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ISRN Gastroenterology
Volume 2012 (2012), Article ID 903240, 9 pages
Review Article

Critical Analysis of Esophageal Multichannel Intraluminal Impedance Monitoring 20 Years Later

1Department of Surgery, São Paulo Medical School, Federal University of São Paulo, 04021-001 São Paulo, SP, Brazil
2Surgical Gastroenterology, Division of Esophagus and Stomach, Hospital São Paulo, Rua Diogo de Faria 1087 cj 301, 04037-003 São Paulo, SP, Brazil

Received 29 July 2012; Accepted 13 September 2012

Academic Editors: G. H. Kang, A. Nakajima, and C.-T. Shun

Copyright © 2012 Fernando A. M. Herbella. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Multichannel intraluminal impedance (MII) for the evaluation of esophageal diseases was created in 1991 trying to solve previous limitations of esophageal function test. MII-pH is able to determine the physical characteristics of the refluxate (liquid, gas, or mixed) and nonacidic GER. MII-manometry can determine the presence of bolus and its relation with peristalsis. This paper makes a critical analysis of the clinical applications of MII 20 years after its creation. Literature review shows that MII made great contributions for the understanding of esophageal physiology; however, direct clinical applications are few. MII-pH was expected to identify patients with normal acid reflux and abnormal nonacidic reflux. These patients are rarely found off therapy, that is, nonacidic reflux parallels acid reflux. Furthermore, the significance of isolated nonacidic reflux is unclear. Contradictory MII-manometry and conventional manometry findings lack better understanding and clinical implication as well as the real significance of bolus transit.