100 patients per arm Inclusion:All controlled trials of medical and surgical management of objectively diagnosed chronic GORD. Randomised trials were regarded as being most relevant, but non-randomised trials were also included, with an emphasis on assessing potential bias. There were no age or sex restrictionsExclusion:Not statedIntervention:Surgical treatment for GORDComparator: Medical treatment for GORDTime to treatment failureMean lower oesophageal pressureMean DeMeester acid reflux scoreReduction in grade of endoscopic oesophagitisMean % time pH <4 / absence of refluxDecrease in pulmonary medicationDevelopment of atrophic gastritisGalmiche et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FsbWljaGU8L0F1dGhvcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2FsbWljaGU8L0F1dGhvcj48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ADDIN EN.CITE.DATA (2011)Department of Gastroenterology and Hepatology, Nantes University, Nantes, FranceRandomised controlled trialLevel: IIQuality: 21/26554 patients288 randomised to receive surgery (199 males, mean age 45?years), 248 underwent surgery, 180 completed 5-year follow-up266 randomised to esomeprazole (199 males, mean age 45?years), 192 completed 5-year follow-upInclusion:Patients aged 18–70?years with chronic symptomatic GORD, diagnosed on the basis of typical clinical history and presence of oesophageal mucosal breaks at endoscopy and/or pH monitoring. All patients had to be eligible for both treatmentsExclusion:Not statedIntervention:Standard laparoscopic anti-reflux surgeryComparator:Esomeprazole, 20–40?mg/d, allowing for dose adjustmentsTime-to-treatment failureAcid regurgitationPost-operative symptomsEndoscopic findingsHealth-related quality of lifeSafetyGrant, Cotton et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JhbnQ8L0F1dGhvcj48WWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R3JhbnQ8L0F1dGhvcj48WWVh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ADDIN EN.CITE.DATA (2013)Health Services Research Unit, University of Aberdeen, Aberdeen, UKRandomised controlled trialLevel: IIQuality: 17/26810 original participants, 357 were randomised178 patients allocated to surgery, 111 received surgery, 127 had 5-year follow-up179 patients allocated to medication, 10 received surgery, 119 had 5-year follow-up Inclusion:Patients had had >12?months of maintenance treatment with PPIs (or alternative), reasonable control of GORD symptoms, evidence of GORD (endoscopy or pH monitoring), were suitable for both treatments and the recruiting doctor was uncertain which management policy to followExclusion:Not statedIntervention:Anti-reflux fundoplication (type of surgery was chosen by the surgeon)Comparator:Optimised continued medical management (reviewed and adjusted as judged best by local gastroenterologist)Health-related quality of life (REFLUX)Health status (SF-36, EuroQol)Use of anti-reflux drugsSurgical complicationsIndividual symptomsWileman et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Wileman Samantha</Author><Year>2010</Year><RecNum>613</RecNum><DisplayText>(2010)</DisplayText><record><rec-number>613</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">613</key></foreign-keys><ref-type name="Electronic Article">43</ref-type><contributors><authors><author>Wileman Samantha, M.</author><author>McCann, Sharon</author><author>Grant Adrian, M.</author><author>Krukowski Zygmunt, H.</author><author>Bruce, Julie</author></authors></contributors><titles><title>Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults</title><secondary-title>Cochrane Database of Systematic Reviews</secondary-title></titles><periodical><full-title>Cochrane Database of Systematic Reviews</full-title></periodical><number>3</number><keywords><keyword>Fundoplication [methods]</keyword><keyword>Gastroesophageal Reflux [surgery] [therapy]</keyword><keyword>Health Status</keyword><keyword>Quality of Life</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Adult[checkword]</keyword><keyword>Humans[checkword]</keyword><keyword>Hm-uppergi</keyword></keywords><dates><year>2010</year></dates><publisher>John Wiley & Sons, Ltd</publisher><accession-num>CD003243</accession-num><urls><related-urls><url>;(2010)Cochrane Collaboration, the Cochrane LibrarySystematic reviewLevel: IQuality: 23/27Four randomised controlled trials were included. Two studies were performed in multiple studies in the UK, one study was conducted in 11 European countries, and one study was conducted in a centre in Canada. Sample sizes ranged from 104 to 554 participants, with a total of 1,232 randomised patients Inclusion:All randomised controlled trials and quasi-randomised controlled trials comparing medical management with laparoscopic fundoplication surgeryExclusion:Non-randomised studiesIntervention:Surgery: laparoscopic fundoplication surgery (all types)Comparator:Medical management: either PPIs or histamine receptor antagonists (H2RAs)Health-related quality of lifeGORD-specific quality of lifeHeartburnRegurgitation (acid reflux)DysphagiaOther GORD-related symptomsConversion to open surgeryIntraoperative complicationsPostoperative complicationsAdmission to intensive treatment unit / high-dependency unitReoperationMortality during index admissionMedication use Length of operationLength of hospital stayTime off workVisits to GP due to GORDVisits to hospital due to GORDpH monitoring (% time pH <4 / DeMeester score)Manometry (LOS pressure)EndoscopyOther complications or adverse eventsFalse positivesStudy settingStudy design Study population / Included studiesInclusion criteria / exclusion criteria‘True diagnosis’ and misdiagnosisHealth outcomes assessedAuvin et al. PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXV2aW48L0F1dGhvcj48WWVh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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+QXV2aW48L0F1dGhvcj48WWVh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==
ADDIN EN.CITE.DATA (2012)Insitut National de la Santé et de la Recherche Medicale, Paris, FranceRetrospective case series83 infants diagnosed with infantile spasms were included (19 in Paris, 20 in Naples, 44 in Baltimore)Median age of onset symptoms: 6 months 28 patients (34%) were diagnosed more than 30?days after initial presentationInclusion:Not statedExclusion: Patients for whom data on diagnostic delay were unavailableTrue diagnosis: West syndrome or infantile spasmsMisdiagnosis:No diagnosis (behavioural symptoms, not organic): 301/362 physicians, 83.3%GORD: 7%Constipation: 7%Colitis: 3%Seizures at age 2?yearsPsychomotor development at age 2?yearsNapuri et al. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Napuri</Author><Year>2010</Year><RecNum>618</RecNum><IDText>1164-1166</IDText><DisplayText>(2010)</DisplayText><record><rec-number>618</rec-number><foreign-keys><key app="EN" db-id="xzw5efdflddz5ae2x035rp2fz22sewrvr0wr">618</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Napuri, S.</author><author>Le Gall, E.</author><author>Dulac, O.</author><author>Chaperon, J.</author><author>Riou, F.</author></authors></contributors><auth-address>Department of Child and Adolescent Medicine, CHU de Rennes, Rennes, France
Paediatric Neurology Department, H?pital Necker-Enfants Malades, AP-HP, Inserm U663, Paris, France
Faculty of Medicine, University Paris Descartes, Paris, France
Public Health Department, CHU de Rennes, Rennes, France</auth-address><titles><title>Factors associated with treatment lag in infantile spasms</title><secondary-title>Developmental Medicine and Child Neurology</secondary-title></titles><periodical><full-title>Developmental Medicine and Child Neurology</full-title></periodical><pages>1164-1166</pages><volume>52</volume><number>12</number><dates><year>2010</year><pub-dates><date>//</date></pub-dates></dates><urls><related-urls><url>;(2010)Department of Child and Adolescent Medicine, Rennes, FranceRetrospective case series156 infants diagnosed with infantile spasms were included87 male (55%), 69 female (45%)45 (29%) symptomatic spasmsMedian age onset: 20?weeks, mean age onset: 22.4?weeks (SD 13.3?weeks)Time lag from first symptom to diagnosis ranged from a few days to 44?weeks with a peak at 4?weeksInclusion:A combination of clusters of spasms, altered psychomotor development and paroxysmal EEG activity, as defined by the International League Against EpilepsyExclusion: Not statedTrue diagnosis:Infantile spasmsMisdiagnosis:Epilepsy: 96 (62%)GORD: 26 (17%)Healthy: 29 (18%)Miscellaneous: 5 (3%)Response to treatmentNA = not available; SCJ = squamo-columnar junction; LOS = lower oesophageal sphincter; GORD = gastro-oesophageal reflux disease; GI = gastrointestinal; PPIs = proton pump inhibitors; GOJ = gastro-oesophageal junction; RDQ = Reflux Disease Questionnaire; NS = not significantAppendix DExcluded studiesConference abstractsAng, D, Ang, TL, Lim, KB, Kiong, TE & Fock, KM 2009, 'To Bravo or not? wireless pH monitoring versus conventional nasopharyngeal pH catheter monitoring in the evaluation of gastroesophageal reflux disease in a multiracial Asian cohort', Gastroenterology, vol. 136, no. 5, pp. A295–A296.Ang, D, Ang, TL, Lim, KB, Teo, EK & Fock, KM 2010, 'Efficacy and safety of the wireless capsule pH monitoring system in the evaluation of gastroesophageal reflux disease (GERD): results from a multiracial Asian cohort', Gastroenterology, vol. 138, no. 5, p. S494.Ang, D, Ang, TL, Xu, Y, Poh, CH, Law, NM, Tan, M & Fock, KM 2012, 'Wireless oesophageal pH monitoring: feasibility, safety and establishing values in a multiracial cohort of asymptomatic Asian subjects', Journal of Gastroenterology and Hepatology, vol. 27, pp. 286–287.Bradley, AG, Crowell, MD, DiBaise, JK, Kim, HJ, Sharma, VK & Fleischer, DE 2009, 'Patient characteristics predict variation in tolerance of wireless pH-metry', Gastroenterology, vol. 136, no. 5, pp. A525–A526.Chander, B, Hanley-Williams, N, Deng, Y & Sheth, AA 2011, '48-hour BRAVO (wireless) esophageal pH monitoring improves symptom correlation as compared to 24-hour studies alone', Gastroenterology, vol. 140, no. 5, p. S251.Chehade, RJ, Lacy, BE & Crowell, MD 2010, 'Gastroesophageal reflux disease: a prospective study comparing a symptom-based reflux disease questionnaire to BRAVO pH capsule monitoring', Gastroenterology, vol. 138, no. 5, p. S493.Crowell, M, Lacy, B & DiBaise, J 2010, 'Intrasession variability and yield of wireless pH-metry following sedated and unsedated capsule placement', American Journal of Gastroenterology, vol. 105, p. S17.Daboul, I & Earla, JRP 2005, 'Comparison of the wireless (Bravo) pH-monitoring device monitoring parameters with the traditional 24 hr pH monitoring in the evaluation of gastroesophageal reflux disease', American Journal of Gastroenterology, vol. 100, no. 9, pp. S42.Daboul, I & Ghai, V 2006, 'Validity of the DeMeester's score for the evaluation of GERD with 24 hr conventional pH monitor and the wireless Bravo capsule', American Journal of Gastroenterology, vol. 101, no. 9, pp. S72.Dutton, TJ, Owais, D, Whybrow, J, McGhee, R & Wajed, S 2011, 'Six year experience of the Bravo (TM) pH-monitoring device for detecting gastro-oesophageal reflux requiring surgery', British Journal of Surgery, vol. 98, pp. 182.Finn, R, Lacy, B & Crowell, M 2011, 'Wireless pH capsule testing: the effects of diabetes and narcotic use and the safety of clopidogrel and warfarin during testing', American Journal of Gastroenterology, vol. 106, pp. S30–S31.Fox, M 2012, 'Prolonged wireless pH-monitoring', Diseases of the Esophagus, vol. 25, p. 7A.Fox, MR, Sweis, R, Menne, D, Anggiansah, A & Wong, T 2011, 'Increasing reflux study duration progressively improves diagnostic consistency: a prospective study with 96-hr wireless pH recordings', Gastroenterology, vol. 140, no. 5, pp. S246–S247.Gawron, A, Fareeduddin, A, Fought, A, Toto, E, Boris, L, Kahrilas, PJ & Pandolfino, JE 2011, 'Proton pump inhibitor (PPI) utilization in patients after negative BRAVO (TM) pH testing for GERD; do they discontinue therapy?', Gastroenterology, vol. 140, no. 5, p. S390.Gillies, RS, Stratford, JM, Jones, L, Sohanpal, J, Booth, MI & Dehn, TCB 2004, 'Does a 48-hour Bravo pH study facilitate the diagnosis of gastro-oesophageal reflux disease', Gut, vol. 53, pp. A30.Gomez, J, Bohm, M & Richter, J 2009, 'Refractory gastroesophageal reflux disease (RGERD) patients with normal upper endoscopy (EGD) should have pH testing off proton pump inhibitors (PPIs)', Gastroenterology, vol. 136, no. 5, p. A85.Grigolon, A, Consonni, D, Bravi, I, Tenca, A & Penagini, R 2010, '96 h wireless vs 24 h traditional pH monitoring: usefulness in