Mucosal Impedance in the Diagnosis and Surgical Management of Gastroesophageal Reflux Disease

Objective assessment of gastroesophageal reflux disease (GERD) has traditionally relied on endoscopy to identify macroscopic injury and ambulatory pH monitoring to quantify reflux burden. However, acid exposure time does not directly assess epithelial injury or mucosal recovery, and normalization of reflux metrics does not consistently predict symptom resolution after intervention. Mucosal impedance (MI) is an endoscopic, tissue-level measure of esophageal mucosal integrity that reflects cumulative reflux-related injury and barrier dysfunction. Clinical studies demonstrate reduced distal esophageal impedance in GERD, including non-erosive phenotypes, and with improvement following effective medical or surgical therapy. By complementing conventional reflux testing with direct assessment of mucosal integrity, MI potentially offers a framework for refined phenotyping, improved patient selection, and objective evaluation of treatment response. This review synthesizes the physiologic rationale, technical considerations, and clinical evidence supporting MI, with emphasis on its implications for surgical decision-making and outcome assessment in GERD.