Bravo (wireless) ambulatory esophageal pH monitoring: How do day 1 and day 2 results compare?

AIM： To investigate if differences exist for patients＇ gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2.METHODS： A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under Ⅳ conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2.RESULTS： The mean doses of fentanyl and midazolam were 90.4 μg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH 〈 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score.CONCLUSION： Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d i compared to d 2. The Ⅳ sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients＇ true GE reflux profile.

Comparison of multichannel intraluminal impedance-pH monitoring and reflux scintigraphy in pediatric patients with suspected gastroesophageal reflux

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.

Gastroesophageal reflux disease in pediatric esophageal atresia:Assessment of clinical symptoms and pH-impedance data

BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia(Barrett’s esophagus)is increased in adults with EA compared with the general population.Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIM To assess symptoms and pH-impedance data in children after EA,in order to identify their specific features of GERD.METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair(51.35%boys,48.65%girls;age range:1-14 years,median:4.99 years).GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established:EA without GERD,n=17;EA with GERD,n=20.A control group was established with 66 children with proven GERD(68.18%boys,31.82%girls;median age:7.21 years),composed of a nonerosive reflux disease(referred to as NERD)group(n=41)and a reflux esophagitis group(n=25).Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough(70%and 76.5%respectively).The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group(P=0.03).In the control reflux esophagitis group,prevalence of gastrointestinal symptoms was significantly higher than in the NERD group(P=0.017).For both EA groups,there was strong correlation with index of proximal events(IPE)and total proximal events(EA with GERD:0.96,P<0.001;EA without GERD:0.97,P<0.001)but level of IPE was significantly lower than in GERD patients without any surgical treatment(P<0.001).Data on distal mean nocturnal baseline impedance were significantly different between the EA with GERD group(P<0.001)and the two control groups but not between EA without GERD and the two control groups.CONCLUSION Mean nocturnal baseline impedance may have diagnostic value for GERD in EA children after open surgical repair.IPE might be an additional parameter of pHimpedance monitoring.

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.

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

Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease

Gastro-esophageal reflux disease(GERD)is one of the most prevalent chronic diseases.Although proton pump inhibitors(PPIs)represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief,several studies have shown that up to 40%of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily.Several mechanisms have been proposed as involved in PPIs resistance,including ineffective control of gastric acid secretion,esophageal hypersensitivity,ultrastructural and functional changes in the esophageal epithelium.The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation,upper endoscopy,esophageal manometry and ambulatory pH-impedance monitoring,which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn.Treatment has been primarily based on doubling the PPI dose or switching to another PPI.Patients with proven disease,not responding to PPI twice daily,are eligible for anti-reflux surgery.

Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough

AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.

Gastroesophageal reflux in cirrhotic patients without esophageal varices

AIM: To evaluate the esophageal motility and abnormal acid and bile reflux incidence in cirrhotic patients without esophageal varices (EV). METHODS: Seventy-eight patients with liver cirrhosis without EV confirmed by upper gastroesophageal endoscopy and 30 healthy control volunteers were prospectively enrolled in this study. All the patients were evaluated using a modified protocol including Child-Pugh score, upper gastrointestinal endoscopy, esophageal manometry, simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring. All the patients and volunteers accepted the manometric study. RESULTS: In the liver cirrhosis group, lower esophageal sphincter pressure (LESP, 15.32 ± 2.91 mmHg), peristaltic amplitude (PA, 61.41 ± 10.52 mmHg), peristaltic duration (PD, 5.32 ± 1.22 s), and peristaltic velocity (PV, 5.22 ± 1.11 cm/s) were all significantly abnormal in comparison with those in the control group (P < 0.05), and LESP was negatively correlated with Child-Pugh score. The incidence of reflux esophagitis (RE) and pathologic reflux was 37.18% and 55.13%, respectively(vs control, P < 0.05). And the incidence of isolated abnormal acid reflux, bile reflux and mixed reflux was 12.82%, 14.10% and 28.21% in patients with liver cirrhosis without EV. CONCLUSION: Cirrhotic patients without EV presented esophageal motor disorders and mixed acid and bile reflux was the main pattern; the cirrhosis itself was an important causative factor.

Accurate positioning of the 24-hour pH monitoring catheter:Agreement between manometry and pH step-up method in two patient positions

AIM： TO investigate the agreement between esophageal manometry and pH step-up method in two different patient positions. METHODS： Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter （LES） was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed. RESULTS： In the supine position, the measurement of only one subject was outside the range accepted for correct positioning （~〈 3 cm distal or proximal to the LES）. In the upright position, errors in measurement were recognized in five subjects. Bland-Airman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position. CONCLUSION： In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. Thisshould increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.

Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management

Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5^(th) International Consensus Conference on sleeve gastrectomy.

