24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease: Analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis

AIM: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). METHODS: 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age χ = 20.78 ± 17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups. RESULTS: 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting > 5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed. CONCLUSION: 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.

Esophageal manometry and 24-hour pH monitoring in esophagus surgery:28-year Chinese experience in a single center

Objective To retrospectively review the experience of esophageal manometry and 24-hour pH monitoring in e-sophagus surgery. Methods From 1982 to 2010,patients with unspecific chest pain and undergone esophageal surgery were received esophageal manometry and 24-hour pH monitoring. Results Among the patients with

Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

AIM: To determine the gastroesophageal refl uxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) f indings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS f indings as a predictor of gastroesophageal refl ux (GER). METHODS: In 45/500 patients, refl uxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduo denoscopy (EGD), 24-h pH monitoring and manometry. RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal refl ux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no refl ux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F refl ux-negatives with HSE (n = 18), and Groups A + F refl ux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry fi ndings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid refl ux and/or pathologic manometry fi nding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PRbetween Groups B + D and E (AUC = 0.775, P = 0.015). CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.

食管测压联合食管24 h pH监测对胃食管反流相关性胸痛的诊断价值

目的探讨食管测压联合食管24 h pH监测对胃食管反流相关性胸痛的诊断价值。方法选取通辽市医院2017年6月至2021年12月接收的疑似胃食管反流引起的相关性胸痛患者145例,男92例,女53例,采用食管测压联合食管24 h pH进行监测,以是否胃食管反流分为胃食管反流组与无反流组。收集两组患者的年龄、性别、蠕动收缩百分数、pH<4反流次数、最长反流持续时间等资料,采用t、χ2检验进行统计比较,通过多因素logistic回归分析、受试者工作特征曲线(ROC)分析上述指标与胃食管反流相关性胸痛的相关性。结果145例疑似胃食管反流相关性胸痛患者,经诊断为胃食管返流36例,无返流109例。经多因素logistic回归分析发现,蠕动收缩百分数、pH<4反流次数、最长反流持续时间均是胃食管反流引起的相关性胸痛的影响因素[比值比(OR)=3.155、2.998、3.459,P=0.003、0.012、0.001]。经ROC分析,食管测压、pH<4反流次数、最长反流持续时间联合预测胃食管反流引起的相关性胸痛的灵敏度与曲线下面积(AUC)均高于各指标单独预测时(P=0.001、0.001、0.004),联合预测的特异度与各指标单独预测时差异无统计学意义(P=0.852)。结论食管测压联合食管24 h pH监测对于胃食管反流引起的相关性胸痛的诊断、治疗具有重要意义,值得临床推广应用。

Prevalence of overweightedness in patients with gastro-esophageal reflux

AIM: To evaluate whether the prevalence of overweight and obese conditions is increased in gastro-esophageal reflux disease (GERD) patients (with 24-h pathological pH recordings) in comparison to general population. METHODS: A total of 196 consecutive patients (103 females, age range 18-83 years) with symptoms of gastro-esophageal reflux (GER) and 24-h pathological esophageal pH-metry. Body mass index (BMI) of the patients was calculated and its distribution (%) was compared with that of the Italian general population as assessed by National Bureau of Census (ISTAT). To evaluate the association of GERD with weight categories, the binomial test was employed. P < 0.05 was considered statistically significant. RESULTS: In males, overweightedness (BMI 25-25.9) was present in 43% of GERD patients vs 41.8% of Italian population (IP) (ns), obesity (BMI ≥ 30) in 10.9% vs 9.1% (ns). In females overweight was present in 34.9% of GERD patients vs 25.7% of IP (P < 0.01), obesity in 13.6% of GERD patients vs 9.1% of IP (P < 0.01). No statistically significant differences were noted in different age classes. CONCLUSION: In comparison to the Italian general population, the prevalence of overweightedness and obesity is increased in female but not in male patients with ascertained gastro-esophageal reflux disease.

Can pH Monitoring Predict Gastric Emptying Measured by ¹³C-Acetate Breath Test in Gastroesophageal Reflux with Neurological Impairment?

