Esophageal Intraluminal Baseline Impedance Differentiates Gastroesophageal Reflux Disease From Functional Heartburn
Esophageal Intraluminal Baseline Impedance Differentiates Gastroesophageal Reflux Disease From Functional Heartburn
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DOI：
10.1016/j.cgh.2014.11.033
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发表时间：
2015-06-01
影响因子：
12.6
通讯作者：
Malfertheiner, Peter
中科院分区：
文献类型：
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作者：
Kandulski, Arne;Weigt, Jochen;Malfertheiner, Peter
背景与目的：可以通过测量腔内基线阻抗（BI）来评估胃食管反流病（GERD）患者的粘膜完整性。然而，目前尚不清楚BI在功能性胃灼热（FH）患者中是否异常，或者是否可以用于区分他们与GERD患者。我们比较了FH和GERD患者BI的差异。方法：我们对2009年2月至2012年12月在某三级大学医院就诊的52例患者（16例男性，平均年龄55岁，范围23-78岁）进行了前瞻性研究。35例患者发生胃食管反流（19例为非糜烂性反流病[NERD]， 16例为糜烂性反流病[ERD]）， 17例为FH。所有患者均停止质子泵抑制剂治疗，然后接受食管胃十二指肠镜检查和多通道腔内阻抗和pH监测。在平卧患者食管下括约肌近3、5、7、9、15和17 cm处评估BI。在胃食管交界处以上3cm处取活检标本；进行组织学分析以识别和半定量评分（评分，0-3）扩大的细胞间隙。结果：NERD或糜烂性反流病（ERD）患者的食管远端基线阻抗显著低于FH （P = 0.0006）。在截断值小于2100 Omega时，BI测量确定GERD患者的敏感性为78%，特异性为71%，阳性和阴性预测值为75%。同样在食管近端，仅在ERD患者中发现BI水平降低。BI水平与酸暴露时间（r = -0.45; P = .0008）、酸反流发作次数（r = -0.45; P = .001）和近端程度（r = -0.40; P = .004）呈负相关。与FH患者相比，NERD或ERD患者的活检标本细胞间隙扩张明显增加；食管远端细胞间隙扩张与BI呈负相关（r = -0.28; P = 0.06）。结论：测量食管下段BI可将ERD或NERD患者与FH患者区分开来（78%的敏感性和71%的特异性），因此应考虑将其作为质子泵抑制剂难治性反流患者的诊断工具。低水平的BI与酸暴露增加和细胞间隙扩张有关，表明BI是粘膜完整性的标志。
BACKGROUND & AIMS: Mucosal integrity can be assessed in patients with gastroesophageal reflux disease (GERD) by measuring intraluminal baseline impedance (BI). However, it is not clear whether BI is abnormal in patients with functional heartburn (FH), or can be used to distinguish them from patients with GERD. We compared differences in BI between patients with FH vs GERD.METHODS: We performed a prospective study of 52 patients (16 men; mean age, 55 y; range, 23-78 y) seen at a tertiary university hospital from February 2009 through December 2012. Thirty-five patients had GERD (19 had nonerosive reflux disease [NERD], 16 had erosive reflux disease [ERD]) and 17 had FH. All patients discontinued proton pump inhibitor therapy and then underwent esophagogastroduodenoscopy and multichannel intraluminal impedance and pH monitoring. BI was assessed at 3, 5, 7, 9, 15, and 17 cm proximal to the lower esophageal sphincter in recumbent patients. Biopsy specimens were taken from 3 cm above the gastroesophageal junction; histology analysis was performed to identify and semiquantitatively score (scale, 0-3) dilated intercellular spaces.RESULTS: Baseline impedance in the distal esophagus was significantly lower in patients with NERD or erosive reflux disease (ERD) than FH (P = .0006). At a cut-off value of less than 2100 Omega, BI measurements identified patients with GERD with 78% sensitivity and 71% specificity, with positive and negative predictive values of 75%. Also in the proximal esophagus, reduced levels of BI levels were found only in patients with ERD. There were negative correlations between level of BI and acid exposure time (r = -0.45; P = .0008), number of acidic reflux episodes (r = -0.45; P = .001), and proximal extent (r = -0.40; P = .004). Biopsy specimens from patients with NERD or ERD had significant increases in dilation of intercellular spaces, compared with those from patients with FH; there was an inverse association between dilated intercellular spaces and BI in the distal esophagus (r = -0.28; P = .06).CONCLUSIONS: Measurement of BI in the lower esophagus can differentiate patients with ERD or NERD from patients with FH (78% sensitivity and 71% specificity), and therefore should be considered as a diagnostic tool for patients with proton pump inhibitor-refractory reflux. Low levels of BI are associated with increased exposure to acid and dilation of intercellular spaces, indicating that BI is a marker of mucosal integrity.