patients' management', Digestive and Liver Disease, vol. 42, pp. S103–S104.Guardino, JM, Ours, T & Richter, J 2002, 'Utilizing the Bravo (TM) esophageal pH-monitoring system to compare pH profiles in GERD patients and healthy adult volunteers', Gastroenterology, vol. 122, no. 4, pp. A338.Guerriero, C, Cuofano, S & Spinelli, P 2012, 'Impact of wireless prolonged ph studies on diagnosis of gastroesophageal reflux: retrospective study', Digestive and Liver Disease, vol. 44, p. S219.Jung, KW, Francis, DL, Romero, Y & Murray, JA 2010, 'The comparison of the discomfort between catheter and catheterless pH test', Gastroenterology, vol. 1, p. S492.Korrapati, V, Bonasera, RJ, Balani, AR, Grendell, JH & Kongara, KR 2009, 'Does deep sedation impact the results of 48-hour catheter-less pH testing?', Gastroenterology, vol. 136, no. 5, p. A291.Kushnir, V, Sayuk, GS & Gyawali, CP 2009, 'Improving diagnostic utility of ambulatory pH testing', Gastroenterology, vol. 136, no. 5, p. A84.Lee, SY, Park, YD, Yoon, SJ, Chung, YJ, Jeon, SW, Cho, CM, Tak, WY, Kweon, YO, Kim, SR, Choi, YH & Kim, JY 2007, 'Wireless esophageal pH monitoring: is it really tolerable?', Neurogastroenterology and Motility, vol. 19, pp. 65–66.Lin, E, Waring, JP, Ramaswamy, A, Swafford, V, Tucker, A, Khaitan, L, Ramshaw, BJ & Smith, CD 2003, 'Analysis of 245 consecutive studies using 48-hour wireless pH (BRAVO) probes for GERD evaluation', Gastrointestinal Endoscopy, vol. 57, no. 5, pp. AB100.Macdonald, J, Porter-Ritchie, V, Mackie, B & McNamara, D 2011, 'Assessment of tolerance, safety and efficacy of ambulatory oesophageal ph monitoring using the catheter-free Bravo system in a scottish population', Gut, vol. 60, pp. A182-A183.McCann, V & Nompleggi, D 2012, 'Chest discomfort with catheter-free ambulatory ph monitoring can be predicted by response to ppis', American Journal of Gastroenterology, vol. 107, p. S27.Morley-Fletcher, A, Souza, ALL, Nurko, S & Rodriguez, L 2009, 'Experience with BRAVO wireless pH study in children', Gastroenterology, vol. 1, p. A513.Rao, N, Campbell, DI, Narula, P, Taylor, C, Thomson, M & Rao, P 2012, 'Two year experience of a catheter-free, radio telemetric, oesophageal pH-monitoring (Bravo (TM)) system in children at a single UK tertiary centre', Archives of Disease in Childhood, vol. 97, p. A56.Rodriguez, L, Rosengaus, L, Morley-Fletcher, A & Nurko, S 2011, 'Does general anesthesia change the amount of gastroesophageal reflux in children? A study using BRAVO wireless ph capsule', Gastroenterology, vol. 140, no. 5, p. S748.Seren, S, Bayraktar, UD & Ehrinpreis, MN 2007, 'Esophageal pH monitoring with Bravo (TM) capsule in patients with suspected gastroesophageal reflux disease', American Journal of Gastroenterology, vol. 102, pp. S130.Seza, A, Odaka, T, Kobayashi, M, Yamaguchi, T, Genn, S, Suzuki, T & Saisho, H 2006, 'Esophageal and intragastric pH monitoring using a wireless system (BRAVO) to evaluate esophageal acid exposure and gastric acid secretion', Gastroenterology, vol. 130, no. 4, pp. A166.Sifrim, D 2012, '24-h esophageal pH-monitoring: why do we need more?', Diseases of the Esophagus, vol. 25, p. 7A.Souza, ALL, Morley-Fletcher, A, Nurko, S & Rodriguez, L 2009, 'BRAVO wireless pH in children: is there an effect of anesthesia?', Gastroenterology, vol. 136, no. 5, p. A510.Strohl, A, Khatri, N, Palese, C, Evans, S & Benjamin, S 2010, 'Is 48-hr Bravo pH monitoring more efficacious than 24-hr ph monitoring for patients with refractory gerd undergoing evaluation for Nissen fundoplication?', American Journal of Gastroenterology, vol. 105, p. S16.Sweis, R, Anggiansah, A, Anggiansah, R, Fox, MR & Wong, T 2009, '96 hour BRAVO increases yield in patients with negative 24-hour esophageal catheter pH test results', Gastroenterology, vol. 1, p. A286.Sweis, RR, Anggiansah, A, Anggiansah, R, Fox, M & Wong, T 2009, '96 hour Bravo increases yield in patients with negative 24-hour oesophageal catheter ph tests results', Gut, vol. 58, p. A33.Xu, B, Yuan, Y & Zhu, Q 2009, '48-hour wireless esophageal pH monitoring increases sensitivity in detecting abnormal esophageal acid exposure', Digestion, vol. 1, p. 71.Incorrect/irrelevant interventionCaparello, C, Bravi, I, Cantu, P, Grigolon, A, Tenca, A, Mauro, A & Penagini, R 2012, 'Traditional vs wireless intragastric pH monitoring: are the two techniques comparable?', Neurogastroenterology and Motility, vol. 24, no. 10, pp. 44– 49.Li, JN, Liu, CL & Tao, XH 2013, 'Clinical utility and tolerability of JSPH-1 wireless esophageal pH-monitoring system', BMC Gastroenterology, vol. 13, p. 10.Yamaguchi, T, Seza, A, Odaka, T, Shishido, T, Ai, M, Gen, S, Kouzu, T & Saisho, H 2006, 'Placement of the Bravo wireless pH-monitoring capsule onto the gastric wall under endoscopic guidance', Gastrointestinal Endoscopy, vol. 63, no. 7, pp. 1046–1050.Irrelevant outcomesGonzalez, JO & Barkin, JS 2005, 'Endoscopic visualization of deployment of the Bravo pH System to prevent malplacement', Gastrointestinal Endoscopy, vol. 62, no. 1, pp. 178–180.Unable to retrieve full textArmas, H & Cabrera, R 2005, 'Esophageal pH monitoring: indications and techniques', PHmetría esofágica: indicaciones y técnica, An Pediatr Contin, vol. 3, no. 4, pp. 253–256.Becmeur, F, Rebeuh, J & Molinaro, F 2009, 'Gastroesophageal reflux in children', [Le reflux gastro-?sophagien chez l'enfant], Médecine et Thérapeutique Pédiatrie, vol. 12, no. 1, pp. 45–51.Hagemann, D & Schmitz, F 2006, 'Esophageal pH monitoring with the BRAVO capsule: safety, tolerability and variability of the reflux pattern', [?sophagus-pH-metrie mit der BRAVO-Kapsel: Sicherheit, vertr?glichkeit und variabilit?t der refluxmuster], Der Gastroenterologe, vol. 1, no. 1, pp. 56–59.Hellmig, S & F?lsch, UR 2007, 'Gastroesophageal reflux disease: diagnosis and treatment of an endemic disease', [Gastro?sophageale refluxerkrankung: diagnostik und therapie einer volkskrankheit], Medizinische Klinik, vol. 102, no. 5, pp. 373–380.Labenz, J & Borkenstein, DP 2003, 'Pathophysiology and diagnosis of gastroesophageal reflux disease', [Pathophysiologie und diagnostik der refluxkrankheit], Internist, vol. 44, no. 1, pp. 11–19.Magistà, AM, Lionetti, E, Boscarelli, G, Chiarelli, T, Latela, S, Rigillo, N, Miniello, VL & Francavilla, R 2003, 'Instrumental diagnosis of gastroesophageal reflux', [Diagnostica strumentale del reflusso gastro-esofageo], Otorinolaringologia Pediatrica, vol. 13-14, pp. 26–33.Moreno, JP, Martínez, C, Del Mar Tolín Hernani, M & Calatayud, G? 2013, 'Diagnosis and treatment of gastroesophageal reflux', [Diagnóstico y tratamiento del reflujo gastroesofágico], Publicado en An Pediatr Contin, vol. 11, no. 1, pp. 1–10.Not in English, and not of a higher level of evidence than the English language literature des Varannes, BS, Roman, S, Mion, F, Letard, JC & Zerbib, F 2012, 'Wireless pH-monitoring: technical aspects and clinical contribution', Hepato-Gastro, vol. 19, no. 1, pp. 21–27.Carmona-Sánchez, R & Solana-Sentíes, S 2004, '[Efficacy, diagnostic utility and tolerance of intraesophageal pH ambulatory determination with wireless pH-testing monitoring system]', Revista de Gastroenterología de México, vol. 69, no. 2, pp. 69–75, <;.[No authors listed] 2007, '[Clinical guidelines of diagnosis and treatment of gastroesophageal reflux disease]', Revista de Gastroenterología de México, vol. 72, no. 2, pp. 163–176.Dantas, RO 2008, '[Electrode placement for esophageal pH recording]', Arquivos de Gastroenterologia, vol. 45, no. 4, pp. 259–260.Gonzalez Martinez, MA 2004, '[Ambulatory esophageal pH-monitoring with wireless system]', Revista de Gastroenterología de México, vol. 69, no. 2, pp. 111–113.Marchese, M, Spera, G, Spada, C & Costamagna, G 2004, 'Wireless pH-monitoring. [Italian] Capsula per studio pH-metrico', Giornale Italiano di Endoscopia Digestiva, vol. 27, no. 2, pp. 129–132.M?nkemüller, K, Neumann, H, Fry, LC, Kolfenbach, S & Malfertheiner, P 2009, '[Catheter-free pH-metry using the Bravo capsule versus standard pH-metry in patients with non-erosive reflux disease (NERD)]' Zeitschrift für Gastroenterologie, vol. 47, no. 4, pp. 351–356, DOI 10.1055/s-2008-1027945, < Diaz, MA, Remes Troche, JM, Ruiz Aguilar, JC, Schmulson, MJ & Valdovinos-Andraca, F 2004, 'Successful esophageal pH monitoring with Bravo capsule in patients with gastroesophageal reflux disease. [Spanish] [‘Medicion exitosa del pH esofagico con la capsula Bravo en pacientes con enfermedad por reflujo gastroesofagico'], Revista de Gastroenterología de México, vol. 69, no. 2, pp. 62–68.Irrelevant or incorrect study designBittinger, M & Messmann, H 2007, 'Gastroesophageal reflux disease and Barrett's esophagus', Endoscopy, vol. 39, no. 2, pp. 118–123.Chotiprashidi, P, Liu, J, Carpenter, S, Chuttani, R, DiSario, J, Hussain, N, Somogyi, L & Petersen, BT 2005, 'ASGE Technology Status Evaluation Report: wireless esophageal pH-monitoring system', Gastrointestinal Endoscopy, vol. 62, no. 4, pp. 485–487.Dranove, JE 2008, 'Focus on diagnosis: new technologies for the diagnosis of gastroesophageal reflux disease', Pediatrics in Review, vol. 29, no. 9, pp. 317–320.Fox, M 2006, 'Bravo wireless versus catheter pH-monitoring systems', Gut, vol. 55, no. 3, pp. 434–435.Federa??o Brasileira de Gastroenterologia, Sociedade Brasileira de Endoscopia Digestiva, Colégio Brasileiro de Cirurgia Digestiva & Sociedade Brasileira de Pneumologia e Tisiologia. 'Gastroesophageal reflux disease: diagnosis', 2011, Revista da Associacao Medica Brasileira, vol. 57, no. 5, pp. 489–497.Grigolon, A, Bravi, I, Duca, P, Pugliese, D & Penagini, R 2010, 'Prolonged wireless pH monitoring: importance of how to analyse oesophageal acid exposure', Scandinavian Journal of Gastroenterology, vol. 45, no. 9, pp. 1133–1134.Herbella, FA, Nipominick, I & Patti, MG 2009, 'From sponges to capsules: the history of esophageal pH monitoring', Diseases of the Esophagus, vol. 22, no. 2, pp. 99–103.Hess, T, Hahn, EG & Konturek, PC 2009, 'BRAVO wireless 48-hour pH-metric system', Medical Science Monitor, vol. 15, no. 1, pp. RA17–RA21.Holloway, RH 2005, 'Capsule pH monitoring: is wireless more?', Gut, vol. 54, no. 12, pp. 1672–1673.Horton, BE, Schweitzer, S, DeRouin, AJ & Ong, KG 2011, 'A varactor-based, inductively coupled wireless pH sensor', Ieee Sensors Journal, vol. 11, no. 4, pp. 1061–1066.Javors, BR & Bukman, R 2011, 'Radiographic demonstration of a wireless capsule pH monitor in the esophagus', Dysphagia, vol. 26, no. 2, pp. 193–195.Kahrilas, PJ & Pandolfino, JE 2005, 'Review article: oesophageal pH monitoring--technologies, interpretation and correlation with clinical outcomes', Alimentary Pharmacology & Therapeutics, vol. 22, Suppl 3, pp. 2–9.Lee, JS 2012, 'Is wireless capsule pH monitoring better than catheter systems?', Journal of Neurogastroenterology and Motility, vol. 18, no. 2, pp. 117–119.Malfertheiner, P, Asaka, M, Freston, JW 2006, 'Looking to the future: unmet needs in understanding and managing upper GI diseases', Drugs, vol. 66, pp. 1–33.Mainie, I, Tutuian, R & Castell, DO 2006, 'The limitations of pH monitoring for detecting gastroesophageal reflux', Clinical Gastroenterology and Hepatology, vol. 4, no. 9, p. 1184.Perez-de-la-Serna, J, Ruiz-de-Leon-San-Juan, A & Sevilla-Mantilla, C 2010, 'Proximal esophageal pH-monitoring', Revista Espa?ola de Enfermedades Digestivas, vol. 102, no. 7, pp. 403–405.Richter, JE 2009, 'Optimal utilization of esophageal pH monitoring in GERD patients', Gastroenterology and Hepatology, vol. 5, no. 4, pp. 249–251.Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) 2006, 'Special report: wireless esophageal pH monitoring', Executive summary, TEC Assessments, vol. 21, no. 2, pp. 1–2.Vaezi, MF 2006, 'Should we Bravo?', Gastroenterology, vol. 130, no. 7, pp. 2238–2239.Williams, C, Neshev, E, Heitman, S, Storr, M, Cole, M & Andrews, C 2009, 'A prospective, randomized trial comparing non-endoscopic, unsedated Bravo (TM) wireless pH capsule insertion versus conventional catheter-based pH monitoring', Canadian Journal of Gastroenterology, vol. 23, Supplement SA, Poster 137.Did not meet inclusion criteria regarding populationAng, D, Xu, Y, Ang, TL, Law, NM, Poh, CH, Teo, EK & Fock, KM 2013, 'Wireless oesophageal pH monitoring: Establishing values in a multiracial cohort of asymptomatic Asian subjects', Digestive and Liver Disease, vol. 45, no. 5, pp. 371–376.Friedman, M & Schalch, P 2007, 'Upper esophageal pH monitoring: transnasal placement of the Bravo wireless capsule system', Operative Techniques in Otolaryngology–Head & Neck Surgery, vol. 18, no. 4, pp. 324–328.Pandolfino, JE, Schreiner, MA, Lee, TJ, Zhang, Q, Boniquit, C & Kahrilas, PJ 2005, 'Comparison of the Bravo (TM) wireless and Digitrapper (TM) catheter-based pH-monitoring systems for measuring esophageal acid exposure', American Journal of Gastroenterology, vol. 100, no. 7, pp. 1466–1476.Pandolfino, JE, Zhang, Q, Ghosh, SK, Roth, MP, Boniquit, C & Kahrilas, PJ 2007, 'Does the Bravo (TM) pH capsule affect esophageal motor function?', Diseases of the Esophagus, vol. 20, no. 5, pp. 406–410.Pandolfino, JE, Zhang, Q, Schreiner, MA, Ghosh, S, Roth, MP & Kahrilas, PJ 2005, 'Acid reflux event detection using the Bravo wireless versus the Slimline catheter pH systems: why are the numbers so different?', Gut, vol. 54, no. 12, pp. 1687–1692.Appendix E Safety data Table 70Complications and adverse events of catheter-free monitoring compared with catheter-based monitoring in adultsStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringp-valueAdditional notesWenner, Johnsson et al. (2007) Level IIQuality: 20/26CXP2Randomised crossover trial31 participants catheter group31 participants wireless groupPatients’ experience, median cm VAS (IQR) Nose/throat symptoms: 0.2 (0.0–1.9)Swallow-induced symptoms: 2.1 (0.5–5.0)Chest symptoms: 2.4 (0.3–5.9)All adverse symptoms: 2.1 (0.5–4.6)Interference work activities: 0.3 (0.0–1.4)Interference physical activities: 0.6 (0.2–2.7)Interference food intake: 1.4 (0.2–4.9)Interference normal daily life: 0.7 (0.2–3.4)Patients’ experience, median cm VAS (IQR) Nose/throat symptoms: 6.5 (1.5–8.0)Swallow-induced symptoms: 5.2 (2.1–6.7)Chest symptoms: 1.1 (0.3–2.9)All adverse symptoms: 5.1 (2.0–6.6)Interference work activities: 6.8 (1.7–9.0)Interference physical activities: 5.0 (2.6–8.5)Interference food intake: 4.0 (1.8–7.0)Interference normal daily life: 5.7 (2.3–8.0)-<0.00010.0330.084<0.0010.005<0.00010.056<0.0001-Andrews et al. (2012)Level IIQuality: 19/26CXP2Dual centre, randomised, non-blinded trial43 participants catheter group43 participants wireless grouppH placement discomfort (mm VAS ± SE)Nasal: 6 ± 2Throat: 32 ± 4Chest: 14 ± 3Overall: 29 ± 4-pH-test discomfort (mm VAS ± SE)Nasal: 10 ± 3Throat: 19 ± 4Chest: 29 ± 4Overall: 26 ± 4Eating/drinking: 75 ± 5 Ability usual activities: 92 ± 2pH placement discomfort (mm VAS ± SE)Nasal: 36 ± 4Throat: 37 ± 3Chest: 13 ± 3Overall: 33 ± 4-pH-test discomfort (mm VAS ± SE)Nasal: 39 ± 3Throat: 43 ± 4Chest: 14 ± 3Overall: 39 ± 4Eating/drinking: 51 ± 4Ability usual activities: 75 ± 5-<0.0010.3170.9680.406--<0.001<0.0010.0010.012<0.001<0.0012 patients were unable to tolerate the nasal (standard) pH catheter and 1 patient did not tolerate peroral insertion of the capsule due to excessive gagging and anxietyWong et al. (2005)Level IIQuality: 16.5/26CXP2Randomised controlled trial25 participants catheter group25 participants wireless groupNose pain: 8 (32%)Runny nose: 13 (52%)Throat pain: 4 (16%)Throat discomfort: 12 (48%)Cough: 5 (20%)Chest discomfort: 9 (36%)Headache: 5 (20%)Nose bleeding: 1 (4%)Nose pain: 15 (60%)Runny nose: 24 (96%)Throat pain: 12 (48%)Throat discomfort: 23 (92%)Cough: 7 (28%)Chest discomfort: 2 (8%)Headache: 14 (56%)Nose bleeding: 00.0470.0010.0320.0010.5080.0370.0091.0-Grigolon et al. (2007)Level III-1Quality: 13.5/26CXP2Pseudo-randomised controlled trial78 participants catheter group55 participants wireless groupPlacement discomfort (mm VAS ± SE) 29 ± 4Discomfort during whole test (mm VAS ± SE)22 ± 3Limitation of food intake (score 0–3)0.4 ± 0.1Limitation of daily activities (score 0–3)0.2 ± 0.1None to mild discomfort: 41/55 (74.5%)Chest discomfort: 17/55 (30.9%)Placement discomfort (mm VAS ± SE) 32 ± 3Discomfort during whole test (mm VAS ± SE)37 ± 3Limitation of food intake (score 0–3)0.9 ± 0.1Limitation of daily activities (score 0–3)1.2 ± 0.1None to mild discomfort: 40/78 (51.3%)NS<0.001<0.05<0.001<0.0517/55 catheter-free monitoring: chest discomfort Sweis et al. (2009)Level III-2Quality: 15/26CXP1Cohort study110 participants catheter group134 participantswireless groupOverall satisfaction: 4.4/5Overall satisfaction: 3.5/5<0.001Bradley et al. (2011)Level III-2Quality: 15/26CXP2Cohort study106 participants catheter group234 participants wireless groupForeign body chest: 62%Foreign body throat: 21%Chest discomfort: 51%Chest pain: 33%Difficulty swallowing: 42%Painful swallowing: 44%Early fullness: 29%Diminished appetite: 24%Abdominal pain: 19%Nausea: 18%Vomiting: 6%Foreign body chest: 34% Foreign body throat: 22%Chest discomfort: 26%Chest pain: 19%Difficulty swallowing: 91%Painful swallowing: 62%Early fullness: 22%Diminished appetite: 32%Abdominal pain: 14%Nausea: 20%Vomiting: 6%0.0000.8870.0000.0090.0000.0020.1880.1440.3540.7661.000Ang et al. (2010)Level III-2Quality: 14/26CXP2Cohort study59 participants catheter group66 participants wireless group0 intolerance for device (0%)4 intolerance for device (6.8%)?Hakanson et al. (2009)Level III-2Quality: 14/26CXP2Case-control study45 volunteers and 47 patients (simultaneous recording) 0 complications0 complicationsNSGillies et al. (2007)Level III-2Quality: 13.5/26CXP2Non-randomised controlled trial 100 participants catheter group 85 participants wireless group (but 100 studies)27% no overall discomfort23% discomfort score >586% no impact on work attendance3% no overall discomfort45% discomfort score >518% no impact on work attendance<0.0001NS<0.0001Pandolfino et al. (2003)Level III-2Quality: 11.5/26CXP3Case-control study30 participants catheter group29 participants wireless groupSatisfaction (the lower the better): 0.8 ± 0.1Throat discomfort: 4/29Oesophageal discomfort: 10/29Change daily routine: 0/29Affected diet: 3%Affected activity: 0%Disrupted sleep: 2/22Satisfaction (the lower the better): 1.9 ± 0.2Throat discomfort: 22/30Oesophageal discomfort: 5/30Change daily routine: 11/30Affected diet: 47%Affected activity: 60%Disrupted sleep: 9/30<0.001<0.001<0.05<0.001<0.001NSWireless group: 2 subjects had discomfort to the extent that the capsule had to be removed; 1 non-detachment; 4 had moderate chest painSchneider et al. (2007)Level III-2Quality: 9/26CXP3 Non-randomised controlled trial55 participants catheter group78 participants wireless groupThroat discomfort: 3 (3.8%)Oesophagus discomfort: 14 (17.9%)Reduced activities: 5 (6.4%)Reliability: 75 (96.1%)Throat discomfort: 52 (94.5%)Oesophagus discomfort: 18 (32.7%)Reduced activities: 55 (100%)Reliability: 54 (98.1%)0.001NS0.0001NSTable 71Complications and adverse events of catheter-free monitoring compared with catheter-based monitoring in childrenStudyLevel and qualityNWireless pH monitoringCatheter-based pH monitoringp-valueCroffie et al. (2007)Level IIQuality: 14.5/25CXP2Randomised controlled trial16 participants catheter group18 participants wireless group Vomiting more than usual 6/18 (33%)Chest pain 7/18 (39%)Throat pain 8/18 (44%)Oesophageal discomfort 7/18 (39%)Appetite on scale from 1–5: 3.54Activity on scale from 1–5: 3.66 Overall satisfaction on scale from 1–5: 4.31Vomiting more than usual 3/16 (19%)Chest pain 1/16 (6%)Throat pain 15/16 (94%) Oesophageal discomfort 11/16 (69%)Appetite on scale from 1–5: 2.72Activity on scale from 1–5: 2.33Overall satisfaction on scale from 1–5: 3.110.250.020.0010.060.0290.0010.003Table 72Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in adultsStudyLevel and qualityPopulation Complications per procedureLacy et al. (2011)Level IVQ1Post-test case series375 patients1/375 procedures1 transient chest discomfortNusrat, Roy & Bielefeldt (2012)Level IVQ1Retrospective case series356 patients0/356 proceduresAll patients tolerated the study without significant side effectsCrowell et al. (2008)Level IVQ1Case series294 patients?/294 procedures147 foreign-body sensation121 chest discomfort82 chest pain82 diminished appetiteTseng et al. (2005)Level IVQ1Retrospective case series190 procedures, 186 patients?/190 procedures1 extreme gagging2 sufficient chest painMost patients noted a foreign-body sensationAhlawat et al. (2006)Level IVQ1Retrospective case series82 patients4/82 procedures4 severe chest pain53 patients were physically aware of the presence of the pH-monitoring capsule in the oesophagus, symptoms ranging from a foreign-body sensation to a mild discomfort, to chest painTharavej et al. (2006)Level IVQ1Case series80 patients10/80 procedures10 new onset chest painIn 6 of these patients the chest pain was associated with hypertensive oesophageal contractionsRemes-Troche et al. (2005)Level IVQ1Prospective case series77 patients51/77 procedures26 chest pain11 foreign-body sensation5 nausea9 patients had more than one symptomdes Varannes et al. (2005)1Level IVQ1In-subject simultaneous recording study40 patients4/40 procedures2 placement failures due to poor tolerance with vomiting1 dizzy spell during insertion1 epistaxisMarchese et al. (2006)Level IVQ1Prospective case series39 patients7/39 procedures2 severe retrosternal chest pain2 mild epistaxis3 pharyngeal irritationKaramanolis et al. (2012)Level IVQ1Post-test case series32 patients4/32 procedures3 throat pain2 back pain1 globus sensation1 patient with 2 symptomsTu et al. (2004)Level IVQ1Prospective case series30 patients1/30 procedures1 mucosal abrasion and minor haemorrhageAzzam et al. (2012)aLevel IVQ1In-subject simultaneous recording study25 patients0/25 proceduresNo patient experienced severe chest pain or any other symptom requiring endoscopic removal of the capsulePrakash et al. (2006)Level IVQ2Retrospective case series452 patients8/452 procedures (but this only gives the major side effects of the patients who requested removal of the capsule)7 severe chest pain and/or odynophagia1 severe foreign-body sensationBhat, McGrath & Bielefeldt (2006)Level IV Q2Prospective case series203 patients19/203 procedures18 significant chest discomfort1 rashTurner et al. (2007)Level IVQ2Case series191 patients1/191 procedures1 intolerable chest pain requiring capsule removalDomingues, Moraes-Filho & Domingues (2011)Level IVQ2Retrospective case series74 patients19/74 procedures17 mild foreign-body sensation2 chest pain during meal periodsScarpulla et al. (2007)Level IVQ2Retrospective case series83 patients21/83 procedures21 occasional retrosternal discomfort on swallowingFrancis (2008)Level IVQ2Retrospective case series76 patients 4/76 procedures1 severe chest pain1 capsule dislodgement in the mouth1 capsule dislodgement in the pyriform sinus1 capsule dislodgement in the stomachde Hoyos & Esparza (2010); de Hoyos, Esparza & Loredo (2010)Level IVQ2Prospective case series66 patients2/66 procedures1 intolerable chest pain1 detachment failureTankurt et al. (2011)Level IVQ2Case series64 patients11/64 procedures11 mild to moderate retrosternal pain or discomfortGarrean et al. (2008)Level IVQ2Post-test case series60 patients8/60 procedures3 back pain3 throat pain1 globus sensation1 chest painBelafsky et al. (2004)Level IVQ2Prospective case series46 patients9/46 procedures2 laryngospasm 2 epistaxis1 vasovagal reaction4 foreign-body sensationSweis et al. (2011)Level IVQ2Case series38 patients0/38 proceduresNo patient complained of severe symptoms during the study and no capsule needed to be removedCalabrese et al. (2008)Level IVQ2Post-test case series24 patients5/24 procedures5 occasional retrosternal discomfort on swallowingHirano et al. (2005)Level IVQ2Post-test case series18 patients0/18 proceduresNo patient reported any adverse events of the Bravo procedure such as chest pain, dysphagia or bleedingPandolfino et al. (2006)aLevel IVQ2Case-control study10 control subjects and 10 patients with GORD7/20 procedures7 mild chest discomfort or foreign-body sensationSofi et al. (2011)Level IVQ3Retrospective case series58 patients?