Predictors of proton pump inhibitor failure in non-erosivereflux disease: A study with impedance-pH monitoringand high-resolution manometry
Predictors of proton pump inhibitor failure in non-erosivereflux disease: A study with impedance-pH monitoringand high-resolution manometry
复制标题
非糜烂性反流病质子泵抑制剂失效的预测因素：阻抗-pH 监测和高分辨率测压法的研究
DOI：
10.1111/nmo.12763
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Y. XIAO
中科院分区：
文献类型：
--
作者：
Y. SHI;N. TAN;N. ZHANG;L. XIONG;S. PENG;J. LIN;M. CHEN;Y. XIAO
背景大约三分之一的胃食道反流病(GERD)患者的症状对质子泵抑制剂(PPI)耐药。我们应用高分辨率测压(HRM)和多通道管腔内阻抗-pH(Mii-pH)监测来探讨非糜烂性反流病(NERD)患者PPI失败的潜在预测因素。在PPI治疗前进行症状问卷GerdQ、HRM和24小时MII-pH监测。PPI衰竭被定义为在最后一周内持续反流症状超过1天，连续4周服用埃索美拉唑(20 mg，每日两次)。结果质子泵抑制剂失效患者的体重指数(BMI)较低，伴有功能性消化不良(FD)症状较多。食道动力衰竭患者的I型食管胃连接部形态比例较高(p=0.005)，食管胃连接部增大(p=0.000)，食道动力障碍的患病率较高(p=0.005)，症状指数阴性的比例较高(p=0.000)。多因素回归分析显示，伴有FD症状、EGJ增大和负SI是NERD患者PPI失败的独立危险因素。结论与推断在HRM中，近一半的PPI失败患者存在食道动力障碍。NERD患者PPI失败的独立危险因素是伴随的FD症状、EGJ增大和阴性SI。
BackgroundApproximately one‐third of gastroesophageal reflux disease (GERD) patients have symptoms resistant to proton pump inhibitor (PPI). We used the high‐resolution manometry (HRM) and multichannel intraluminal impedance‐pH (MII‐pH) monitoring to investigate potential predictors of PPI failure in non‐erosive reflux disease (NERD) patients.MethodsOne hundred and seventeen NERD patients were included, within which there were 44 PPI failure patients. The symptomatic questionnaire GerdQ, HRM and 24‐hour MII‐pH monitoring were performed before PPI therapy. PPI failure was defined as persistent reflux symptoms for more than 1 day during the last week on esomeprazole (20 mg twice daily) for continuous 4 weeks. The predictors for PPI failure were investigated by multivariable logistic regression analysis.Key ResultsProton pump inhibitor failure patients had lower body mass index (BMI) and more concomitant functional dyspepsia (FD) symptoms. PPI failure patients had a higher percentage of type I esophagogastric junction (EGJ) morphology (p= 0.005), increased EGJ augmentation (p= 0.000), higher prevalence of esophageal motility disorders (p= 0.005) and a higher ratio of negative symptom index (SI,p= 0.000). Multivariable regression analysis showed that concomitance of FD symptoms, EGJ augmentation and negative SI were independent risk factors for PPI failure in NERD.Conclusions & InferencesApproximately half of PPI failure patients were found to have esophageal motility disorders in HRM. The independent risk factors for PPI failure in NERD were concomitant FD symptoms, increased EGJ augmentation and negative SI.