Pathogenesis of Potassium-Competitive Acid Blocker-Resisitant Non-Erosive Reflux Disease
Pathogenesis of Potassium-Competitive Acid Blocker-Resisitant Non-Erosive Reflux Disease
复制标题
钾竞争性酸阻滞剂耐药性非糜烂性反流病的发病机制
作者：
Kawami N;Hoshino S;Hoshikawa Y;Takenouchi N;Umezawa M;Hanada Y;Kaise M;Iwakiri K
本研究探讨了钾竞争酸阻滞剂（P-CAB）抗性非糜烂性反流病（NERD）的发病机制。方法本研究纳入43例尽管给予P-CAB，但仍有持续反流症状的NERD患者。在排除嗜酸性粒细胞性食管炎和原发性食管运动障碍后，进行食管阻抗- ph监测。在症状指数（SI）阳性的患者中，根据有无幽门螺杆菌感染，观察SI阳性的发生机制及胃内pH为bb0 4、食管pH< 4的时间百分比。结果43例患者中有1例（2.3%）存在原发性食管运动障碍（Jackhammer食管）。18例（41.9%）和3例（7%）患者分别为液体和气体反流si阳性，其余21例si阴性患者（48.8%）有功能性胃灼热。所有患者液体反流si阳性，弱酸性反流si阳性。无论是否存在幽门螺杆菌感染，P-CAB都能充分抑制胃酸。结论51%的耐p - cab耐药的NERD患者的发病机制已被阐明。所有液体反流si阳性患者的症状均与弱酸性反流相关，且与酸性反流相关的症状可通过给予P-CAB排除。
BackgroundThe present study examined the pathogenesis of potassium-competitive acid blocker (P-CAB)-resistant non-erosive reflux disease (NERD).MethodsForty-three patients with NERD, who had persistent reflux symptoms despite the administration of P-CAB, were included in this study. After excluding eosinophilic esophagitis and primary esophageal motility disorders, esophageal impedance-pH monitoring was performed. In symptom index (SI)-positive patients, the mechanism of SI-positivity and percent time with intragastric pH> 4 and with esophageal pH< 4 were investigated according to the presence or absence of Helicobacter pylori infection.ResultsOne (2.3%) of 43 patients had a primary esophageal motility disorder (Jackhammer esophagus). Eighteen (41.9%) and 3 (7%) patients were SI-positive for liquid and gas-only reflux, respectively, and the remaining 21 patients who were SI-negative (48.8%) had functional heartburn. All patients SI-positive for liquid reflux were SI-positive for weakly acidic reflux. Gastric acid was sufficiently suppressed by P-CAB, regardless of the presence or absence of H. pylori infection.ConclusionsThe pathogenesis of P-CAB-resistant NERD was elucidated in 51% of patients. Symptoms in all patients SI-positive for liquid reflux were related to weakly acidic reflux, and symptoms related to acid reflux may be ruled out by the administration of P-CAB.