/58 procedures19 sore throat17 dysphagia13 chest pain (2 with severe chest pain)6 cough12 patients had day(s) off workLee et al. (2005)Level IVQ3Post-test case series40 patients18/40 procedures1 retrosternal discomfort with protuberant mucosal lesion17 retrosternal foreign-body discomfortaThese studies are not case series but are still included as level IV safety evidence because they do not report a(n) (appropriate) comparison regarding complications or adverse events.Table 73Complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoring in childrenStudyLevel and qualityPopulation Complications per procedureCabrera et al. (2011)Level IVQ1Prospective case series289 children1/289 procedures1 failure to release capsule with tear of oesophageal mucosaGunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008)Level IVQ1Case series58 children 5/58 procedures1 mild chest discomfort1 period of coughing3 dysphagiaHochman & Favaloro-Sabatier (2005)Level IVQ2Retrospective case series38 children26/38 procedures26 discomfort7 significant discomfortBothwell, Phillips & Bauer (2004)Level IVQ2Retrospective case series25 children1/25 procedures1 superficial mucosal tearTable 74Case reports reporting complications and adverse events resulting from catheter-free (wireless) oesophageal pH monitoringStudyStudy designPopulationComplications per procedureAgrawal, Kerman & Rich (2009)Case report1 patient1/1 procedure:1 severe retrosternal chest discomfortFajardo et al. (2006)Case report1 patient1/1 procedure:1 oesophageal perforationHogan et al. (2009)Case report1 patient1/1 procedure:1 retention (>2?years) of the capsule in a colonic diverticulum Kramer & Chokhavatia (2012)Case report1 patient1/1 procedure:1 capsule dislodgement in the left pyriform sinusShahid & Fisher (2011)Case report1 patient1/1 procedure:1 capsule dislodgement in the left mainstem bronchusTriester et al. (2005)Case report1 patient1/1 procedure:1 sharp substernal chest pain and dyspnoeaRenteln et al. (2008)Case report1 patient1/1 procedure:1 capsule aspiration and decreased oxygen saturationTable 75Chest discomfort / complications resulting from catheter-free (wireless) oesophageal pH monitoring in adultsStudyLevel and qualityPopulation Chest discomfort / complications per procedureLacy et al. (2011)Level IVQ1Post-test case series375 patients1/375 procedures1 transient chest discomfortCrowell et al. (2008)Level IVQ1Case series294 patients203/294 procedures121 chest discomfort82 chest painTseng et al. (2005)Level IVQ1Retrospective case series190 procedures, 186 patients2/190 procedures2 sufficient chest painAhlawat et al. (2006)Level IVQ1Retrospective case series82 patients4/82 procedures4 severe chest pain53 patients were physically aware of the presence of the pH-monitoring capsule in the oesophagus, with symptoms ranging from a foreign-body sensation to a mild discomfort, to chest painTharavej et al. (2006)Level IVQ1Case series80 patients10/80 procedures10 new onset chest painIn 6 of these patients the chest pain was associated with hypertensive oesophageal contractionsRemes-Troche et al. (2005)Level IVQ1Prospective case series77 patients26/77 procedures26 chest painMarchese et al. (2006)Level IVQ1Prospective case series39 patients2/39 procedures2 severe retrosternal chest painAzzam et al. (2012)aLevel IVQ1In-subject simultaneous recording study25 patients0/25 proceduresNo patient experienced severe chest pain or any other symptom requiring endoscopic removal of the capsulePrakash et al. (2006)Level IVQ2Retrospective case series452 patients7/452 procedures (but this only gives the major side effects of the patients who requested removal of the capsule)7 severe chest pain and/or odynophagiaBhat, McGrath & Bielefeldt (2006)Level IV Q2Prospective case series203 patients18/203 procedures18 significant chest discomfortTurner et al. (2007)Level IVQ2Case series191 patients1/191 procedures1 intolerable chest pain requiring capsule removalDomingues, Moraes-Filho & Domingues (2011)Level IVQ2Retrospective case series74 patients2/74 procedures2 chest pain during meal periodsScarpulla et al. (2007)Level IVQ2Retrospective case series83 patients21/83 procedures21 occasional retrosternal discomfort on swallowingFrancis (2008)Level IVQ2Retrospective case series76 patients1/76 procedures1 severe chest painde Hoyos & Esparza (2010); de Hoyos, Esparza & Loredo (2009)Level IVQ2Prospective case series66 patients1/66 procedures1 intolerable chest painTankurt et al. (2011)Level IVQ2Case series64 patients11/64 procedures11 mild to moderate retrosternal pain or discomfortGarrean et al. (2008)Level IVQ2Post-test case series60 patients1/60 procedures1 chest painCalabrese et al. (2008)Level IVQ2Post-test case series24 patients5/24 procedures5 occasional retrosternal discomfort on swallowingHirano et al. (2005)Level IVQ2Post-test case series18 patients0/18 proceduresNo patient reported any adverse events of the Bravo procedure such as chest pain, dysphagia or bleedingPandolfino et al. (2006)aLevel IVQ2Case-control study10 control subjects and 10 patients with GORD7/20 7 mild chest discomfort or foreign-body sensationSofi et al. (2011)Level IVQ3Retrospective case series58 patients13/5811 chest pain2 severe chest painLee et al. (2005)Level IVQ3Post-test case series40 patients18/40 procedures1 retrosternal discomfort with protuberant mucosal lesion17 retrosternal foreign-body discomfortaThese studies are not case series but are still included as level IV safety evidence because they do not report a(n) (appropriate) comparison regarding complications or adverse events.Appendix F Non-comparative technical efficacy dataTable 76Technical efficacy of catheter-free (wireless) oesophageal pH monitoring in adultsStudyStudy designN Technical/operative/equipment/recording failureLacy et al. (2011)Case seriesLevel: IVQuality: Q1CX P2358 patients6/358 procedures: (1.7%)6 early detachments or loss of signalNusrat, Roy & Bielefeldt (2012)Retrospective case seriesLevel: IVQuality: Q1CX P2356 patients6/356 procedures: (1.7%)6 early detachmentsPark et al. 2013(2013)Case seriesLevel: IVQuality: Q1CXP2230 patients32/230 procedures: (13.9%)17 early detachments10 attachment failures or misplacements5 recording failuresTseng et al. (2005)Retrospective case seriesLevel: IVQuality: Q1CX P2209 patients (and 213 procedures)23/213 procedures (10.8%):18 incomplete data captures (<18?hours on at least 1?day)5 early detachmentCrowell et al. (2009)Case seriesLevel: IVQuality: Q1CXP2180 patients15/180 procedures (8.3%)15 early detachmentsDoma et al. (2010)Post-test case seriesLevel: IVQuality: Q1CX P2161 patients56/161 procedures: (38.0%)56 errors in placement (inaccurate placement of the capsule)Iqbal et al. (2007)Retrospective case seriesLevel: IVQuality: Q1CX P2100 patients11/100 procedures (11.0%)11 early detachmentsAhlawat et al. (2006)Retrospective case seriesLevel: IVQuality: Q1CX P290 patients9/90 procedures: (10.0%)3 failure to transmit data to receiver1 capsule failed to deploy from catheter4 incomplete data captures1 failure of attachment to the oesophageal mucosaPandolfino et al. (2003)aCase-control studyLevel: IVQuality: Q1CX (clinical diagnosis)P341 patients and 44 volunteers3/85 procedures (3.5%):2 capsules failed to deploy from catheter1 detachment failureRemes-Troche et al. (2005)Prospective case seriesLevel: IVQuality: Q1CX P284 patients7/84 procedures (8.3%):4 attachment failures3 early detachmentsBansal et al. (2009)Case seriesLevel: IVQuality: Q1CXP248 patients8/48 procedures: (16.7%)4 premature detachments2 cardia placements2 incomplete data capturesMarchese et al. (2006)Prospective case seriesLevel: IVQuality: Q1CX P238 patients2/38 procedures (5.3%):1 capsule displacement (in the stomach)1 failure because of previous nasal surgery (tight nasal vault?)Tu et al. (2004)Prospective case seriesLevel: IVQuality: Q1CXP230 patients1/30 procedures (3.3%)1 attachment failureBhat, McGrath & Bielefeldt (2006)Prospective case seriesLevel: IVQuality: Q2CX P2217 patients10/217 procedures (4.6%):1 capsule failed to deploy from catheter2 receiver malfunction7 early detachmentsTurner et al. (2007)Case seriesLevel: IVQuality: Q2CX P2191 patients42/191 procedures (22.0%):27 incomplete data captures15 early detachmentGillies et al. (2007)aNon-randomised controlled trialLevel IVQuality: Q2CXP2100 procedures (85 patients) in catheter-free group 17/100 procedures (17%)7 early detachments4 incomplete or no data capture6 failures of attachment to the oesophageal mucosaDomingues, Moraes-Filho & Domingues (2011)Retrospective case seriesLevel: IVQuality: Q2CX P2100 patients7/100 procedures (7.0%):1 failure of attachment to the oesophageal mucosa2 early detachments2 recording failure2 downloaded data lostScarpulla et al. (2007)Retrospective case seriesLevel: IVQuality: Q2CX P283 patients9/83 procedures (10.8%):4 failures to deploy or transmission failures5 early detachmentsFrancis (2008)Retrospective case seriesLevel: IVQuality: Q2CX P276 patients9/76 procedures (11.8%):5 technical failures2 early detachments4 failures of attachment to the oesophageal mucosaWenner et al. (2007 & 2008)aDiagnostic case-control studyLevel: IVQuality: Q2CXP370 patients4/70 procedures (5.7%):1 failure to pass through the upper oesophagus1 early detachment1 technical failure1 placement failurede Hoyos & Esparza (2010); de Hoyos, Esparza & Loredo (2009)Prospective case seriesLevel: IVQuality: Q2CX P266 patients9/66 procedures (13.6%):3 capsules had poor data reception3 early detachments1 transmission failure1 detachment failure1 error in placementTankurt et al. (2011)Case seriesLevel: IVQuality: Q2CXP264 patients2/64 procedures (3.1%):2 early detachmentsWard et al. (2004)Case seriesLevel: IVQuality: Q2CX P260 patients9/60 procedures (15%):7 failures of attachment to the oesophageal mucosa2 failures to retrieve data from recorderGarrean et al. (2008)Post-test case series Level: IVQuality: Q2CX P260 patients1/60 procedures (1.7%):1 capsule malfunctionGrigolon et al. (2011)aOne arm of matched pairs retrospective cohort studyLevel: IVQuality: Q2CXP257 patients in the catheter-free group 6/57 procedures (10.5%):3 incomplete data capture3 early detachmentBelafsky et al. (2004)Prospective case seriesLevel: IVQuality: Q2CXP246 patients6/46 procedures (13.0%):2 failures because of tight nasal vault 2 early detachments1 lost data recorder1 capsule failed to deploy from catheterSweis et al. (2011)Case seriesLevel: IVQuality: Q2CX P238 patients0/38 procedures (0%):0 early detachments (detachment occurred between 48 and 72?hours in 5 patients and between 72 and 96?hours in 12 patients)Martinez de Haro et al. (2008)aOne arm of non-randomised controlled trialLevel: IVQuality: Q2CXP225 patients and 10 volunteers6/35 procedures (17.1%)3 incorrect placements2 early detachments1 immediate detachment with aspirationBechtold et al. (2007)Retrospective case seriesLevel: IVQuality: Q2CXP227 patients1/27 procedures (3.7%): 1 early detachmentFrancis et al. (2012)aRandomised blinded controlled trialLevel: IV Quality: Q2C1P222 patients0/22 procedures (0%):All capsules were placed successfully on the first attemptPandolfino et al. (2006)aCase-control studyLevel: IV Quality: Q2CX (clinical diagnosis)P310 patients and 10 volunteers2/20 procedures (10%):2 early detachmentsSofi et al. (2011)Retrospective case seriesLevel: IVQuality: Q3CXP258 patients5/58 procedures (8.6%):2 malfunctions of the device during insertion3 transmission failuresLee et al. (2005)Prospective case seriesLevel: IVQuality: Q3CX P240 patients4/40 procedures (10%):3 attachment failures1 early detachmentaThese studies are not case series but are still included as level IV safety evidence because they do not report a(n) (appropriate) comparison regarding technical efficacy.Table 77Technical efficacy of catheter-free (wireless) oesophageal pH monitoring in childrenStudyStudy designNTechnical/operative/equipment/recording failureCabrera et al. (2011)Prospective case seriesLevel: IVQuality: Q1CXP2289 children41/289 procedures (14.2%)3 capsules failed to calibrate8 failures of attachment to the oesophageal mucosa4 capsules failed to deploy from catheter1 recording failure4 early detachments21 incomplete data capturesGunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008)Case seriesLevel: IVQuality: Q1CX P258 children3/58 procedures (5.2%):1 transmission failure2 attachment failuresHochman & Favaloro-Sabatier (2005)Retrospective case seriesLevel: IVQuality: Q2CX P250 children5/50 procedures (10%):1 failure of attachment to the oesophageal mucosa4 shorter monitoring periods Appendix G Day-to-day variability in oesophageal acid exposureTable 78Day-to-day variability in oesophageal acid exposure with catheter-free monitoring in adultsStudyLevel and qualityNOutcomesDay 1Day 2p-value Correlation co-efficientdes Varannes et al. (2005)In-subject simultaneous recording studyLevel: II Quality: 20/26CXP230 patientsMedian % total time pH <4 (25%–75%)Number of reflux episodes >5 minutesNumber of reflux episodes24-hour acid exposure values2.4 (0.7–3.9)2 (1–5)23 (10–32)3.3 (1.4–7.5)4 (2–8)23 (13–36)<0.040.07NS0.79Grigolon et al. (2007)Pseudo-randomised controlled trialLevel: III-1Quality: 13.5/26CXP255 patients% total time pH <4 3.4 (0.6–9.8)4.9 (1.7–8.3)NSGillies et al. (2007)Non-randomised Controlled trialLevel: III-2Quality: 13.5/26CXP289 patientsMedian % total time pH <4 (IQR)Median % upright time pH <4 (IQR)Median % supine time pH <4 (IQR)DeMeester score4.0 (1.2–10.3)5.0 (1.4–12.0)0.5 (0–5.0)15.9 (5.1–34.6)4.3 (1.0–10.0)5.0 (1.5–11.3)0.5 (0–3.9)16.2 (4.5–34.8)0.640.560.230.90Hakanson et