Introduction: Delayed gastric emptying (DGE) often occurs in patients with gastroesophageal reflux (GER) due to neurological impairment (NI). 13C has been used as an alternative tool for measuring the gastric emptying rates. The aim of this study was to predict gastric emptying in children with GER using 13C-acetate breath test (ABT) by 24-hour pH monitoring. Methods: Nineteen patients were divided into 2 groups: a DGE group with NI (14 patients), and normal-emptying group without NI (5 patients). The liquid test meal consisted of RacolTM (5 ml/kg) mixed with 13C-acetate (50 mg for infants, 100 mg for children, and 150 mg for adolescents). 13CO2 was measured using a gas chromatograph-isotope ratio mass spectrometer. The results are expressed as the % of 13C expired per hour and cumulative 13C excretion over a 3-hour periods including the parameters of half excretion and lag time. Results: The mean half excretion time was 1.762 hour in the DGE group and 1.095 hour in the normal-emptying group (P = 0.0196). The mean lag time was 0.971 hour in the DGE group and 0.666 hour in the normal-emptying group (P = 0.0196). Therefore, DGE was significantly more prevalent in the DGE compared to the normal-emptying group. The percentage of the time when the pH was less than 4 on 24-hour esophageal pH monitoring was 21.6% ± 9.2% in the DGE group and 28.5% ± 11.6% in the normal-emptying group (P = 0.4634). Conclusion: The percentage of time when the pH is less than 4 on 24-hour pH monitoring cannot predict DGE measured by the 13C-ABT in GER.

不同平面胃食管吻合术后食管腔内24小时pH监测

目的为了解食管癌、贲门癌切除术后胃食管在颈部、弓上和弓下吻合术后发生胃食管反流的差异。方法对１０例正常人和３０例在３个不同平面作胃食管吻合的患者术后１～３月进行残留食管腔内连续２４小时ｐＨ监测。结果（１）食管癌、贲门癌患者术后无论吻合平面位于何处，术后近期内２４小时食管腔内ｐＨ各项监测指标均高于正常（Ｐ＜０．０１）；（２）２４小时总反流次数在３个不同吻合平面吻合术间无差异（Ｐ＞０．０５）；（３）其余监测指标颈部吻合＞弓上吻合＞弓下吻合（Ｐ＜０．０１）。结论食管癌、贲门癌患者术后普遍存在胃食管反流现象。吻合平面越高，反流越严重。降低吻合平面，缩小胸胃体积有利于减少术后反流，提高生活质量。

24h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH<4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值<4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流(GER)28例(占49.1%);有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义(P<0.05)。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。

和胃降逆法对反流性食管炎患者24h食管pH的影响

[目的]观察应用和胃降逆法治疗反流性食管炎,24h食管pH监测的变化情况。[方法]将60例反流性食管炎(RE)患者随机分为对照组(30例)和治疗组(30例),对照组给予西医治疗,治疗组给予中医和胃降逆法治疗,分别观察两组治疗前后24h食管pH监测的变化情况。[结果]在减低食管黏膜24h pH<4总次数、pH<4总时间、pH<4百分时间以及Demeester积分等方面,西医治疗与中医和胃降逆法对于反流性食管炎患者的作用相当;中医和胃降逆法对于食管黏膜24h最长反流持续时间的减低较西医治疗更为显著,西医治疗对于反流时间持续≥5min次数的减低较中医和胃降逆法更为显著。[结论]和胃降逆法能够有效降低食管pH值,治疗反流性食管炎疗效确切。

多通道阻抗联合24 h食管pH监测在胃食管反流病中的应用

目的探讨多通道阻抗联合24 h pH监测在胃食管反流病(gastroesophageal reflux disease,GERD),尤其在pH(-)GERD患者中的应用价值。方法 48例GERD患者应用多通道阻抗联合24 h pH监测,根据Demeester评分分为pH(-)与pH(+),其中pH(-)GERD 30例,pH(+)GERD 18例;另相同监测健康大学生志愿者20例做正常对照组。结果 GERD组酸反流次数、卧位食团暴露时间及总食团暴露时间均高于正常对照组,差别有统计学意义(P=0.01,P=0.002,P=0.03);GERD组非酸反流次数低于正常对照组,差别有统计学意义(P=0.002)。pH(-)GERD组卧位食团暴露时间高于正常对照组(P=0.015),pH(-)GERD酸反流次数及卧位食团暴露时间均低于pH(+)GERD,差别有统计学意义(P=0.02,P=0.04)。结论多通道阻抗联合24 h pH监测能发现更多的反流事件,在GERD尤其对pH(-)GERD患者的诊断有实用意义,需进一步研究。

