Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease
Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease
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DOI：
10.5056/jnm14038
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发表时间：
2014-10-01
影响因子：
3.4
通讯作者：
Al-Ashgar, Hamad
中科院分区：
文献类型：
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作者：
Khan, Mohammed Q.;Alaraj, Ali;Al-Ashgar, Hamad
背景/目的大约三分之一的非糜烂性反流病（NERD）患者对质子泵抑制剂（PPI）难以治疗，并且面临治疗挑战。因此，利用多通道腔内阻抗- ph （MII-pH）来区分病理性和非病理性反流是很重要的，以分析症状-反流的相关性，并诊断真正的NERD与超敏性食管（HE）和功能性胃灼热（FH）。在此，我们评估了MII-pH对难治性NERD的诊断率，并根据酸/非酸反流和反流症状关联的数量和质量对其进行了分类。方法对60例有症状的NERD患者，应用每日2次PPI治疗1 ~ 2个月，采用MII-pH进行前瞻性评价。测量远端和近端反流、剂量暴露时间（BET）、食道酸暴露时间、症状指数（SI）和症状关联概率（SAP）。结果32例（53%）患者BET < 1.4% (MII-pH阳性-真NERD)， 28例（47%）患者BET < 1.4% (MII-pH阴性NERD)，其中SI和SAP在15/60（25%，归类为FH）中呈阴性，SI或SAP在13/60（22%，归类为HE）中呈阳性。38例（63%）患者报告了显著的SI或SAP参数，其中bbb80 %的症状与非酸反流相关。真正的NERD与FH或HE的远端反流数量有显著差异，但FH和HE之间无显著差异。结论：大约60%的难治性PPI NERD患者出现反流症状阳性，主要是由于非酸反流。近一半的接受PPI治疗的NERD患者MII-pH监测正常，进一步细分为FH和HE。
Background/AimsApproximately one-third of non-erosive reflux disease (NERD) patients are refractory to proton pump inhibitors (PPI) and face a therapeutic challenge. Therefore, it is important to differentiate between pathological and non-pathological reflux utilizing multichannel intraluminal impedance-pH (MII-pH) to analyze symptom-reflux association and diagnose true NERD versus hypersensitive esophagus (HE) and functional heartburn (FH). Herein, we evaluated the diagnostic yield of MII-pH in refractory NERD and sub-classified it based on quantity and quality of acid/non-acid reflux and reflux-symptom association.MethodsSixty symptomatic NERD patients on twice daily PPI for > 2 months were prospectively evaluated by MII-pH. Distal and proximal refluxes, bolus exposure time (BET), esophageal acid exposure time, symptom index (SI) and symptom association probability (SAP) were measured.ResultsThirty-two (53%) patients had BET > 1.4% (MII-pH positive-true NERD), while 28 (47%) had BET < 1.4% (MII-pH negative NERD) where SI and SAP were negative in 15/60 (25%; categorized as FH) and SI or SAP were positive in 13/60 (22%; identified as HE). Thirty-eight (63%) patients reported significant SI or SAP parameters where > 80% of symptoms were associated with non-acid reflux. The number of distal refluxes in true NERD versus FH or HE were significantly different, but not between FH and HE.ConclusionsApproximately 60% of refractory PPI NERD patients had positive reflux-symptom association, primarily due to non-acid reflux. Nearly half of NERD patients on PPI had normal MII-pH monitoring, sub-divided further into FH and HE equally.