GERD phenotypes from pH-impedance monitoring predict symptomatic outcomes on prospective evaluation.
GERD phenotypes from pH-impedance monitoring predict symptomatic outcomes on prospective evaluation.
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DOI：
10.1111/nmo.12745
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发表时间：
2016-04
影响因子：
3.5
通讯作者：
Gyawali CP
中科院分区：
文献类型：
--
作者：
Patel A;Sayuk GS;Kushnir VM;Chan WW;Gyawali CP
ph -阻抗监测的反流参数组合（酸暴露时间，AET；症状关联概率，SAP）描述了反流证据的不同置信度。我们比较了具有不同预先确定的反流参数的表型之间的结果。在这项观察性队列研究中，与两个历史机构pH监测队列相比，接受5年pH阻抗测试的患者通过反流证据强度分为强（AET异常，SAP阳性）、好（AET异常，SAP阴性）、反流超敏（RH， AET正常，SAP阳性）和反流证据模糊。在基线和前瞻性随访时通过问卷评估症状负担（显性症状强度，DSI；总体症状严重程度，GSS），并比较表型之间的差异。在94名未接受PPI治疗的患者中，有强烈反流证据的基线症状负担最高，有不明确证据的基线症状负担最低（各组间DSI: p=0.01; GSS: p=0.03）。在3.1±0.2年的随访后，手术或药物治疗的症状改善在有力或良好的证据下最高，在模棱两可的情况下最低（各组间DSI: p=0.008; GSS: p=0.005）。这在典型症状中最为明显（DSI: p=0.001；各组间GSS: 0.016），但不典型症状（DSI: p=0.6; GSS: p=0.2）。对于PPI治疗的测试，只有GSS遵循类似的趋势（GSS: p=0.057, DSI: p=0.3）。与仅监测pH值的历史队列相比，RH部分替代了反流的模棱两可证据，特别是PPI （p<0.0001）。通过PPI的ph阻抗测试的反流证据强度对GERD进行表型分析，可以有效地对症状结果进行分层，特别是对于典型症状，并且可以用于计划管理。
Combinations of reflux parameters (acid exposure time, AET; symptom association probability, SAP) on pH-impedance monitoring describe varying confidence in reflux evidence. We compared outcomes between phenotypes with distinct pre-identified reflux parameters. In this observational cohort study, patients undergoing pH-impedance testing over a 5-year period were phenotyped by strength of reflux evidence as strong (abnormal AET, positive SAP), good (abnormal AET, negative SAP), reflux hypersensitivity (RH, normal AET, positive SAP), and equivocal evidence of reflux, and compared to two historical institutional pH monitoring cohorts. Symptom burden (dominant symptom intensity, DSI; global symptom severity, GSS) was assessed by questionnaire at baseline and on prospective follow-up and compared between phenotypes. Of 94 patients tested off PPI therapy, baseline symptom burden was highest with strong reflux evidence and lowest when equivocal (DSI: p=0.01; GSS: p=0.03 across groups). After 3.1±0.2 years follow-up, symptomatic improvement with surgical or medical therapy was highest with strong or good evidence, and lowest when equivocal (DSI: p=0.008; GSS: p=0.005 across groups). This was most pronounced for typical symptoms (DSI: p=0.001; GSS: 0.016 across groups), but not atypical symptoms (DSI: p=0.6; GSS: p=0.2). For testing on PPI therapy, only GSS followed a similar trend (GSS: p=0.057, DSI: p=0.3). Compared to historical cohorts with pH monitoring alone, equivocal evidence for reflux was partly replaced by RH, especially off PPI (p<0.0001). Phenotyping GERD by strength of reflux evidence on pH-impedance testing off PPI efficiently stratifies symptomatic outcome, especially for typical symptoms, and could be useful in planning management.