Esophageal Acid Exposure Decreases Intraluminal Baseline Impedance Levels
Esophageal Acid Exposure Decreases Intraluminal Baseline Impedance Levels
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DOI：
10.1038/ajg.2011.276
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发表时间：
2011-12-01
影响因子：
9.8
通讯作者：
Smout, A. J. P. M.
中科院分区：
文献类型：
--
作者：
Kessing, Boudewijn F.;Bredenoord, Albert J.;Smout, A. J. P. M.
目的：腔内基线阻抗水平由食管壁的电导率决定，在胃食管反流病（GERD）患者中可以降低。本研究的目的是调查胃食管反流患者、使用和停用质子泵抑制剂（PPI）以及健康对照者的基线阻抗。方法：对(i) 24例有病理性食道酸暴露的胃食管反流患者和24例无病理性食道酸暴露的胃食管反流患者进行24小时ph阻抗动态监测，同时对10名健康对照和（ii） 20例有难治性胃食管反流症状的患者进行24小时ph阻抗动态监测。评估最远端和最近端阻抗通道的基线阻抗水平。结果：生理性（2,090 (1,537-2,547)Omega）和病理性（781 (612-1,137)Omega）酸暴露的患者远端基线阻抗中位数（四分位数范围）低于对照组（2,827 (2,127-3,270)Omega, P < 0.05和P < 0.001）。24小时酸暴露时间与基线阻抗呈负相关（r = -0.7, P < 0.001）。在停用和停用PPI的患者中，停用PPI的中位远端基线阻抗显著低于使用PPI的患者（886（716- 1354）比1,372 (961-1,955)ω, P < 0.05），且这两组的远端基线阻抗显著低于健康对照组（P < 0.05和P < 0.001）。在停用PPI和使用PPI的患者之间，近端基线阻抗无显著差异（1,793（1,384-2,489）对1,893 (1,610-2,561)ω）；然而，两项测量的基线阻抗值均显著低于健康对照组（3,648 (2,815-3,932)ω， P均< 0.001）。结论：这些研究结果表明，基线阻抗与食管酸暴露有关，可能是食管黏膜反流性改变的标志。
OBJECTIVES: Intraluminal baseline impedance levels are determined by the conductivity of the esophageal wall and can be decreased in gastroesophageal reflux disease (GERD) patients. The aim of this study was to investigate the baseline impedance in GERD patients, on and off proton pump inhibitor (PPI), and in healthy controls.METHODS: Ambulatory 24-h pH-impedance monitoring was performed in (i) 24 GERD patients with and 24 without pathological esophageal acid exposure as well as in 10 healthy controls and in (ii) 20 patients with refractory GERD symptoms despite PPI, once on PPI and once off PPI. Baseline impedance levels in the most distal and the most proximal impedance channels were assessed.RESULTS: Median (interquartile range) distal baseline impedance in patients with physiological (2,090 (1,537-2,547) Omega) and pathological (781 (612-1,137) Omega) acid exposure was lower than in controls (2,827 (2,127-3,270) Omega, P < 0.05 and P < 0.001). A negative correlation between 24-h acid exposure time and baseline impedance was observed (r = -0.7, P < 0.001). In patients measured off and on PPI, median distal baseline impedance off PPI was significantly lower than on PPI (886 (716-1,354) vs. 1,372 (961-1,955) Omega, P < 0.05) and distal baseline impedance in these groups was significantly lower than in healthy controls (P < 0.05 and P < 0.001). Proximal baseline impedance did not differ significantly between the patients off PPI and on PPI (1,793 (1,384-2,489) vs. 1,893 (1,610-2,561) Omega); however, baseline impedance values in both measurements were significantly lower than in healthy controls (3,648 (2,815-3,932) Omega, both P < 0.001).CONCLUSIONS: These findings suggest that baseline impedance is related to esophageal acid exposure and could be a marker of reflux-induced changes to the esophageal mucosa.