Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux.
Majority of symptoms in esophageal reflux PPI non-responders are not related to reflux.
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DOI：
10.1111/nmo.12666
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发表时间：
2015-11
影响因子：
3.5
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Roman S;Keefer L;Imam H;Korrapati P;Mogni B;Eident K;Friesen L;Kahrilas PJ;Martinovich Z;Pandolfino JE
质子泵抑制剂（PPI）治疗后持续性胃食管反流症状的发生机制尚不完全清楚。我们的目的是确定24小时pH值阻抗监测PPI和相关的阻抗模式和PPI无应答者的症状发生的反流模式。78例PPI无应答患者接受了24小时PPI pH阻抗监测。反流阻抗表征包括胃和胃上打嗝和近端反流程度。如果症状发生在反流事件后5分钟内，则认为与反流相关。将患者分为3组：持续性酸反流（酸食管暴露（AET）>5%的时间）、反流敏感性（AET<5%，症状指数（SI）≥50%）和功能性症状（AET<5%，SI<50%）。确定每例患者的主要阻抗模式。7例（9%）患者存在持续性酸反流，28例（36%）患者存在反流敏感，43例（55%）患者存在功能性症状。共确定了4，296起反流事件（每例患者的中位数为45（范围4-221））。虽然液体反流是所有组中最常见的模式，但具有反流敏感性和功能性症状的患者的模式特征具有更大的变异性，其中很大一部分与胃和胃上打嗝相关。只有417例反流事件（9.7%）与症状相关。胃上成分和近端程度的反流更可能与症状相关。PPI无应答者的阻抗反流特征不均匀，大多数反流事件与症状无关。因此，PPI无应答者的治疗应侧重于反流以外的机制，如内脏高敏感性和过度警觉。
Genesis of persistent gastro-esophageal reflux symptoms despite proton pump inhibitor (PPI) therapy is not fully understood. We aimed at determining reflux patterns on 24-h pH-impedance monitoring performed on PPI and correlating impedance patterns and symptom occurrence in PPI non-responders. 78 PPI non-responder patients underwent 24-h pH-impedance monitoring on PPI. Reflux impedance characterization included gastric and supragastric belches and proximal extent of reflux. Symptoms were considered associated with reflux if occurring within 5 min after a reflux event. Patients were classified into 3 groups: persistent acid reflux (acid esophageal exposure (AET) >5% of time), reflux sensitivity (AET<5%, symptom index (SI) ≥50%), and functional symptoms (AET<5%, SI<50%). Dominant impedance pattern was determined for each patient. 7 patients (9%) had persistent acid reflux, 28 (36%) reflux sensitivity and 43 (55%) functional symptoms. A total of 4,296 reflux events were identified (median per patient 45 (range 4–221)). Although liquid reflux was the most common pattern in all groups, patients with reflux sensitivity and functional symptoms had much more variability in their pattern profile with a large proportion being associated with gastric and supra-gastric belching. Only 417 reflux events (9.7%) were associated with symptoms. Reflux with a supragastric component and proximal extent were more likely to be associated with symptoms. The impedance reflux profile in PPI non-responders was heterogeneous and the majority of reflux events were not associated with symptoms. Thus, the treatment of PPI non-responders should focus on mechanisms beyond reflux, such as visceral hypersensitivity and hypervigilance.