P2222 - Wireless pH Intolerance and Complications: Insights From a Neurogastroenterology Center of Excellence

Maria Krakovski, BS¹, Katelyn Madigan, MD², Alexa Cecil, MD, MPH², Avery Kerwin, BA¹, Steven Clayton, MD¹, Nyree Thorne, MD², Jessica W. Hollingsworth, MD^2
1Wake Forest University School of Medicine, Winston-Salem, NC; ²Atrium Health Wake Forest Baptist, Winston-Salem, NC

Introduction: Wireless capsule endoscopy has been a key diagnostic modality in quantifying pathological GERD. Following capsule placement 6cm proximal to the squamous columnar junction, pH data is collected for 48-96 hours. Common complications are wireless capsule retention and post-deployment pain. Our study aims to evaluate contributing factors, patient characteristics, and pre-placement interventions that may relate to wireless pH capsule complications.

Methods: This retrospective study analyzed adult gastroenterology patients at Atrium Health Wake Forest Baptist Medical Center [Winston-Salem, North Carolina] who underwent wireless pH monitoring from January 2017 to June 2023. Descriptive statistics and pairwise statistical tests of association were calculated for each clinical covariate. Additionally, a multivariate logistic regression model was utilized to examine the relationship between post-procedure pain and various clinical covariates.

Results: Among the 206 participants who underwent wireless pH capsule placement, 18 (8.73%) experienced post-procedural intolerance. Two of those cases were severe enough to require endoscopic removal before the 96-hour monitoring was complete. Additionally, seven patients had capsule retention lasting 4-14 days. Significant associations were found between post-procedural pain and both capsule retention (p< 0.001) and irritable bowel syndrome (IBS) diagnosis (p=0.015). As demonstrated in Table 1, patients with depression had 8.18 times higher odds of experiencing post-procedural pain/intolerance (95% CI: 1.53, 53.5; p=0.019), whereas antidepressant use was associated with a significant reduction in odds for post-procedural intolerance (95% CI: 0.03, 0.77; p=0.029). Alternative diagnoses such as anxiety or fibromyalgia, endoscopic interventions, pathologic gastroesophageal reflux disease diagnosis [per Lyon Consensus 2.0], and symptom type were not significantly linked to post-procedure intolerance.

Discussion: Both IBS and depression were linked to post-procedural intolerance, while post-procedural intolerance was associated with esophageal capsule retention. Notably, anti-depressant use appeared protective, potentially due to their neuromodulating properties. Further studies are needed to confirm these findings.


Disclosures:


Maria Krakovski, BS¹, Katelyn Madigan, MD², Alexa Cecil, MD, MPH², Avery Kerwin, BA¹, Steven Clayton, MD¹, Nyree Thorne, MD², Jessica W. Hollingsworth, MD². P2222 - Wireless pH Intolerance and Complications: Insights From a Neurogastroenterology Center of Excellence, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.