食管动力学及24小时食管pH监测在胸痛诊断中的意义

目的 探讨食管动力学、2 4小时食管 p H及 2 4小时动态心电图监测对反复发作性胸痛的诊断价值。方法 对 4 6例反复发作胸痛的患者进行食管动力学检测、2 4小时食管 p H及 2 4小时动态心电图监测 ,根据检查结果 ,给予相应治疗 ,并观察近期效果。 结果 4 6例患者中发现非特异性食管功能障碍 2 4例 ,其中伴有胃食管反流 14例、心肌缺血 4例 ;贲门失弛缓症 5例 ,其中伴有胃食管反流 1例 ;弥漫性食管痉挛 4例 ,其中伴有胃食管反流 4例、心肌缺血 2例 ;胡桃夹食管 (nutcracker esophagus) 1例。 结论 对反复发作性胸痛患者联合食管测压、2 4小时食管 p H和 2 4小时动态心电图监测有助于食管源性及心源性胸痛的诊断 ,而且对其鉴别诊断亦有帮助。

糖尿病患者食管和胃24小时pH动态监测及临床意义

目的 了解糖尿病患者食管酸碱反流情况及胃内ｐＨ变化，探讨其诊断胃、食管分泌及运动障碍的临床意义。方法 采用便携式２４小时ｐＨ动态监测仪，对３４例２型糖尿病患者进行非卧床食管和胃２４小时ｐＨ动态监测，对食管反流的６项ｐＨ指标综合分析，并与４０例正常人进行比较。结果 糖尿病组食管酸反流的６项指标及总计分明显高于对照组（Ｐ＜ ０．００１）。食管碱反流及胃内２４小时各项ｐＨ指标与对照组相比无显著性差异（Ｐ＞ ０．０５）。结论 ７１．４％ 的２型糖尿病患者有异常的胃、食管反流（ＧＥＲ）。

哮喘和慢阻肺急性加重期食管24小时pH监测

应用食管24小时动态监测仪对哮喘发作期和慢性阻塞性肺疾病（慢阻肺）急性加重期进行研究。其中哮喘发作期（A组）23例，慢阻肺急性加重期（B组）20例，正常对照组（C组）10例。对其中12例并发GER的病人应用雷尼替丁和奥美拉唑治疗前后进行24小时pH监测。结果：24小时食管pH＜4的总时间百分丰，pH＜4的立位总时间百分率，pH＜4的卧位急时间百分率，反流≥5分钟的次数，最长反流持续时间pH＜4的反流次数以及总计分，A、B两组均显著高于对照组（P＜0．01），而且A组显著高于B组。以总计分＞16．7为判断标准，A组GER发生率87％，B组70％。pH＜4的发作时间与哮喘发作呈正相关（γ-0．602，P＜0．005），总计分与哮喘病情严重度呈正相关关系（γ=0．537，P＜0．01）。伴有GER的病人经雷尼替丁（8例）和奥美拉唑（4例）治疗2周后，24小时食管pH各项指标基本正常（P＜0．01）。结论：哮喘和慢阻肺急性加重期GER发生率显著升高，宜常规进行食管24小时pH监测，如发现GER，及时应用H2受体拮抗剂或质子泵抑制剂治疗，两者均是治疗GER的有效药物。

24h食管pH值监测胃食管反流的临床分析

目的 分析24h食管pH值监测胃食管反流的临床价值.方法 回顾性分析2009年7月～2013年12月在本科就诊,可疑胃食管反流的患儿507例,给予24 h食管pH值监测,分析监测结果.结果 反复呕吐254例,喘息134例,反复咳嗽117例,重症肺炎72例,胸痛、胸闷11例,其他13例.随着年龄的增长胃食管反流发生率降低,年龄越小,重度胃食管反流的比例越高.结论 24h食管pH值监测应用广泛,涉及多个系统疾病,具有重要的临床价值.

胃食管反流性咳嗽患者24h食管pH值检测的特点

目的：分析与探究对胃食管反流性咳嗽患者24 h食管pH值监测的特点。方法：对疑似患有胃食管反流性咳嗽的60例患者进行24 h的食管pH检测。采用Demeester积分≥14.72和/或反流与咳嗽的症状相关概率SAP≥75%为判断标准进行相关分析,并针对监测异常的患者进行相关促进胃动力以及抗酸治疗3周～3个月。结果：经过24 h的pH值监测后,结果无异常患者15例,异常患者45例,其中经过相关治疗3～4周咳嗽症状无缓解者10例,其可能为剧烈咳嗽所致的恶心反流,3个月后5例患者咳嗽症状减缓不明显,经分析可能为胆汁反流所致,30患者咳嗽症状基本得以控制。结论：胃食管反流性咳嗽患者24 h食管pH值检测对由于胃食管反流所致咳嗽的诊断具有重要的意义。

