AIM To evaluate the agreement of multichannel intraluminal impedance-p H monitoring(MII-p HM) and gastroesophageal reflux scintigraphy(GES) for the diagnosis of gastroesophageal reflux disease. METHODS Seventy-five co...AIM To evaluate the agreement of multichannel intraluminal impedance-p H monitoring(MII-p HM) and gastroesophageal reflux scintigraphy(GES) for the diagnosis of gastroesophageal reflux disease. METHODS Seventy-five consecutive patients with suspectedgastroesophageal reflux disease(GERD) underwent 24-h combined MII-p HM recording and one hour radionuclide scintigraphy during the course of the MIIpH M study. Catheters with 6 impedance channels and 1 p H sensor were placed transnasally. Impedance and p H data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index(RI, percentage of the entire record that esophageal p H is < 4.0) greater than 4.2% for p HM and number of refluxes more than 50 for 24 h for MII were accepted as positive test results. At scintigraphy, 240 frames of 15 seconds duration were acquired in the supine position. Gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen's kappa.RESULTS Sufficient data was obtained from 60(80%) patients(34 male, 56.7%) with a mean age of 8.7 ± 3.7 years(range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pH M was 22.8 ± 2.4 h(range: 16-30 h; median: 22.7 h). At least one test was positive in 57(95%) patients. According to diagnostic criteria, GERD was diagnosed in 34(57.7%), 44(73.3%), 47(78.3%) and 51(85%) patients by means of p HM, MII, GES and MII-p HM, respectively. The observed percentage agreements/κ values for GES and p HM, GES and MII, GES and MII-p HM, and MII and p HM are 48.3%/-0.118; 61.7%/-0.042; 73.3%/0.116 and 60%/0.147, respectively. There was no or slight agreement between GES and p HM alone, MII alone or MII-p HM. p H monitoring alone missed 17 patients compared to combined MII-p HM. The addition of MII to pH monitoring increased the diagnosis rate by 50%.CONCLUSION No or slight agreement was found among p H monitoring, MII monitoring, MII-pH monitoring and GES for the diagnosis of gastroesophageal reflux disease.展开更多
A recent multicenter study demonstrated that two variants of LRRK2, S1647T and R1398H, are associated with sporadic Parkinson＇s disease. The present study analyzed LRRK2 gene polymorphisms of S1647T and R1398H, demon...A recent multicenter study demonstrated that two variants of LRRK2, S1647T and R1398H, are associated with sporadic Parkinson＇s disease. The present study analyzed LRRK2 gene polymorphisms of S1647T and R1398H, demonstrating that the LRRK2 gene polymorphism S1647T variant is a risk factor for Parkinson＇s disease in a Chinese Han population. However, the R1398H variant did not influence the risk for Parkinson＇s disease. In addition, there was no difference in clinical symptoms of Parkinson＇s disease patients with various genotypes. Results showed that the LRRK2 S1647T variant was associated with an increased risk for developing early-onset Parkinson＇s disease in a Chinese Hart population. In addition, there was no correlation between LRRK2 S1647T, R1398H variants and G2385R, R1628P variants in Parkinson＇s disease patients.展开更多
We report an unexpected, previously unreported complication of Bravo p H capsule dislodgement. During Bravo p H testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visua...We report an unexpected, previously unreported complication of Bravo p H capsule dislodgement. During Bravo p H testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall after deployment. After multiple attempts to detect the capsule, it was visualized in the left pyriform sinus. As there was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for safe removal. Ultimately, ENT successfully retrieved the capsule with a foreign body removal forceps. The Bravo p H test is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications have been reported, technical difficulties can occur, including poor data reception, misplacement, and early dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to capsule aspiration. Gastroenterologists performing this procedure should be aware of the low, but nontrivial, risk of complications.展开更多