al. (2009)Case-control study with in-subject simultaneous recordingLevel: III-2Quality: 14/26C1 (for accuracy)P255 patientsMedian % total time pH <4 in 1st series of patients (5th–95th percentile)Median % total time pH <4 in 2nd series of patients (5th–95th percentile)3.2(0.1–7.9)2.4(0–9.6)6.9 (0.7–16.3)5.2 (0.2–14.8)Pandolfino et al. (2003)Case seriesLevel: Q2Quality: 11.5/26CX (clinical diagnosis)P337 patientsMean % total time pH <4 (SEM)Mean % upright time pH <4 (SEM)Mean % supine time pH <4 (SEM)6.6 (0.8–27.6)7.9 (1.40–29.1)1.2 (0.0–23.9)7.7 (0.9–28.6)7.2 (1.1–31.1)1.5 (0.0–45.5)NSNSNSAyazi et al. (2011)Case seriesLevel: IVQuality: Q1CX (no comparator)P2310 patients% total time pH <4% upright time pH <4% supine time pH <4Number of reflux episodesNumber of episodes >5 minutesLongest reflux episode (minutes)Composite pH scoreAbnormal composite pH score on 1 of the 2 daysOnly abnormal pH score on day 1Only abnormal pH score on day 2% total time pH <4 (day 1 vs day 2)Composite pH score (day 1 vs day 2)3.7 (1.0–9.9)4.5 (1.2–12.1)0.3 (0.0–11.5)39 (13–74)2 (0–7)10 (3–25)13.1 (4.7–32.0) 19% (60/310)45% (27/60)55% (33/60)4.5 (0.9–9.7)4.8 (1.0–11.5)0.3 (0.0–6.3)36 (14.5–76)2 (0–7)9 (3.0–21.5)14.4 (3.9–30.5)0.16790.52380.49630.57460.38690.30060.65520.94 (0.93-0.95)0.83 (0.79-0.86)Tseng et al. (2005)Retrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2190 patients% total time pH <4 more than 5.3% (N)DeMeester score >14.7 (N)961068778Crowell et al. (2009)Case seriesLevel: IVQuality: Q1CX (no comparator)P2165 patients% total time pH <46.97.60.20Chander et al. (2012)Retrospective case seriesLevel: IVQuality: Q1CX (no comparator)P2124 patientsMedian % total time pH <4 (range)Median % upright time pH <4 (range)Median % supine time pH <4 (range)Median number of reflux episodes (range)DeMeester scores3.55 (0.00–29.90)4.50 (0.00–35.30)0.80 (0.00–46.40)35.50 (0.00-253.00)13.25 (0.30-104.00)3.75 (0.00–29.10)5.50 (0.00–32.10)0.20 (0.00–28.80)38.5 (0.00–299.00)15.15 (0.00–96.20)0.80920.54640.1778<0.0001NAAhlawat et al. (2006)Retrospective case seriesLevel: IVQuality: Q1CX (no comparator)P282 patientsSignificant correlation in reflux patterns in patients from day 1 to day 2No predictable pattern of reflux seen 74.4%28% (23/82)Remes-Troche et al. (2005)Prospective case seriesLevel: IVQuality: Q1CX (no comparator)P277 patientsMedian % total time pH <4 (range)Median % upright time pH <4 (range)Median % supine time pH <4 (range)Mean number of reflux episodes ± SEMean number of long reflux episodes ± SE5.5 (0–35)5.9 (0–22)1.4 (0–31.3)45.3 ± 34.2 ± 0.55.7 (0–22)6.0 (0–20)0.66 (0–24)65 ± 53.05 ± 0.9NSNSNS0.004NSPrakash & Clouse (2006)Case seriesLevel: IVQuality: Q1CX (no comparator)P262 patients% total time pH <4 off therapy% total time pH <4 on therapy5.2 ± 0.81.6 ± 0.45.6 ± 0.90.8 ± 0.4Lacy et al. (2009)Prospective case seriesLevel: IVQuality: Q1CX (no comparator)P250 patientsMean % total time pH <4 (SD)Mean total time pH <4 (SD)Mean total number of reflux episodes (SD)Mean total number of long reflux episodes (SD)Mean DeMeester score (SD)Abnormal study (% time pH <4 is more than 6%)6.6 ± 5.990.2 ± 82.780 ± 523 ± 424.7 ± 21.628 (56%)5.4 ± 4.674.6 ± 64.267 ± 443 ± 319.4 ± 15.921 (42%)Bhat, McGrath & Bielefeldt (2006)Prospective case seriesLevel: IVQuality: Q2CX (no comparator)P2203 patients% time abnormal pH5.5 (CI = 2.1–10.4)4.2 (CI = 1.2–9.2)<0.001Turner et al. (2007)Case seriesLevel: IVQuality: Q2CX (no comparator148 patients% total time pH <4 is more than 4% (N)% upright time pH <4 is more than 6.3% (N)% supine time pH <4 is more than 1.2% (N)7667546551530.03Korrapati et al. (2011)Retrospective case seriesLevel: IVQuality: Q2CX (no comparator)P2108 patients% total time pH <4: mean, median, SD (range)% upright time pH <4: mean, median, SD (range)% supine time pH <4: mean, median, SD (range)DeMeester score: mean, median, SD (range)6.36, 4.85, 7.60 (0.0–48.1)7.31, 5.70, 7.55 (0.0–41.4)4.01, 0.25, 8.94 (0.0–60.2)22.0, 16.3, 25.7 (0.0–163.7)6.02, 4.25, 8.02 (0.0–67.1)6.52, 4.85, 7.89 (0.0–59.6)4.66, 0.00, 12.20 (0.0–87.4)21.1, 15.2, 25.6 (0.0–213.0)0.730.05760.560.90Domingues, Moraes-Filho & Domingues (2011)Retrospective case seriesDiagnostic yield studyLevel: IVQuality: Q2CX (no comparator)P274 patientsAbnormal pH data (total time pH <4 is >4.4%)Positive SAP51 (68.9%)19 (44.1%)49 (70.2%)17 (40.4%)Belafsky et al. (2005)Retrospective case seriesLevel: IVQuality: Q2CX (no comparator)P278 sedated placements and 128 unsedated placementsMean reflux episodes (sedated group)Mean reflux episodes (unsedated group)% total time pH <4 (sedated group)% total time pH <4 (unsedated group) Mean composite score (sedated group)Mean composite score (unsedated group)Number of reflux episodes day 1 : day 2% total time pH <3 day 1 : day 2 Composite score day 1 : day 2Number of long reflux episodes day 1 : day 246565.56.718.323.346525.16.818.222.20.7150.6500.6940.773Garrean et al. (2008)Post-test case seriesLevel: IVQuality: Q2CX (no comparator)P260 patientsNumber of reflux episodes (median)2420NSBechtold et al. (2007)Retrospective case seriesLevel: IVQuality: Q2CX (no comparator)P226 patients% total time pH <4% total upright time pH <4% total supine time pH <4Number of reflux episodes (mean)Number of long reflux episodes (mean)Mean duration of long refluxes (minutes)Total heartburn episodesHeartburn episodes with pH <4Symptom score10.411.79.465.36.826.56.22.50.3237.16.310.055.63.819.78.02.90.2540.00490.00510.85960.02570.00770.06170.27520.6860.1353NS = not significantTable 79Day-to-day variability in oesophageal acid exposure with catheter-free monitoring in childrenStudyLevel and qualityNOutcomesDay 1Day 2p-value Croffie et al. (2007)Level: IIQuality:14.5/26Randomised controlled trial27 childrenMedian reflux index (range)2.3 (0.4–16.6)2.8 (0.2–15.6)0.345Gunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008)Case seriesLevel: IVQuality: Q1CX (no comparator)P258 childrenMedian % total time pH <4, SD (range)Median number of reflux episodes, SD (range)Median number of long reflux episodes, SD (range)Median longest reflux episode, SD (range)DeMeester score, SD (range)5.4 ± 6.8 (0–32.2)60 ± 47 (0–203)3 ± 5 (0–70)13 ± 15 (0–70)20.5 ± 23.7 (0.3–112.4)6.2 ± 8.4 (0–41.2)59 ± 51 (0–258)3 ± 5 (0–26)17 ± 20 (0–83)22.9 ± 28.7 (0.3–140.8)NSNSNSNSNSHochman & Favaloro-Sabatier (2005)Retrospective case seriesLevel: IVQuality: Q2CX (no comparator)P244 childrenMedian number of reflux episodes (range)Median number of long reflux episodes (range)Median % total time pH <4 (range)Median reflux time (minutes) (range)Longest reflux time (minutes) (range)28 (0, 83)2 (0, 13)4.2 (0, 23.6)54.5 (0, 309)10.5 (0, 53)22 (2, 96)1 (0, 14)2.6 (0.1–18.6)31 (1, 257)5 (1, 46)0.990.110.010.010.0007No correlation co-efficients calculated.NS = not significantAppendix H Non-comparative diagnostic yieldTable 80Non-comparative diagnostic yield with catheter-free monitoring in adultsStudyNDiagnostic yield (%) wireless pH monitoring Ayazi et al. (2011)310 patients suspected of GORDBased on composite pH scoreBoth days: 123 (39.7) On 1 day only: 60 (19.4) Ayazi et al. (2009)28 patients with strong clinical GORD evidence (1) and 77 patients with indeterminate clinical evidence of GORD (2)Based on composite pH score1: Both days: 19 (67.9)1: Overall: 26 (92.9)2: Day 1: 40 (52)2: Day 2: 42 (55)2: Both days: 31 (40)Bansal et al. (2009)20 patients with erosive oesophagitis (EO) and 20 patients with non-erosive reflux disease (NERD)EO proximal: 15 (75)EO distal: 17 (85)NERD proximal: 11 (51)NERD distal: 6 (30)Bhat, McGrath & Bielefeldt (2006)209 patients suspected of GORD95 (45.5)Domingues, Moraes-Filho & Domingues (2011)74 patients suspected of GORDOverall: 58 (78.3)Day 1: 51 (68.9)Day 2: 49 (70.2)Gillies et al. (2007)95 patients suspected of GORD, or following anti-reflux surgeryOverall: 66 (69)Only on day 1 (normal day 2): 7 (7)Only on day 2 (normal day 1): 10 (10)Grigolon et al. (2011)51 patients suspected of GORDDay 1: 24 (47.1)Overall (48h): 25 (49.0)Overall (96h): 29 (56.9)Karamanolis et al. (2012)32 patients with non-cardiac chest pain17 (53.1)Lacy et al. (2011)175 patients on PPI therapy and 177 patients off PPI therapyOn PPI therapy: 45 (25.7)Off PPI therapy: 108 (61.0)Pandolfino et al. (2003)37 GORD patientsBoth days: 24 (64.9)Day 1: 25 (67.6)Worst day: 31 (83.8)Scarpulla et al. (2007)34 patients suspected of GORDDay 1: 12 (35.3)48h: 14 (41.2)72h: 16 (47.1)96h: 19 (55.9)Worst day: 21 (61.8)Turner et al. (2007)115 patients suspected of GORDBoth days: 58 (50.4)Only on day 1 (normal day 2): 18 (15.7)Only on day 2 (normal day 1): 7 (6.1)On 1 day only: 25 (21.7)Day 1: 76 (66.1)Day 2: 65 (56.5)Ward et al. (2004)58 patients suspected of GORD30 (52)Table 81Non-comparative diagnostic yield with catheter-free monitoring in childrenStudyNDiagnostic yield (%) wireless pH monitoring Gunnarsdottir, Stenstrom & Arnbjornsson (2007, 2008)49 children suspected of GORDBased on DeMeester scores:33 (67.3)Appendix I MBS items for anti-reflux surgeryTable 82Anti-reflux surgery MBS item descriptors and claims from July 2012 to June 2013MBS item numberDescriptionNumber of claims 2012–1343951GASTRO-OESOPHAGEAL REFLUX with or without hiatus hernia, laparotomy and fundoplication for, without gastrostomy, Fee: $871.308643954GASTRO-OESOPHAGEAL REFLUX with or without hiatus hernia, laparotomy and fundoplication for, with gastrostomy, Fee: $1,065.75531464ANTIREFLUX OPERATION BY FUNDOPLASTY, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, by laparoscopic technique - not being a service to which item 30601 applies, Fee: $871.301,12930527ANTIREFLUX OPERATION by fundoplasty, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus not being a service to which item 30601 applies, Fee: $871.3030930530ANTIREFLUX operation by cardiopexy, with or without fundoplasty, Fee: $784.20305Figure 10Claims for anti-reflux procedures for GORD, July 2012 – June 2013, per age groupAppendix JEconomic literature searchTable 83Literature search in PubMed 21 November 2013Add to builderQueryItems found#13AddSearch (#9 and #12)6#12AddSearch pH monitoring194301#9AddSearch (#4) AND model62#4AddSearch (#2) AND #3758#3AddSearch ((economic) OR cost-effective) OR cost-utility693357#2AddSearch ((gastroesophageal reflux) OR GORD) OR GERD26220#1AddSearch ((gastroesophageal reflux) OR GORD) OR GORD25124Table 84Literature containing economic models relating to pH monitoring and management of GORD symptoms Author, JournalTitleDescription, CommentKleiman DA, Beninato T, Bosworth BP, Brunaud L, Ciecierega T, Crawford CV Jr, Turner BG, Fahey TJ 3rd and Zarnegar R 2014Journal of Gastrointestinal Surgery, vol. 18, no. 1, pp. 2–33; discussion pp. 33–34. Early referral for esophageal pH monitoring is more cost-effective than prolonged empiric trials of proton-pump inhibitors for suspected gastroesophageal reflux diseaseCost analysis of routine pH monitoring (after 8-week trial of PPI) vs ongoing treatment and delayed pH monitoring. Modelled cohort-based analysis with up to 10?years of costing data (retrospective). No outcome analysis. US setting. Some clinical inputs/assumptions are applicable.Lee WC, Yeh YC, Lacy BE, Pandolfino JE, Brill JV, Weinstein ML, Carlson AM, Williams MJ, Wittek MR and Pashos CL 2008Current Medical Research and Opinion, vol. 24, no. 5, pp. 1317–1327.Timely confirmation of gastro-esophageal reflux disease via pH monitoring: estimating budget impact on managed care organizationsModelled cost analysis of wireless pH monitoring vs empiric treatment in patients with normal endoscopy. One-year time horizon. No outcome analysis. US setting. Some clinical inputs/assumptions are applicable.Ofman JJ, Dorn GH, Fennerty MB and Fass R 2002Alimentary Pharmacology & Therapeutics, vol. 16, no. 2, pp. 261–273. The clinical and economic impact of competing management strategies for GORDCost-effectiveness analysis of diagnostic management of GORD; ‘step-up management [H2RAs reg then high-dose, PPIs reg then high-dose, endoscopy, pH monitoring] vs high-dose PPI trial. Results presented as costs/symptom-free patient and cost/QALY. One-year time horizon. US setting. Structure/inputs not directly applicable. Botoman VA 2002Journal of Clinical Gastroenterology, vol. 34, no. 1, pp. 6–14.Non-cardiac chest painOpinion piece – no economic modelling.Borzecki AM, Pedrosa MC, Prashker MJ 2000Archives of Internal Medicine, vol. 160, no. 6, pp. 844–452.Should non-cardiac chest pain be treated empirically? A cost-effectiveness analysisCost-minimisation analysis of empirical medication vs series of investigations. US setting. Not directly applicable.Ancona