Tailored therapy for the refractory GERD patients by combined multichannel intraluminal impedance-pH monitoring
Tailored therapy for the refractory GERD patients by combined multichannel intraluminal impedance-pH monitoring
复制标题
多通道管腔内阻抗-pH联合监测为难治性GERD患者量身定制治疗
DOI：
10.1111/jgh.13049
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Chen M
中科院分区：
文献类型：
--
作者：
Xiao Y;Liang M;Peng S;Zhang N;Chen M
背景与目的质子泵抑制剂（PPI）治疗无效的胃食管反流病（GERD）患者约占30%。很少研究亚洲GERD患者PPI失败的原因，治疗方法仍不清楚。目的是探讨PPI失败的可能原因，并治疗这些患者的指导下，24小时多通道腔内阻抗-pH值（MII-pH）monitoring. MethodsThirty-nine连续难治性GERD患者入组; 24小时MII-pH监测进行PPI。MII‐pH监测后，将难治性GERD患者分为胃酸过度、非胃酸反流和功能性胃灼热。PPI或帕罗西汀的双重剂量给药难治性GERD患者在不同组resultsThe组的酸过度，非酸反流，功能性胃灼热的患者人数分别为6，12，和21。胃酸过多组的胃酸反流事件最多。酸过量组中，5例（5/6）患者用双倍剂量埃索美拉唑缓解症状。非酸反流组患者，双倍剂量埃索美拉唑使一半（6/12）患者症状缓解。功能性烧心组21例患者中，帕罗西汀治疗后14例症状缓解。总的来说，在MII‐pH监测的指导下，64.1%（25/39）的难治性GERD患者完成了症状缓解。ConclusionsAcid overexpansion，非酸反流，功能性烧心是持续反流症状的常见原因，尽管PPI。在MII‐pH的指导下，定制治疗可以解决三分之二患者的持续反流症状。
Background and AimsAbout 30% of patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI). The reason for the PPI failure in Asian GERD patients has rarely been studied, and the therapy remained unclear. The aims were to explore the possible reasons for PPI failure and to treat these patients with the guidance of 24‐h multichannel intraluminal impedance‐pH (MII‐pH) monitoring.MethodsThirty‐nine consecutive patients with refractory GERD were enrolled; 24‐h MII‐pH monitoring was performed on PPI. The refractory GERD patients were grouped into acid overexposure, non‐acid reflux, and functional heartburn after the MII‐pH monitoring. Double dose of either PPI or paroxetine was administered to refractory GERD patients within different groups.ResultsThe number of patients in groups of acid overexposure, non‐acid reflux, and functional heartburn was 6, 12, and 21, respectively. The acid overexposure group had the most acid reflux events. Among the acid overexposure group, five (5/6) patients accomplish symptom relief with double dose of esomeprazole. For the patients in non‐acid reflux group, double dose of esomeprazole made half (6/12) of the patients obtain symptom relief. For the patients in functional heartburn group, the paroxetine had relieved the symptoms in 14 patients among all the 21 patients. In total, with the guidance of MII‐pH monitoring, 64.1% (25/39) of refractory GERD patients accomplished symptom relief.ConclusionsAcid overexposure, non‐acid reflux, and functional heartburn were the common reasons for persistent reflux symptoms despite PPI. With the guidance of MII‐pH, a tailored therapy could resolve the persistent reflux symptoms among two‐third of patients.