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...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。展开更多
目的:分析老年胃食管反流病患者的反流特点.方法:随机选取2011-01/2013-12在我院门诊就诊的患者28例,入组年龄为60-85岁,试验入组标准为症状符合蒙特利尔Ⅲ会议共识,反流组12例(男8例,女4例),非反流组为正常人16例(男10例,女6例).所有...目的:分析老年胃食管反流病患者的反流特点.方法:随机选取2011-01/2013-12在我院门诊就诊的患者28例,入组年龄为60-85岁,试验入组标准为症状符合蒙特利尔Ⅲ会议共识,反流组12例(男8例,女4例),非反流组为正常人16例(男10例,女6例).所有入组者均行胃镜或消化道造影、食管测压及24 h pH-Z监测.数据为正态分布者,统计方法采用独立样本t检验,非正态分布者,采用非参数秩和检验.P<0.05为差异有统计学意义.结果:反流组和非反流组年龄分别为67.92岁±9.88岁和64.94岁±7.38岁(P>0.05).下食管括约肌长度分别为反流组:3.14 cm±1.46cm,非反流组:3.13 cm±0.84 cm(P=0.983).反流组直立位胃食管反流次数多于非反流组(10.85±12.89 vs 0.75±0.889,P=0.01),仰卧位的胃食管反流次数两者间无明显差别(10.28±22.35 vs 0.36±0.58,P=0.024).食管近端酸反流次数、弱酸反流次数在反流组和非反流组间有显著性差异(P=0.012,P=0.036),而非酸反流在两者间无显著性差异(P=0.18).食管远端酸反流次数、弱酸反流次数及非酸反流次数之间均无显著性差异(P=0.072,P=0.197,P=0.067).食团胃酸暴露于立卧位及两组间均无明显差异.结论:老年人下食管括约肌压力均较正常人偏低,但在反流组和非反流组间无统计学差别,LES长度也在两组间无统计学差别.反流组直立位酸反流次数比非反流组频繁,仰卧位无显著性差异.反流组患者食管近端酸反流、弱酸反流较非反流组次数频繁,非酸反流两组间无差别.展开更多
目的本文研究了Hp阴性和Hp阳性的胃食管反流病(GERD)患者食管动力学和食管酸暴露情况,以阐明Hp感染和GERD两者之间的关系。方法纳入GERD患者64例,按Hp感染情况分为Hp阳性组37例,Hp阴性组27例。检测前1周停用抑酸药和胃肠动力药。对2组...目的本文研究了Hp阴性和Hp阳性的胃食管反流病(GERD)患者食管动力学和食管酸暴露情况,以阐明Hp感染和GERD两者之间的关系。方法纳入GERD患者64例,按Hp感染情况分为Hp阳性组37例,Hp阴性组27例。检测前1周停用抑酸药和胃肠动力药。对2组进行食管动力学检测和食管24 h pH监测。结果①Hp阳性和Hp阴性组性别、年龄和体质量指数无显著性差异(P>0.05)。②Hp阳性和Hp阴性组食管动力学检测:LES压力、长度及食管体部的各项动力学指标均无显著差异(P>0.05)。③Hp阳性和Hp阴性组24 h食管pH监测DeMeester评分、食管pH<4时间百分比、pH<4反流次数、pH<4大于5min反流次数、pH<4最长反流持续时间均无显著性差异(P>0.05)。④本研究中GERD患者食管下端括约肌压力(LESP)为(9.1±1.9)mm Hg,明显低于正常人,但它和DeMeester评分无相关性(r=0.130,P=0.304)。结论①Hp感染对胃食管反流病患者的LESP和食管体部的运动功能无明显影响;②Hp感染对胃食管反流病患者的食管酸暴露也没有显著影响;③Hp感染与胃食管反流病的发生没有明显关系。展开更多
基金Supported by the Scientific and Technological Research Council of Turkey,No.106S191-SBAG-3439
文摘AIM To evaluate the agreement of multichannel intraluminal impedance-p H monitoring(MII-p HM) and gastroesophageal reflux scintigraphy(GES) for the diagnosis of gastroesophageal reflux disease. METHODS Seventy-five consecutive patients with suspectedgastroesophageal reflux disease(GERD) underwent 24-h combined MII-p HM recording and one hour radionuclide scintigraphy during the course of the MIIpH M study. Catheters with 6 impedance channels and 1 p H sensor were placed transnasally. Impedance and p H data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index(RI, percentage of the entire record that esophageal p H is < 4.0) greater than 4.2% for p HM and number of refluxes more than 50 for 24 h for MII were accepted as positive test results. At scintigraphy, 240 frames of 15 seconds duration were acquired in the supine position. Gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen's kappa.RESULTS Sufficient data was obtained from 60(80%) patients(34 male, 56.7%) with a mean age of 8.7 ± 3.7 years(range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pH M was 22.8 ± 2.4 h(range: 16-30 h; median: 22.7 h). At least one test was positive in 57(95%) patients. According to diagnostic criteria, GERD was diagnosed in 34(57.7%), 44(73.3%), 47(78.3%) and 51(85%) patients by means of p HM, MII, GES and MII-p HM, respectively. The observed percentage agreements/κ values for GES and p HM, GES and MII, GES and MII-p HM, and MII and p HM are 48.3%/-0.118; 61.7%/-0.042; 73.3%/0.116 and 60%/0.147, respectively. There was no or slight agreement between GES and p HM alone, MII alone or MII-p HM. p H monitoring alone missed 17 patients compared to combined MII-p HM. The addition of MII to pH monitoring increased the diagnosis rate by 50%.CONCLUSION No or slight agreement was found among p H monitoring, MII monitoring, MII-pH monitoring and GES for the diagnosis of gastroesophageal reflux disease.