E, Zaninotto G, Costantini M, Polo R and Origbe E 1991Minerva Chirurgica vol. 46, 7 Suppl, pp. 263–271. [Esophageal manometry and pH-monitoring: cost–benefit analysis]Article in Italian and inadequate detail in abstract to be useful. Not reviewed further.H2RA = histamine-2 receptor antagonist, PPI = proton pump inhibitorAppendix KAdditional information relating to the economic evaluationTable 85A summary of variables used in the modelParameterValueAlternatives testedSource and DiscussionPrevalence40%20% to 80%Broeders et al 2010, for the base case. Range approximates Lacy et al 2011 to Domingues et al 2011).Sensitivity of wireless testing100%86%, 90%, 95%,Assumption, informed by the clinical report and with sensitivity analysis based on clinical report findings.Specificity of wireless testing100%77%, 90%, 95%Assumption, informed by the clinical report and with sensitivity analysis based on clinical report findings.Sensitivity of catheter-based testing100%80.5%Specified as the reference standard in the DAP specification. Sensitivity analysis informed by diagnostic yield in the report findings and expert opinion.Specificity of catheter-based testing100%No testedSpecified as the reference standard in the DAP specification.Technical failure rate of wireless testing7.50%22.5% (i.e. trebled)Main body of Report. Although this technically refers to the failure rate during insertion, reports vary considerably and a learning curve may exist. Technical failure rate of catheter-based testing0.89%-Main body of Report. A conservative estimate given that it its less than one third the rate attributed to wireless monitoring, yet the best comparative evidence suggested a RR of failure of 3.0.Technical failure re-attempt rate50%90%Arbitrary estimates.Standard GORD treatment effectiveness 89%Effectiveness of high dose GORD medication or routine fundoplication surgery (in patients with acid-related conditions) assumed equivalent, based on Beck et al 2009, Broeders et al 2010, Grant, Boachie, 2013).Surgery uptake in +ve patients25%75%Calibration of Medicare data on catheter-based testing and surgery rates.Surgery revision rate10%*Medicare revision surgery rate. Note: Sensitivity analysis were surgery costs are increased by $10,000pp is equivalent to base case surgery cost and revision rate >100%.Surgery Mortality rate0.05%nil - 0.5%Base case from Grant et al 2008. Alternative; Epstein et al 2009.Medication compliance100%-Applies to both PPIs and alternative medications – assumption.Investigation for alternative diagnosis90%50%-100%Arbitrary estimate, consistent with expert opinion and conservative approach.Treatment success for alternative conditions (non-acid related)100%-Specified assumption in DAPTable 86Scenario/sensitivity tests around other inputs into the economic model (Model 1 vs empirical treatment)Cost (wireless pH monitoring)Outcomes (wireless pH monitoring)Costs (no test)Outcomes (no test)ICERBase-case$8,7057.874$6,927 7.751$14,457No discounting vs 5% per year discounting costs and outcomes$8,9248.137$7,1588.01$13,907Surgical mortality rate 0.1% vs base-case rate of 0.05%$8,7057.874$6,9277.751$14,457Surgical mortality rate 0.5%vs base-case rate of 0.05%$8,7017.871$6,9277.751$14,785Technical failure rate tripled to 22.5%vs base-case rate of 7.5%$8,8287.864$6,9277.751$16,827Re-test after failure uptake: 90%vs base-case rate of 50%$8,7567.878$6,9277.751$14,403Surgery costs (incl. revisions) with additional cost of $10,000 per patient($17,294 vs base-case of $7,294)$9,6677.874$6,9277.751$22,278Costs of alternative treatment investigation/treatment increased by $1000/month in the initial 12 months. (i.e. up to ($1050/month vs $50/month)$14,6077.874$12,7237.751$16,050Prevalence of acid-related condition in refractory population; 20% (vs base case rate of 40%)$8,3087.917$6,6617.750$9,863Prevalence of acid-related condition in refractory population; 80% (vs base case rate of 40%)$9,4997.787$7,4607.755$63,723Appendix LAdditional information for the financial and costing analysisTable 87Copy of “Table 1. Bravo pH Monitoring System components and costs” as published in the ‘ASGE Technology Status Evaluation Report: wireless esophageal pH monitoring system’ (Chotiprashidi et al, 2005).DescriptionPrice (US$)Bravo pH capsule with delivery system, box of 5$1,125AA lithium batteries (pack of 4)$15Bravo pH receiver$6,900Calibtration buffer pH 1.07 (500mL bottle)$22Calibtration buffer pH 7.01 (500mL bottle)$22Bravo Kit (includes 2 Bravo receivers, Datalink, calibration stand, vacuum pump, calibration buffers pH 7.01 and 1.07, 4 pack AA lithium batteries)$16,649Bravo Kit with software (includes 2 Bravo receivers, POLYGRAM NET pH Testing Application software, Datalink, calibration stand, vacuum pump, calibration buffers pH 7.01 and 1.07, 4 pack AA lithium batteries)$22,149Bravo Kit with softare and Workstation (includes 2 Bravo receivers, POLYGRAM NET pH Testing Application software, Datalink, calibration stand, vacuum pump, calibration buffers pH 7.01 and 1.07, 4 pack AA lithium batteries, Gastro Workstation - Standing)$28,139Bravo-in-a-box (includes 2 Bravo receivers, POLYGRAM NET pH Testing Application software, Datalink, calibration stand, vacuum pump, calibration buffers pH 7.01 and 1.07, 4 pack AA lithium batteries, dedicated notebook computer, HP Desk Jet color printer)$25,704Filter$4.50System tubing (canister-to-filter)$6Patient tubing (Bravo delivery system-to-filter)$4.50References ADDIN EN.REFLIST Agrawal, D, Akerman, PA & Rich, H 2009, 'Removal of a Bravo 24-hour pH capsule with endoscopic scissors', Gastrointestinal Endoscopy, vol. 70, no. 2, pp. 385–386.Ahlawat, SK, Novak, DJ, Williams, DC, Maher, KA, Barton, F & Benjamin, SB 2006, 'Day-to-day variability in acid reflux patterns using the BRAVO pH-monitoring system', Journal of Clinical Gastroenterology, vol. 40, no. 1, pp. 20–24.Al Talalwah, N & Woodward, S 2013, 'Gastro-oesophageal reflux. Part 3: medical and surgical treatment', British Journal of Nursing, vol. 22, no. 7, pp. 409–415.Allgood, PC & Bachmann, M 2000, 'Medical or surgical treatment for chronic gastrooesophageal reflux? A systematic review of published evidence of effectiveness', European Journal of Surgery, vol. 166, no. 9, pp. 713–721.Andrews, CN, Sadowski, DC, Lazarescu, A, Williams, C, Neshev, E, Storr, M, Au, F & Heitman, SJ 2012, 'Unsedated peroral wireless pH capsule placement vs standard pH testing: a randomized study and cost analysis', BMC Gastroenterology, vol. 12, p. 58.Ang, D, Teo, EK, Ang, TL, Ong, J, Poh, CH, Tan, J & Fock, KM 2010, 'To Bravo or not? A comparison of wireless esophageal pH monitoring and conventional pH catheter to evaluate non-erosive gastroesophageal reflux disease in a multiracial Asian cohort', Journal of Digestive Diseases, vol. 11, no. 1, pp. 19–27.Anvari, M, Allen, C, Marshall, J, Armstrong, D, Goeree, R, Ungar, W & Goldsmith, C 2011, 'A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes', Surgical Endoscopy, vol. 25, no. 8, pp. 2547–2554.Arguedas, MR, Heudebert, GR, Klapow, JC, Centor, RM, Eloubeidi, MA, Wilcox, CM & Spechler, SJ 2004, 'Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease: the value of long-term data collection', American Journal of Gastroenterology, vol. 99, no. 6, pp. 1023–1028.Armitage, P, Berry, G & Matthews, JNS 2002, Statistical methods in medical research, 4th edn, Blackwell Science, Oxford.Auvin, S, Hartman, AL, Desnous, B, Moreau, AC, Alberti, C, Delanoe, C, Romano, A, Terrone, G, Kossoff, EH, Del Giudice, E & Titomanlio, L 2012, 'Diagnosis delay in West syndrome: misdiagnosis and consequences', European Journal of Pediatrics, vol. 171, no. 11, pp. 1695–1701.Ayazi, S, Hagen, JA, Zehetner, J, Banki, F, Augustin, F, Ayazi, A, DeMeester, SR, Oh, DS, Sohn, HJ, Lipham, JC & DeMeester, TR 2011, 'Day-to-day discrepancy in Bravo pH monitoring is related to the degree of deterioration of the lower esophageal sphincter and severity of reflux disease', Surgical Endoscopy, vol. 25, no. 7, pp. 2219–2223.Ayazi, S, Lipham, JC, Portale, G, Peyre, CG, Streets, CG, Leers, JM, Demeester, SR, Banki, F, Chan, LS, Hagen, JA & Demeester, TR 2009, 'Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy', Clinical Gastroenterology and Hepatology, vol. 7, no. 1, pp. 60–67.Azzam, RS, Sallum, RA, Brandao, JF, Navarro-Rodriguez, T & Nasi, A 2012, 'Comparative study of two modes of gastroesophageal reflux measuring: conventional esophageal pH monitoring and wireless pH monitoring', Arquivos de Gastroenterologia, vol. 49, no. 2, pp. 107–112.Bandolier 1999, Bandolier editorial: Diagnostic testing emerging from the gloom? Bandolier, vol. 70, , A, Wani, S, Rastogi, A, Rastogi, K, Goyal, A, Hall, S, Singh, V, Higbee, A & Sharma, P 2009, 'Impact of measurement of esophageal acid exposure close to the gastroesophageal junction on diagnostic accuracy and event-symptom correlation: a prospective study using wireless dual pH monitoring', American Journal of Gastroenterology, vol. 104, no. 12, pp. 2918–2925.Bechtold, ML, Holly, JS, Thaler, K & Marshall, JB 2007, 'Bravo (wireless) ambulatory esophageal pH monitoring: how do day 1 and day 2 results compare?', World Journal of Gastroenterology, vol. 13, no. 30, pp. 4091–4095.Beck, PE, Watson, DI, Devitt, PG, Game, PA & Jamieson, GG 2009, 'Impact of gender and age on the long-term outcome of laparoscopic fundoplication', World Journal of Surgery, vol. 33, no. 12, pp. 2620–2626.Belafsky, PC, Allen, K, Castro-Del Rosario, L & Roseman, D 2004, 'Wireless pH testing as an adjunct to unsedated transnasal esophagoscopy: the safety and efficacy of transnasal telemetry capsule placement', Otolaryngology–Head & Neck Surgery, vol. 131, no. 1, pp. 26–28.Bhat, YM, McGrath, KM & Bielefeldt, K 2006, 'Wireless esophageal pH monitoring: new technique means new questions', Journal of Clinical Gastroenterology, vol. 40, no. 2, pp. 116–121.Bojke, L, Hornby, E & Sculpher, M 2007, 'A comparison of the cost effectiveness of pharmacotherapy or surgery (laparoscopic fundoplication) in the treatment of GORD', Pharmacoeconomics, vol. 25, no. 10, pp. 829–841.Bothwell, M, Phillips, J & Bauer, S 2004, 'Upper esophageal pH monitoring of children with the Bravo pH capsule', Laryngoscope, vol. 114, no. 4, pp. 786–788.Bradley, AG, Crowell, MD, DiBaise, JK, Kim, HJ, Burdick, GE, Fleischer, DE & Sharma, VK 2011, 'Comparison of the impact of wireless versus catheter-based pH-metry on daily activities and study-related symptoms', Journal of Clinical Gastroenterology, vol. 45, no. 2, pp. 100-106.Broeders, JA, Draaisma, WA, Bredenoord, AJ, Smout, AJ, Broeders, IA & Gooszen, HG 2010, 'Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease', British Journal of Surgery, vol. 97, no. 6, pp. 845–852.Cabrera, J, Davis, M, Horn, D, Pfefferkorn, M & Croffie, JM 2011, 'Esophageal pH monitoring with the BRAVO capsule: Experience in a single tertiary medical center', Journal of Pediatric Gastroenterology & Nutrition, vol. 53, no. 4, pp. 404–408.Calabrese, C, Liguori, G, Gabusi, V, Gionchetti, P, Rizzello, F, Straforini, G, Brugnera, R & Di Febo, G 2008, 'Ninety-six-hour wireless oesophageal pH monitoring following proton pump inhibitor administration in NERD patients', Alimentary Pharmacology & Therapeutics, vol. 28, no. 2, pp. 250-255.Chander, B, Hanley-Williams, N, Deng, Y & Sheth, A 2012, '24 Versus 48-hour Bravo pH monitoring', Journal of Clinical Gastroenterology, vol. 46, no. 3, pp. 197–200.Chotiprashidi, P, Liu, J, Carpenter, S, Chuttani, R, DiSario, J, Hussain, N, Somogyi, L & Petersen, BT 2005, 'ASGE Technology Status Evaluation Report: wireless esophageal pH-monitoring system', Gastrointestinal Endoscopy, vol. 62, no. 4, pp. 485–ay, D, Adam, V, da Silveira, EB, Kennedy, W, Mayrand, S & Barkun, AN 2008, 'The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis', Canadian Journal of Gastroenterology, vol. 22, no. 6, pp. 552–558.Croffie, JM, Fitzgerald, JF, Molleston, JP, Gupta, SK, Corkins, MR, Pfefferkorn, MD, Lim, JR, Steiner, SJ & Dadzie, SK 2007, 'Accuracy and tolerability of the Bravo catheter-free pH capsule in patients between the ages of 4 and 18 years', Journal of Pediatric Gastroenterology & Nutrition, vol. 45, no. 5, pp. 559–563, DOI 10.1097/MPG.0b013e3180dc9349, <, MD, Bradley, A, Hansel, S, Dionisio, P, Kim, HJ, Decker, GA, DiBaise, JK & Sharma, VK 2009, 'Obesity is associated with increased 48-h esophageal acid exposure in patients with symptomatic gastroesophageal reflux', American Journal of Gastroenterology, vol. 104, no. 3, pp. 553–559.de Hoyos, A & Esparza, EA 2010, 'Technical problems produced by the Bravo pH test in nonerosive reflux disease patients', World Journal of Gastroenterology, vol. 16, no. 25, pp. 3183–3186.de Hoyos, A, Esparza, EA & Loredo, ML 2009, 'Cold and hot snare endoscopic techniques for removal of the Bravo pH-monitoring capsule', Digestion, vol. 79, no. 1, pp. 14–16.Deeks, JJ 2001, 'Systematic reviews of evaluations of diagnostic and screening tests', British Medical Journal, vol. 323, no. 21, pp. 157–162.Dent, J, El-Serag, HB, Wallander, MA & Johansson, S 2005, 'Epidemiology of gastro-oesophageal reflux disease: a systematic review', Gut, vol. 54, no. 5, pp. 710–717.des Varannes, SB, Mion, F, Ducrotte, P, Zerbib, F, Denis, P, Ponchon, T, Thibault, R & Galmiche, JP 2005, 'Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo)', Gut, vol. 54, no. 12, pp. 1682–1686.Doma, S, Paladugu, S, Parkman, HP & Friedenberg, FK 2010, 'Wireless capsules for esophageal pH monitoring: are we placing them correctly?', Digestion, vol. 82, no. 1, pp. 54–59.Domingues, GR, Moraes-Filho, JP & Domingues, AG 2011, 'Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes', Arquivos de Gastroenterologia, vol. 48, no. 1, pp. 24–29.Downs, SH & Black, N 1998, 'The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions', Journal of Epidemiology and Community Health, vol. 52, no. 6, pp. 377–384.Eckardt, VF, Dilling, B & Bernhard, G 1999, 'The impact of open access 24-h pH-metry on the diagnosis and management of esophageal reflux disease', American Journal of Gastroenterology, vol. 94, no. 3, pp. 616–621.Epstein D, Bojke L, Sculpher M & the REFLUX trial group. 