24h食管pH及胆红素监测在胃食管反流诊治中的应用

目的:探讨酸、胆汁与反流症状、消化不良症状、消化道以外的症状间关系以及24h食管pH和/或胆红素监测在新型术式客观评价中的作用。方法:应用24h食管pH及胆红素监测方法对68例有典型反流症状者,50例有消化不良症状者,20例咽部不适及哮喘,32例食管贲门癌不同术式患者进行监测。结果:①68例有典型反流症状者发生反流占95.5%,而在50例有消化不良症状如有反胃、上腹饱胀、嗳气等而无典型反流症状者中发生反流占72%。②典型酸反流症状者中混合反流占51.4%,即发生反流者中有一半为酸和胆汁反流同时存在。③24h食管pH监测,结果提示保留贲门的食管癌根治间置结肠代食管术治疗的患者发生酸反流者明显少于经典式食管癌根治术治疗者(29.4%vs66.7%,P<0.05)。结论:24h食管pH及胆红素监测为临床诊断胃食管反流或十二指肠胃食管反流的存在提供了客观依据,为食管癌根治新术式的评价提供客观依据。

24小时食管pH监测对胃食管反流病的诊断意义研究

目的探讨24h食管pH值与胃食管反流之间的关系,为临床诊治胃食管反流病提供科学依据。方法用CTD-synectics公司便携式动态pH监测仪,对52例有胃食管反流症状者进行24h食管pH监测。采用Johson和DeMeester6种参数指标,对患者进行综合评分以反映病人的反流程度。结果监测病例组6种参数指标均显著高于对照组(P<0.01);DeMeester评分>14.72,总阳性率为57.7%;以pH<4的反流次数诊断阳性率最高(57.7%),卧位pH<4的总时间诊断阳性率最低(15.4%)。结论24h食管pH监测给反流性疾病的诊断和药物治疗提供了依据,提高了对胃食管反流疾病的认识和治疗效果。

胃食管反流病24小时食管pH监测分析

目的探讨24小时食管pH的监测对胃食管反流的诊断价值及内镜阴性患者是否存在反流。方法对95例有胃食管反流症状者进行24小时pH监测,根据检测结果,分析得出Johnson DeMeester计分。用pH<4.0的总时间百分比J、ohnson DeMeester计分进行分析。结果食管黏膜酸暴露pH<4.0的总时间百分比越长J、ohnson DeMeester计分越高,临床症状及食管炎程度就越重;Johnson DeMeester计分内镜阳性(食管炎)组明显高于内镜阴性组(P<0.05)内镜阴性组食管黏膜酸暴露异常仅为36.59%(15/41)。结论食管炎患者有明显的胃食管反流,且反流症状的发生、程度、镜下食管炎表现与食管酸反流密切相关,部分内镜阴性患者反流症状的发生不伴有酸反流。

老年人食管24h pH监测分析

目的探讨老年人食管酸暴露情况并与其他人群进行对照比较,以了解老年人食管酸反流的特点及其临床意义。方法采用便携式24 h pH动态监测仪对31例老年人进行食管24 h pH监测,并与40例其他人群进行对照比较。结果老年人组24 h食管酸暴露的6项pH指标中有4项与对照组差异有统计学意义(P<0.05)。95%分布范围中,立位pH<4的总时间(%)和pH<4的反流次数的指标两组较为接近,余4项指标老年组数值均高于对照组。总计分老年组为14.9,高于对照组(12.7)。结论老年人组食管酸暴露多项指标高于对照组,提示可能与老年人食管运动功能和清除酸的能力下降以及食管下端括约肌(LES)功能较年轻人减弱有关。

24h动态PH监测在支气管哮喘合并胃食管反流病的临床研究

目的探讨24 h动态PH监测在支气管哮喘合并胃食管反流病(GERD)的诊断价值。方法纳入支气管哮喘患者32例(A组),GERD患者40例(B组),支气管哮喘合并GERD患者32例(C组),对3组患者行24 h食管p H监测,记录胃酸反流的总次数,总计、立位、卧位p H<4的百分比,并行食管测压。结果C组及B组近段、中段远端的食管体部压力低于A组;A组食管括约肌静息压力、蠕动波传导速度高于C组及B组,反流频数C组低于其他两组;A组酸反流总次数,总计、立位、卧位p H<4的百分比和De Meester评分均少于C组及B组。结论 24 h动态PH监测能发现更多的反流时间,卧位p H<4百分比及反流频数是重要的参考指标。