Gastroesophageal and pharyngeal reflux detection using impedance and 24-hour pH monitoring in asymptomatic subjects: Defining the normal environment
Gastroesophageal and pharyngeal reflux detection using impedance and 24-hour pH monitoring in asymptomatic subjects: Defining the normal environment
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DOI：
10.1016/j.gassur.2005.09.005
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Cuenca-Abente, F
中科院分区：
文献类型：
--
作者：
Oelschlager, BK;Quiroga, E;Cuenca-Abente, F
呼吸道症状通常是由于吸入反流物质进入喉部引起的。在这项研究中，我们试图用腔内阻抗来定义正常受试者中反流内容物的频率、特征和近端程度，包括非酸性反流，以提高我们对反流和误吸之间关系的理解。10名没有胃食管反流病或气道疾病症状的受试者，使用导管进行阻抗/pH监测，允许同时监测食管和咽部。在240小时的研究中，阻抗在10名受试者中检测到496次胃食管反流发作。大多数，399例（占总数的81%）为胃酸反流发作（pH < 4）。97种为非酸性（pH为bbbb4）。大多数反流发作（496例中有348例）到达食管中部（食管下括约肌上方9厘米）。51例反流发作到达咽部（PR）。只有13例（25%）PR为酸性（pH < 4）， 38例为非酸性。26例为液体PR， 25例为混合PR（液体和气体）。阻抗测量的PR发作中位数为5（0-10）。在无症状的患者中，大多数胃食管反流发作呈酸性并到达食管中部。胃食管反流似乎比以前认为的更常见，而且大多数这种情况不是酸性的。因此，传统的24小时pH监测可能低估了咽反流的存在。阻抗与pH监测的结合显著提高了我们准确检测潜在微吸的能力。
Airway symptoms are often caused by aspiration of refluxed materials into the larynx. In this study we sought to define the frequency, character, and proximal extent of refluxed contents - including nonacid reflux-in normal subjects using intraluminal impedance to improve our understanding of the relationship between reflux and aspiration. Ten subjects, who had no symptoms of gastroesophageal reflux disease or airway disease, underwent impedance/pH monitoring with a catheter that allowed simultaneous esophageal and pharynygeal monitoring. Impedance detected 496 gastroesophageal reflux episodes in the 10 subjects during 240 hours of study. The majority, 399 (81% of the total) were acid reflux episodes (pH < 4). Ninety-seven were nonacid (pH > 4). Most reflux episodes (348 of 496) reached the mid esophagus (9 cm above lower esophageal sphincter). There were 51 reflux episodes that reached the pharynx (PR). Only 13 (25%) of PR were acidic (pH < 4), while 38 were nonacid. Twenty-six PR episodes were liquid and 25 were mixed (liquid and gas). The median number of PR episodes measured with impedance was 5 (0-10). In asymptomatic subjects, most episodes of gastroesophageal reflux are acidic and reach the midesophagus. Reflux into the PR appears to be more common than previously believed, and most of these episodes are not acidic. Thus, traditional 24-hour pH monitoring may underestimate the presence of pharyngeal reflux. The combination of impedance with pH monitoring markedly enhances our ability to accurately detect potential microaspiration.