2009, Laparoscopic fundoplication compared with medical management for gastro-oesphageal reflux disease: cost effectiveness study, BMJ, vol. 339, p. b2576. Eriksson, S, Langstrom, G, Rikner, L, Carlsson, R & Naesdal, J 1995, 'Omeprazole and H2-receptor antagonists in the acute treatment of duodenal ulcer, gastric ulcer and reflux oesophagitis: a meta-analysis', European Journal of Gastroenterology & Hepatoogyl, vol. 7, no. 5, pp. 467–475.Fajardo, NR, Wise, JL, Locke, GR, III, Murray, JA & Talley, NJ 2006, 'Esophageal perforation after placement of wireless Bravo pH probe', Gastrointestinal Endoscopy, vol. 63, no. 1, pp. 184–185.Fass, R 2009, 'Proton pump inhibitor failure: what are the therapeutic options?', American Journal of Gastroenterology, vol. 104, no. S2, pp. S33–S38.Fox, M 2006, 'Bravo wireless versus catheter pH-monitoring systems', Gut, vol. 55, no. 3, pp. 434–435.Francis, DL 2008, 'Attachment disorder: a decline in the performance of the Bravo pH system', American Journal of Gastroenterology, vol. 103, no. 10, p. 2663.Francis, DO, Sumner, E, Goutte, M, Slaughter, JC, Garrett, CG, Hagaman, D & Vaezi, MF 2012, 'Feasibility of dual wireless esophageal pH monitoring: randomized blinded sham-controlled trial', Otolaryngology–Head and Neck Surgery, vol. 147, no. 1, pp. 91-97.Galmiche, JP, Hatlebakk, J, Attwood, S, Ell, C, Fiocca, R, Eklund, S, Langstrom, G, Lind, T, Lundell, L & Collaborators, LT 2011, 'Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial', Journal of the American Medical Association, vol. 305, no. 19, pp. 1969–1977.Garrean, CP, Zhang, Q, Gonsalves, N & Hirano, I 2008, 'Acid reflux detection and symptom-reflux association using 4-day wireless pH recording combining 48-hour periods off and on PPI therapy', American Journal of Gastroenterology, vol. 103, no. 7, pp. 1631–1637.Gastroenterological Society of Australia 2011, Gastro-oesophageal Reflux Disease in Adults 5th edn) Gastroenterological Society of Australia, Digestive Health Foundation.Gastroenterological Society of Australia 2013, Heartburn (reflux), Gasteroenterological Society of Australia, viewed 21 May 2013, <, AJ, Rothe, J, Fought, AJ, Fareeduddin, A, Toto, E, Boris, L, Kahrilas, PJ & Pandolfino, JE 2012, 'Many patients continue using proton pump inhibitors after negative results from tests for reflux disease', Clinical Gastroenterology and Hepatol,ogy vol. 10, no. 6, pp. 620–625; quiz e657.Gillies, RS, Stratford, JM, Booth, MI & Dehn, TC 2007, 'Oesophageal pH monitoring using the Bravo catheter-free radio capsule', European Journal of Gastroenterology & Hepatology, vol. 19, no. 1, pp. 57–63.Grant, AM, Boachie, C, Cotton, SC, Faria, R, Bojke, L, Epstein, DM, Ramsay, CR, Corbacho, B, Sculpher, M, Krukowski, ZH, Heading, RC & Campbell, MK 2013, 'Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial)', Health Technology Assessment, vol. 17, no. 22, pp. 1–167.Grant, AM, Cotton, SC, Boachie, C, Ramsay, CR, Krukowski, ZH, Heading, RC, Campbell, MK & Group, RT 2013, 'Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX)', BMJ, vol. 346, p. f1908.Grant, AM, Wileman, S, Ramsay, C, Bojke, L, Epstein, D, Sculpher, M, Macran, S, Kilonzo, M, Vale, L, Francis, J, Mowat, A, Krukowski, Z, Heading, R, Thursz, M, Russell, I & Campbell, M 2008, 'The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease - a UK collaborative study. The REFLUX trial', Health Technology Assessment, vol. 12, no. 31, pp. 1–181, iii–iv.Grigolon, A, Bravi, I, Cantu, P, Conte, D & Penagini, R 2007, 'Wireless pH monitoring: better tolerability and lower impact on daily habits', Digestive & Liver Disease, vol. 39, no. 8, pp. 720–724.Grigolon, A, Consonni, D, Bravi, I, Tenca, A & Penagini, R 2011, 'Diagnostic yield of 96-h wireless pH monitoring and usefulness in patients' management', Scandinavian Journal of Gastroenterology, vol. 46, no. 5, pp. 522–530.Gunaratnam, NT, Jessup, TP, Inadomi, J & Lascewski, DP 2006, 'Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease', Alimentary Pharmacology & Therapeutics, vol. 23, no. 10, pp. 1473–1477.Gunnarsdottir, A, Stenstrom, P & Arnbjornsson, E 2007, '48-hour wireless oesophageal pH-monitoring in children: are two days better than one?', European Journal of Pediatric Surgery, vol. 17, no. 6, pp. 378–381.—— 2008, 'Wireless esophageal pH monitoring in children', Journal of Laparoendoscopic & Advanced Surgical Techniques A, vol. 18, no. 3, pp. 443–447.Hakanson, BS, Berggren, P, Granqvist, S, Ljungqvist, O & Thorell, A 2009, 'Comparison of wireless 48-h (Bravo) versus traditional ambulatory 24-h esophageal pH monitoring', Scandinavian Journal of Gastroenterol,ogy vol. 44, no. 3, pp. 276–283.Heidelbaugh, JJ, Goldberg, KL & Inadomi, JM 2010, 'Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting', American Journal of Managed Care, vol. 16, no. 9, pp. e228–234.Heidelbaugh, JJ, Kim, AH, Chang, R & Walker, PC 2012, 'Overutilization of proton-pump inhibitors: what the clinician needs to know', Therapeutic Advances in Gastroenterol,ogy vol. 5, no. 4, pp. 219–232.Heudebert, GR, Marks, R, Wilcox, CM & Centor, RM 1997, 'Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis', Gastroenterology, vol. 112, no. 4, pp. 1078–1086.Hirano, I 2006, 'Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease—Bilitec, intraluminal impedance and Bravo capsule pH monitoring', Alimentary Pharmacology & Therapeutics, vol. 23 Suppl 1, pp. 12–24.Hirano, I, Richter, JE & Practice Parameters Committee of the American College of Gastroenterology 2007, 'ACG practice guidelines: esophageal reflux testing', American Journal of Gastroenterology, vol. 102, no. 3, pp. 668–685.Hirano, I, Zhang, Q, Pandolfino, JE & Kahrilas, PJ 2005, 'Four-day Bravo pH capsule monitoring with and without proton pump inhibitor therapy', Clinical Gastroenterology and Hepatology, vol. 3, no. 11, pp. 1083–1088.Hochman, JA & Favaloro-Sabatier, J 2005, 'Tolerance and reliability of wireless pH monitoring in children', Journal of Pediatric Gastroenterology & Nutrition, vol. 41, no. 4, pp. 411–415.Hogan, RB 2nd, Phillips, P, Boyd, SA & Williams, JC 2009, 'Two-year retention of Bravo capsule in a giant colonic diverticulum', American Journal of Gastroenterology, vol. 104, no. 4, p. 1062.IFFGD 2014, About GERD, International Foundation for Functional Gastrointestinal Disorders, viewed 2 August 2013, <, A, Lee, YK, Vitamvas, M & Oleynikov, D 2007, '48-hour pH monitoring increases the risk of false positive studies when the capsule is prematurely passed', Journal of Gastrointestinal Surgery, vol. 11, no. 5, pp. 638–641.Kahrilas, PJ 2008, 'Clinical practice. Gastroesophageal reflux disease', New England Journal of Medicine, vol. 359, no. 16, pp. 1700–1707.Kahrilas, PJ, Shaheen, NJ & Vaezi, MF 2008, 'American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease', Gastroenterology, vol. 135, no. 4, pp. 1392–1413, e1395.Karamanolis, G, Triantafyllou, K, Psatha, P, Vlachogiannakos, I, Gaglia, A, Polymeros, D, Fessatou, S, Triantafyllou, M, Papanikolaou, IS & Ladas, SD 2012, 'Bravo 48-hour wireless pH monitoring in patients with non-cardiac chest pain: objective gastroesophageal reflux disease parameters predict the responses to proton pump inhibitors', Journal of Neurogastroenterology & Motility, vol. 18, no. 2, pp. 169–173.Katz, PO, Gerson, LB & Vela, MF 2012, 'Guidelines for the diagnosis and management of gastroesophageal reflux disease', American Journal of Gastroenterology, vol. 108, no. 3, pp. 308–328.Kessing, BF, Bredenoord, AJ & Smout, AJPM 2011, 'Erroneous diagnosis of gastroesophageal reflux disease in achalasia', Clinical Gastroenterology and Hepatology, vol. 9, no. 12, pp. 1020–1024.Khan, KS, Ter Riet, G, Glanville, JM, Sowden, AJ & Kleijnen, J 2001, Undertaking systematic reviews of research on effectiveness. CRD's guidance for those carrying out or commissioning reviews, CRD Report no. 4 (2nd edn), NHS Centre for Reviews and Dissemination, University of York, York.Kleiman, DA, Beninato, T, Bosworth, BP, Brunaud, L, Ciecierega, T, Crawford, CV, Jr., Turner, BG, Fahey, TJ, 3rd & Zarnegar, R 2013, 'Early referral for esophageal pH monitoring is more cost-effective than prolonged empiric trials of proton-pump inhibitors for suspected gastroesophageal reflux disease', Journal of Gastrointestinal Surgery, vol. 18, no. 1, pp. 26–33; discussion 33–34.Kleiman, DA, Sporn, MJ, Beninato, T, Metz, Y, Crawford, C, Fahey, TJ, 3rd & Zarnegar, R 2012, 'Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications', Surgical Endoscopy, vol. 27, no. 4, pp.1302–1309.Knox, SA, Harrison, CM, Britt, HC & Henderson, JV 2008, 'Estimating prevalence of common chronic morbidities in Australia', Medical Journal of Australia, vol. 189, no. 2, pp. 66–70.Korrapati, V, Babich, JP, Balani, A, Grendell, JH & Kongara, KR 2011, 'Does deep sedation impact the results of 48 hours catheterless pH testing?', World Journal of Gastroenterology, vol. 17, no. 10, pp. 1304–1307.Kramer, E & Chokhavatia, S 2012, 'An unusual complication of Bravo pH capsule dislodged into the pyriform sinus', American Journal of Gastroenterology, vol. 107, p. S497.Kushnir, VM, Sayuk, GS & Gyawali, CP 2011, 'The effect of antisecretory therapy and study duration on ambulatory esophageal pH monitoring', Digestive Diseases & Sciences, vol. 56, no. 5, pp. 1412–1419.Lacy, BE, Chehade, R & Crowell, MD 2011, 'A prospective study to compare a symptom-based reflux disease questionnaire to 48-h wireless pH monitoring for the identification of gastroesophageal reflux (revised 2-26-11)', American Journal of Gastroenterology, vol. 106, no. 9, pp. 1604–1611.Lacy, BE, Dukowicz, AC, Robertson, DJ, Weiss, JE, Teixeira, P & Kelley, ML, Jr. 2011, 'Clinical utility of the wireless pH capsule', Journal of Clinical Gastroenterology, vol. 45, no. 5, pp. 429–435.Lacy, BE, Edwards, S, Paquette, L, Weiss, J, Kelley, ML, Jr. & Ornvold, K 2009, 'Tolerability and clinical utility of the Bravo pH capsule in children', Journal of Clinical Gastroenterology, vol. 43, no. 6, pp. 514–519.Lagergren, J, Bergstrom, R, Lindgren, A & Nyren, O 1999, 'Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma', New England Journal of Medicine, vol. 340, no. 11, pp. 825–831.Lee, JS 2012, 'Is wireless capsule pH monitoring better than catheter systems?', Journal of Neurogastroenterology & Motility, vol. 18, no. 2, pp. 117–119.Lee, WC, Yeh, YC, Lacy, BE, Pandolfino, JE, Brill, JV, Weinstein, ML, Carlson, AM, Williams, MJ, Wittek, MR & Pashos, CL 2008, 'Timely confirmation of gastro-esophageal reflux disease via pH monitoring: estimating budget impact on managed care organizations', Current Medical Research & Opinion, vol. 24, no. 5, pp. 1317–1327.Lee, YC, Wang, HP, Chiu, HM, Huang, SP, Tu, CH, Wu, MS & Lin, JT 2005, 'Patients with functional heartburn are more likely to report retrosternal discomfort during wireless pH monitoring', Gastrointestinal Endoscopy, vol. 62, no. 6, pp. 834–841.Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JP, Clarke, M, Devereaux, PJ, Kleijnen, J & Moher, D 2009, 'The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration', BMJ, vol. 339, p. b2700.Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JHP & Bossuyt PMM 1999, Empirical evidence of design-related bias in studies of diagnostic tests. JAMA, vol. 282, no. 11, pp. 1061–1066.Maerten, P, Ortner, M, Michetti, P & Dorta, G 2007, 'Wireless capsule pH monitoring: does it fulfil all expectations?', Digestion, vol. 76, no. 3–4, pp. 235–240.Mahon, D, Rhodes, M, Decadt, B, Hindmarsh, A, Lowndes, R, Beckingham, I, Koo, B & Newcombe, RG 2005, 'Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux', British Journal of Surgery, vol. 92, no. 6, pp. 695–699.Marchese, M, Spada, C, Iacopini, F, Familiari, P, Shah, SG, Tringali, A & Costamagna, G 2006, 'Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: feasibility, safety, and efficacy of a manometry-guided procedure', Endoscopy, vol. 38, no. 8, pp. 813–818.Martinez de Haro, LF, Munitiz, V, Ortiz, A, Ruiz de Angulo, D, Navarro, MD & Parrilla, P 2008, '[Outpatient monitoring of oesophageal pH with a catheter-free pH-meter (Bravo system) a study of tolerance, safety and efficacy]', Cirugía Espa?ola, vol. 84, no. 4, pp. 201–209.Mearin, F, Balboa, A, Dot, J, Maldonado, O & Malagelada, JR 1998, 'How standard is a standard day during a standard ambulatory 24-hour esophageal pH monitoring?', Scandinavian Journal of Gastroenterology, vol. 33, no. 6, pp. 583–585.Medicare Australia 2013, Medicare statistics, Medicare Locals Statistics Report, Australian Government, Department of Human Services, viewed 4 February 2014, , G & Pan, Y 2009, 'Gastro-oesophageal reflux disease', in Britt et al. (eds), General practice in Australia, health priorities and policies 1998 to 2008, Cat. no. GEP 24, Australian Institute of Health and Welfare, Canberra.MSAC 2005, Guidelines for the assessment of diagnostic technologies, Medical Services Advisory Committee, Commonwealth of Australia, Canberra, ACT.Mulherin, SA & Miller, WC 2002. 'Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation', Annals of Internal Medicine, vol. 137, no. 7, pp. 598–602.Napuri, S, Le Gall, E, Dulac, O, Chaperon, J & Riou, F 2010, 'Factors associated with treatment lag in infantile spasms', Developmental Medicine and Child Neurology, vol. 52, no. 12, pp. 1164–1166.Nelson, SP, Chen, EH, Syniar, GM & Christoffel, KK 2000, 'Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group', Archives of Pediatric & Adolescent Medicine, vol. 154, no. 2, pp. 150–zer, P, Gut, A, Heer, R, Gries, N, Pfister, M, Halter, F & Inauen, W 1999, 'Five-year audit of ambulatory 24-hour esophageal pH-manometry in clinical practice', Scandinavian Journal of Gastroenterology, vol. 34, no. 7, pp. 676–682.National Health and Medical Research Council (NHMRC) 1999, A guide to the development, implementation and evaluation of clinical practice guidelines, NHMRC, Canberra, Australia.NHMRC 2000, How to use the evidence: assessment and application of scientific evidence, Handbook series on preparing clinical practice guidelines, National Health and Medical Research Council, Canberra.—— 2008, NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Stage 2 consultation, National Health and Medical Research Council, Australian Government, viewed 11 March 2008, <.au/consult/index.htm>.Nusrat, S, Roy, PM & Bielefeldt, K 2012, 'Wireless ambulatory pH studies: manometric or endoscopic guidance?', Diseases of the Esophagus, vol. 25, no. 1, pp. 26–32.Pandolfino, JE, Lee, TJ, Schreiner, MA, Zhang, Q, Roth, MP & Kahrilas, PJ 2006, 'Comparison of esophageal acid exposure at 1 cm and 6 cm above the squamocolumnar junction using the Bravo pH-monitoring system', Diseases of the Esophagus, vol. 19, no. 3, pp. 177–182.Pandolfino, JE, Richter, JE, Ours, T, Guardino, JM, Chapman, J & Kahrilas, PJ 2003, 'Ambulatory esophageal pH monitoring using a wireless system', American Journal of Gastroenterology, vol. 98, no. 4, pp. 740–749.Pandolfino, JE, Schreiner, MA, Lee, TJ, Zhang, Q, Boniquit, C & Kahrilas, PJ 2005, 'Comparison of the Bravo (TM) wireless and Digitrapper (TM) catheter-based pH-monitoring systems for measuring esophageal acid exposure', American Journal of Gastroenterology, vol. 100, no. 7, pp. 1466–1476.Park, EY, Choi, MG, Baeg, M, Lim, CH, Kim, J, Cho, Y, Park, J, Lee, I, Kim, S & Choi, K 2013, 'The value of early wireless esophageal pH monitoring in diagnosing functional heartburn in refractory gastroesophageal reflux disease', Digestive Diseases & Sciences, vol. 58, no. 10, pp. 2933–2939.Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B & Dawes M 2001, Oxford Centre for Evidence-Based Medicine levels of evidence. Centre for Evidence-Based Medicine, Oxford, UK.Prakash, C & Clouse, RE 2005, 'Value of extended recording time with wireless pH monitoring in evaluating gastroesophageal reflux disease', Clinical Gastroenterology and Hepatology, vol. 3, no. 4, pp. 329–334.—— 2006, 'Wireless pH monitoring in patients with non-cardiac chest pain', American Journal of Gastroenterology, vol. 101, no. 3, pp. 446–452.Prakash, C, Jonnalagadda, S, Azar, R & Clouse, RE 2006, 'Endoscopic removal of the wireless pH-monitoring capsule in patients with severe discomfort', Gastrointestinal Endoscopy, vol. 64, no. 5, pp. 828–832.Remes-Troche, JM, Ibarra-Palomino, J, Carmona-Sanchez, RI & Valdovinos, MA 2005, 'Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico', American Journal of Gastroenterology, vol. 100, no. 11, pp. 2382–2386.Renteln, D, Kayser, T, Riecken, B & Caca, K 2008, 'An unusual case of Bravo capsule aspiration', Endoscopy, vol. 40 Suppl 2, Sep, p. E174.Sackett, DL & Haynes, RB 2002, 'The architecture of diagnostic research', BMJ, vol. 324, no. 7336, pp. 539–541.Scarpignato, C 2012, 'Poor effectiveness of proton pump inhibitors in non-erosive reflux disease: the truth in the end!', Neurogastroenterology & Motility, vol. 24, no. 8, pp. 697–704.Scarpulla, G, Camilleri, S, Galante, P, Manganaro, M & Fox, M 2007, 'The impact of prolonged pH measurements on the diagnosis of gastroesophageal reflux disease: 4-day wireless pH studies', American Journal of Gastroenterology, vol. 102, no. 12, pp. 2642–2647.Schneider, JH, Kramer, KM, Konigsrainer, A & Granderath, FA 2007, 'Ambulatory pH: monitoring with a wireless system', Surgical Endoscopy, vol. 21, no. 11, pp. 2076–2080.Shaheen, NJ & Richter, JE 2009, 'Barrett's oesophagus', Lancet, vol. 373, no. 9666, pp. 850–861.Shahid, S & Fisher, R 2011, 'Left, right and out: esophageal probe aspiration', American Journal of Gastroenterology, vol. 106, pp. S378–S379.Sofi, A, Filipiak, C, Sodeman, T, Ahmad, U, Bawany, M & Daboul, I 2011, 'Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method', Turkish Journal of Gastroenterology, vol. 22, no. 3, pp. 243–248.Starr, DS 2006, 'Legal advisor. Case #1: misdiagnosis of smoker's chest pain', Clinical Advisor for Nurse Practitioners, vol. 9, no. 1, pp. 74–75.—— 2007, 'Legal advisor. Case #1: past GERD hides critical new ailment', Clinical Advisor for Nurse Practitioners, vol. 10, no. 3, pp. 141–142.Susman, JL 2009, ' "GERD" turns out to be heart disease', The Journal of Family Practice, vol. 58, no. 5, p. 288.Sweetman, LL, Ng, YT & Kerrigan, JF 2007, 'Gelastic seizures misdiagnosed as gastroesophageal reflux disease', Clinical Pediatrics, vol. 46, no. 4, pp. 325–328.Sweis, R, Fox, M, Anggiansah, A & Wong, T 2011, 'Prolonged, wireless pH-studies have a high diagnostic yield in patients with reflux symptoms and negative 24-h catheter-based pH-studies', Neurogastroenterology & Motility, vol. 23, no. 5, pp. 419–426.Sweis, R, Fox, M, Anggiansah, R, Anggiansah, A, Basavaraju, K, Canavan, R & Wong, T 2009, 'Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies', Alimentary Pharmacology & Therapeutics, vol. 29, no. 6, pp. 669–676.Taddio, A, Bersanini, C, Basile, L, Fontana, M & Ventura, A 2011, 'Gastroesophageal reflux disease at any cost: a dangerous paediatric attitude', Acta Paediatrica, International Journal of Paediatrics, vol. 100, no. 10, pp. e178–e180.Tankurt, E, Tuzomay, N, Sengul, B, Kinik, E & Acil, B 2011, 'Safety and tolerability of BRAVO capsule pH monitoring', Turkish Journal of Gastroenterology, vol. 22, no. 3, pp. 352–353.Tharavej, C, Hagen, JA, Portale, G, Hsieh, CC, Gandamihardja, TA, Lipham, JC, Peters, JH, DeMeester, SR, Crookes, PF, Bremner, CG & DeMeester, TR 2006, 'Bravo capsule induction of esophageal hypercontractility and chest pain', Surgical Endoscopy, vol. 20, no. 5, pp. 783–786.Triester, SL, Leighton, JA, Budavari, AI, Crowell, MD & Fleischer, DE 2005, 'Severe chest pain from an indwelling Bravo pH probe', Gastrointestinal Endoscopy, vol. 61, no. 2, pp. 317–319.Tseng, D, Rizvi, AZ, Fennerty, MB, Jobe, BA, Diggs, BS, Sheppard, BC, Gross, SC, Swanstrom, LL, White, NB, Aye, RW & Hunter, JG 2005, 'Forty-eight-hour pH monitoring increases sensitivity in detecting abnormal esophageal acid exposure', Journal of Gastrointestinal Surgery, vol. 9, no. 8, pp. 1043–1051; discussion 1051–1042.Tu, CH, Lee, YC, Wang, HP, Wu, MS, Chiu, HM & Lin, JT 2004, 'Ambulatory esophageal pH monitoring by using a wireless system: a pilot study in Taiwan', Hepatogastroenterology, vol. 51, no. 60, pp. 1586–1589.Turner, BG, Saltzman, JR, Hua, L, Maurer, R, Feldman, N, Carr-Locke, DL, Burakoff, R & Liu, JJ 2007, 'Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease', Canadian Journal of Gastroenterology, vol. 21, no. 11, pp. 737–741.Tutuian, R 2008, 'Reflux monitoring: current status', Current Gastroenterology Reports, vol. 10, no. 3, pp. 263–270.Ward, EM, Devault, KR, Bouras, EP, Stark, ME, Wolfsen, HC, Davis, DM, Nedrow, SI & Achem, SR 2004, 'Successful oesophageal pH monitoring with a catheter-free system', Alimentary Pharmacology & Therapeutics, vol. 19, no. 4, pp. 449–454.Weber, C, Davis, CS & Fisichella, PM 2011, 'Current applications of evolving methodologies in gastroesophageal reflux disease testing', Digestive & Liver Disease, vol. 43, no. 5, pp. 353–357.Wenner, J, Hall, M, Hoglund, P, Johansson, J, Johnsson, F & Oberg, S 2008, 'Wireless pH recording immediately above the squamocolumnar junction improves the diagnostic performance of esophageal pH studies', American Journal of Gastroenterology, vol. 103, no. 12, pp. 2977–2985.Wenner, J, Johansson, J, Johnsson, F & Oberg, S 2007b, 'Optimal thresholds and discriminatory power of 48-h wireless esophageal pH monitoring in the diagnosis of GERD', American Journal of Gastroenterology, vol. 102, no. 9, pp. 1862–1869.Wenner, J, Johnsson, F, Johansson, J & Oberg, S 2007a, 'Wireless esophageal pH monitoring is better tolerated than the catheter-based technique: results from a randomized cross-over trial', American Journal of Gastroenterology, vol. 102, no. 2, pp. 239–245.Whiting, PF, Rutjes, AW, Reitsma JB, Bossuyt PM & Kleijnen J 2003, 'The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews', BMC Medical Research Methodology, vol. 3, p. 25.Whiting, PF, Rutjes, AW, Westwood, ME, Mallett, S, Deeks, JJ, Reitsma, JB, Leeflang, MM, Sterne, JA & Bossuyt, PM 2011, 'QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies', Annals of Internal Medicine, vol. 155, no. 8, pp. 529–536.Wiener, GJ, Morgan, TM, Copper, JB, Wu, WC, Castell, DO, Sinclair, JW & Richter, JE 1988, 'Ambulatory 24-hour esophageal pH monitoring: reproducibility and variability of pH parameters', Digestive Diseases & Sciences, vol. 33, no. 9, pp. 1127–1133.Wileman SM, McCann, S, Grant Adrian, M, Krukowski Zygmunt, H & Bruce, J 2010, 'Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults', Cochrane Database of Systematic Reviews, no. 3, DOI 10.1002/14651858.CD003243.pub2. Wilson, JA & Vela, MF 2008, 'New esophageal function testing (impedance, Bravo pH monitoring, and high-resolution manometry): clinical relevance', Current Gastroenterology Reports, vol. 10, no. 3, pp. 222–230.Wong, WM, Bautista, J, Dekel, R, Malagon, IB, Tuchinsky, I, Green, C, Dickman, R, Esquivel, R & Fass, R 2005, 'Feasibility and tolerability of transnasal/per-oral placement of the wireless pH capsule vs traditional 24-h oesophageal pH monitoring: a randomized trial', Alimentary Pharmacology Therapeutics, vol. 21, no. 2, pp. 155–163. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- monthly financial report template free
- performance report template in word
- accident report template free printable
- monthly financial report template word
- home inspection report template word
- financial report template samples
- simple annual report template free
- annual report template word
- financial report template word
- lab report template pdf
- free annual report template publisher
- student progress report template word