Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease.
Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease.
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DOI：
10.1111/apt.13777
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发表时间：
2016-10
影响因子：
7.6
通讯作者：
Gyawali CP
中科院分区：
文献类型：
--
作者：
Patel A;Wang D;Sainani N;Sayuk GS;Gyawali CP
平均夜间基线阻抗(MNBI)是一种新的pH阻抗指标，可作为反流负荷的替代指标。目的：评价MNBI对抗返流治疗后症状转归的预测价值。在这项前瞻性观察队列研究中，我们回顾了5年间进行的pH阻抗研究。在三个稳定的夜间10min时间段，从6个通道提取基线阻抗，并取平均值以产生MNBI。分别在3、5、7和9 cm、15和17 cm取食道远端和近端MNBI值的平均值。在内科或外科抗反流治疗后的前瞻性随访中，根据整体症状严重程度(GSS，100 mm视觉模拟评分)的变化来衡量症状结果。单变量和多变量分析评估了MNBI对症状结果的预测价值。在266例患者中，135例(50.8%)停止了PPI治疗，并形成了研究队列(52.1±1.1岁，63.7%)。酸暴露时间延长的59例患者的复合体和远端MNBI值均低于生理性酸暴露组(p<；0.0001)，但近端MNBI值相近(p=0.62)。线性AET与远端髓核指数呈显著负相关(P<0.001.0 5)，与远端髓核密度呈显著负相关(P<0.0 5)，而与近端髓核密度无关(P=0.72)。−‘s r=0，P=0.72。经过前瞻性随访(94例患者随访3.1±0.2年)，单因素和多因素回归模型显示，远端MNBI，而不是近端MNBI，是线性GSS改善的独立预测因素。远端食道MNBI与AET呈负相关，当脱离PPI治疗时，可独立预测抗反流治疗后症状的改善。
Mean nocturnal baseline impedance (MNBI), a novel pH-impedance metric, may be a surrogate marker of reflux burden. To assess the predictive value of MNBI on symptomatic outcomes after antireflux therapy. In this prospective observational cohort study, pH-impedance studies performed over a 5-year period were reviewed. Baseline impedance was extracted from 6 channels at three stable nocturnal 10-min time periods, and averaged to yield MNBI. Distal and proximal esophageal MNBI values were calculated by averaging MNBI values at 3, 5, 7, and 9 cm, and 15 and 17 cm, respectively. Symptomatic outcomes were measured as changes in global symptom severity (GSS, rated on 100-mm visual analog scales) on prospective follow-up after medical or surgical antireflux therapy. Univariate and multivariate analyses assessed the predictive value of MNBI on symptomatic outcomes. Of 266 patients, 135 (50.8%) were tested off PPI therapy and formed the study cohort (52.1±1.1 yrs, 63.7% F). The 59 with elevated acid exposure time (AET) had lower composite and distal MNBI values than those with physiologic AET (p<0.0001), but similar proximal MNBI (p=0.62). Linear AET negatively correlated with distal MNBI, both individually and collectively (Pearson's r=−0.5, p<0.001), but not proximal MNBI (Pearson's r=0, p=0.72). After prospective follow-up (94 patients followed for 3.1±0.2 yrs), univariate and multivariate regression models showed that distal MNBI, but not proximal MNBI, was independently predictive of linear GSS improvement. Distal esophageal MNBI negatively correlates with AET and, when assessed off PPI therapy, is independently predictive of symptomatic improvement following antireflux therapy.
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影响因子：
9.8
作者：
Kessing, Boudewijn F.;Bredenoord, Albert J.;Smout, A. J. P. M.
通讯作者：
Smout, A. J. P. M.
影响因子：
3.5
作者：
Patel A;Sayuk GS;Kushnir VM;Chan WW;Gyawali CP
通讯作者：
Gyawali CP
影响因子：
12.6
作者：
Kandulski, Arne;Weigt, Jochen;Malfertheiner, Peter
通讯作者：
Malfertheiner, Peter
影响因子：
7.6
作者：
Sifrim, D.;Mittal, R.;Gregersen, H.
通讯作者：
Gregersen, H.
影响因子：
12.6
作者：
Zerbib, Frank;Roman, Sabine;Mion, Francois
通讯作者：
Mion, Francois