基金Supported by the National Natural Science Foundation of China, No. 30870846
文摘A recent multicenter study demonstrated that two variants of LRRK2, S1647T and R1398H, are associated with sporadic Parkinson＇s disease. The present study analyzed LRRK2 gene polymorphisms of S1647T and R1398H, demonstrating that the LRRK2 gene polymorphism S1647T variant is a risk factor for Parkinson＇s disease in a Chinese Han population. However, the R1398H variant did not influence the risk for Parkinson＇s disease. In addition, there was no difference in clinical symptoms of Parkinson＇s disease patients with various genotypes. Results showed that the LRRK2 S1647T variant was associated with an increased risk for developing early-onset Parkinson＇s disease in a Chinese Hart population. In addition, there was no correlation between LRRK2 S1647T, R1398H variants and G2385R, R1628P variants in Parkinson＇s disease patients.
文摘We report an unexpected, previously unreported complication of Bravo p H capsule dislodgement. During Bravo p H testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall after deployment. After multiple attempts to detect the capsule, it was visualized in the left pyriform sinus. As there was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for safe removal. Ultimately, ENT successfully retrieved the capsule with a foreign body removal forceps. The Bravo p H test is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications have been reported, technical difficulties can occur, including poor data reception, misplacement, and early dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to capsule aspiration. Gastroenterologists performing this procedure should be aware of the low, but nontrivial, risk of complications.
文摘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。
文摘目的:分析老年胃食管反流病患者的反流特点.方法:随机选取2011-01/2013-12在我院门诊就诊的患者28例,入组年龄为60-85岁,试验入组标准为症状符合蒙特利尔Ⅲ会议共识,反流组12例(男8例,女4例),非反流组为正常人16例(男10例,女6例).所有入组者均行胃镜或消化道造影、食管测压及24 h pH-Z监测.数据为正态分布者,统计方法采用独立样本t检验,非正态分布者,采用非参数秩和检验.P<0.05为差异有统计学意义.结果:反流组和非反流组年龄分别为67.92岁±9.88岁和64.94岁±7.38岁(P>0.05).下食管括约肌长度分别为反流组:3.14 cm±1.46cm,非反流组:3.13 cm±0.84 cm(P=0.983).反流组直立位胃食管反流次数多于非反流组(10.85±12.89 vs 0.75±0.889,P=0.01),仰卧位的胃食管反流次数两者间无明显差别(10.28±22.35 vs 0.36±0.58,P=0.024).食管近端酸反流次数、弱酸反流次数在反流组和非反流组间有显著性差异(P=0.012,P=0.036),而非酸反流在两者间无显著性差异(P=0.18).食管远端酸反流次数、弱酸反流次数及非酸反流次数之间均无显著性差异(P=0.072,P=0.197,P=0.067).食团胃酸暴露于立卧位及两组间均无明显差异.结论:老年人下食管括约肌压力均较正常人偏低,但在反流组和非反流组间无统计学差别,LES长度也在两组间无统计学差别.反流组直立位酸反流次数比非反流组频繁,仰卧位无显著性差异.反流组患者食管近端酸反流、弱酸反流较非反流组次数频繁,非酸反流两组间无差别.
文摘目的本文研究了Hp阴性和Hp阳性的胃食管反流病(GERD)患者食管动力学和食管酸暴露情况,以阐明Hp感染和GERD两者之间的关系。方法纳入GERD患者64例,按Hp感染情况分为Hp阳性组37例,Hp阴性组27例。检测前1周停用抑酸药和胃肠动力药。对2组进行食管动力学检测和食管24 h pH监测。结果①Hp阳性和Hp阴性组性别、年龄和体质量指数无显著性差异(P>0.05)。②Hp阳性和Hp阴性组食管动力学检测:LES压力、长度及食管体部的各项动力学指标均无显著差异(P>0.05)。③Hp阳性和Hp阴性组24 h食管pH监测DeMeester评分、食管pH<4时间百分比、pH<4反流次数、pH<4大于5min反流次数、pH<4最长反流持续时间均无显著性差异(P>0.05)。④本研究中GERD患者食管下端括约肌压力(LESP)为(9.1±1.9)mm Hg,明显低于正常人,但它和DeMeester评分无相关性(r=0.130,P=0.304)。结论①Hp感染对胃食管反流病患者的LESP和食管体部的运动功能无明显影响;②Hp感染对胃食管反流病患者的食管酸暴露也没有显著影响;③Hp感染与胃食管反流病的发生没有明显关系。
