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diagnosing the cause of the pain, this symptom may
be erroneously associated with ischemic heart
disease. An additional complication in the case of
distinguishing between the diseases is that
regurgitation into the esophagus causes, among other
things, a reduction in blood flow in the coronary
arteries. In addition, patients indicate a bitter or
sweet taste in the mouth - a result of activation of the
anti-acid defense mechanism in the esophagus -
secretion by the salivary a fluid containing salts.
Another important symptom associated with the
esophagus reflux diseases is chest pain, often
described as tightness or burning occurring behind
the sternum and radiating to the back, neck, jaw or
arm, which may be incorrectly diagnosed as angina
pectoris. Often, the pain intensifies after a meal or
while under the influence of stress and often causes
awakening from sleep. Typically an episode of pain,
caused by a gastroesophageal reflux disease lasts
from a few minutes to several hours and disappears
spontaneously. Extensive research of the cause of
pain did not give clear answers. It is considered that
the cause of pain for patients with GERD is
multifactorial and related to the concentration of H
+
ions, the volume of the gastric content, the duration
of the reflux episodes and secondary spasm of the
esophagus. Moreover, GERD is the third most
common cause of chronic cough, after the symptoms
associated with sinuses and asthma - it is estimated
that reflux diseases causes approximately 20% of
chronic cough cases. A co-occurrence of GERD in
80% of patients with asthma was observed.
Research also revealed a relationship between
the reflux diseases of the upper gastrointestinal tract
and diseases of the upper respiratory tract - in
particular asthma.
Abnormalities associated with an increased
number of reflux episodes may also be the cause of
ailments and symptoms of laryngological changes,
among which the most common are the reflux
inflammation of laryngitis and also inflammation of
the ear, nose and throat. It should also be noted that
the growing number of patients who are diagnosed
with GERD has a significant economic importance.
In the U.S. alone, the annual cost of antacid
medicine is estimated at 4-5 billion dollars (Yamada,
2006b).
Over the years many different methods for
diagnosis of diseases of the upper gastrointestinal
tract were developed, including invasive and non-
destructive methods, with different values of
specificity or accuracy. By far the most frequently
used invasive method of diagnosing lesions
associated with GERD and LPR is the measurement
Figure 1: MII-pH exam overview (Tutuian and Castell,
2003).
of esophageal pH and, in recent years, the
measurement of the impedance of the esophagus
(Yamada, 2006a; Yamada, 2006b; Kahrilas, 2001;
Lazarescu and Sifrim, 2008; Pritchett et al., 2009;
Shay et al., 2001; Sifrim and Fornari, 2008; Sifrim et
al., 2001; Smith et al., 1993; Villa and Vela, 2013).
The two tests can be performed at the same time,
which not only does not put on the patient any
additional unpleasantness associated with the same
technique but also allows to observe the recorded pH
and impedance under the same conditions and time.
An overview of the exam is shown in Figure 1.
The few existing computer programs to assist in
diagnosing reflux disease - often being added as
software to measuring devices, allow to display the
results and perform simple analysis mainly pH and
relatively rarely, impedance (Tutuian et al., 2008;
Hila et al., 2007). Admittedly, this may affect the
reduction of the analysis time, but the data provided
by the software is not free from interpretation errors
of algorithms, which’s task is to search and
determine reflux episodes. Thus, there is a need to
develop such algorithms to support the analysis of
pH - impedance, with the help of which the
detection of reflux episodes is not only faster, but
more reliable. Moreover, the developed algorithms
can be applied in a variety of support systems
helpful in diagnostics of the upper gastrointestinal
tract, without the need to adapt them to the
specificities of the software environment, which will
highlight their use and application (e.g. after light
modifications they can be used to study diseases of
the upper digestive tract of animals).
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