Measuring luminal esophageal temperature during pulmonary vein isolation of atrial fibrillation

AIM:To investigate the luminal esophageal temperature(LET) at the time of delivery of energy for pulmonary vein isolation(PVI).METHODS:This study included a total of 110 patients with atrial fibrillation who underwent their first PVI procedure in our laboratory between March 2010 and February 2011.The LET was monitored in all patients.We measured the number of times that LET reached the cut-off temperature,the time when LET reached the cut-off temperature,the maximum temperature(T max) of the LET,and the time to return to the original preenergy delivery temperature once the delivery of energy was stopped.RESULTS:Seventy-eight patients reached the cut-off temperature.It took 6 s at the shortest time for the LET to reach the cut-off temperature,and 216.5 ± 102.9 s for the temperature to return to the level before the de-livery of energy.Some patients experienced a transient drop in the LET(TDLET) just before energy delivery.Ablation at these sites always produced a rise to the LET cut-off temperature.TDLET was not observed at sites where the LET did not rise.Thus,the TDLET before the energy delivery was useful to distinguish a high risk of esophageal injury before delivery of energy.CONCLUSION:Sites with a TDLET before energy delivery should be ablated with great caution or,perhaps,not at all.

Noninvasive hemodynamic monitoring of septic shock in children

Septic shock in children is associated with high mortality and morbidity. Its management is time-sensitive and must be aggressive and target oriented. The use of clinical assessment alone to differentiate between cold and warm shock and to select the appropriate inotropic and vasoactive medications is fraught with errors. Semiquantitative and quantitative assessment of the preload,contractility and afterload using non-invasive tools has been suggested,in conjunction with clinical and laboratory assessment,to direct shock management and select between vasopressors,vasodilators and inotropes or a combination of these drugs. This review aims to describe non-invasive tools to assess the hemodynamic status in septic shock including echocardiography,trans-thoracic/trans-esophageal Doppler and electrical cardiometry. As septic shock is a dynamic condition that changes markedly overtime,frequent or continuous measurement of the cardiac output(CO),systemic vascular resistance(SVR) and other hemodynamic parameters using the above-mentioned tools is essential to personalize the treatment and adapt it over time. The different combinations of blood pressure,CO and SVR serve as a pathophysiological framework to manage fl-uid therapy and titrate inotropic and vasoactive drugs. Near infrared spectroscopy is introduced as a noninvasive method to measure end organ perfusion and assess the response to treatment.

Barrett's esophagus in 2016: From pathophysiology to treatment

Esophageal complications caused by gastroesophageal reflux disease(GERD)include reflux esophagitis and Barrett’s esophagus(BE).BE is a premalignant condition with an increased risk of developing esophageal adeno-carcinoma(EAC).The carcinogenic sequence may progress through several steps,from normal esophageal mucosa through BE to EAC.A recent advent of functional esophageal testing(particularly multichannel intraluminal impedance and pH monitoring)has helped to improve our knowledge about GERD pathophysiology,including its complications.Those findings(when properly confirmed)might help to predict BE neoplastic progression.Over the last few decades,the incidence of EAC has continued to rise in Western populations.However,only a minority of BE patients develop EAC,opening the debate regarding the cost-effectiveness of current screening/surveillance strategies.Thus,major efforts in clinical and research practice are focused on new methods for optimal risk assessment that can stratify BE patients at low or high risk of developing EAC,which should improve the cost effectiveness of screening/surveillance programs and consequently significantly affect health-care costs.Furthermore,the area of BE therapeutic management is rapidly evolving.Endoscopic eradication therapies have been shown to be effective,and new therapeutic options for BE and EAC have emerged.The aim of the present review article is to highlight the status of screening/surveillance programs and the current progress of BE therapy.Moreover,we discuss the recent introduction of novel esophageal pathophysiological exams that have improved the knowledge of the mechanisms linking GERD to BE.

Diagnosis of gastroesophageal reflux disease in elderly subjects using 24-houres ophageal pH monitoring

Objective To evaluate the relationship between the parameters of 24 hour esophageal pH monitoring and gastroesophageal reflux disease (GERD) among elderly subjects. Methods Twenty four hour esophageal pH monitoring was carried out in 20 elderly subjects without apparent GERD symptoms (controls) and 69 suspected GERD subjects.Results Normal values of the parameters from 20 elderly controls were obtained. Percent of total time, percent of supine time and percent of upright time in which the pH was <4 (indicating reflux) were less than 3.3%, 1.4%, 5.5%, respectively. The number of reflux episodes and episodes lasting longer than 5 minutes were less than 65 and 2 times respectively. The values obtained in 66 GERD suspected subjects were significantly different from those in norrmal controls. The differences of reflux parameters between the esophagitis group and non esophagitis group, such as percent of total time with pH<4, percent of supine time with pH<4 and number of reflux lasting longer than 5 minutes were also significant. Conclusions About 51.6% patients (34/66) with reflux symptoms but without endoscopic evidence of esophagitis were definitely diagnosed as GERD by esophageal pH monitoring. Duration of esophageal acid exposure correlated with the severity of GERD.

高分辨率食管测压联合24h食管阻抗-pH监测对胃食管反流病病情程度的诊断价值

目的:分析高分辨率食管测压(HRM)联合24 h食管阻抗-pH监测对胃食管反流病(GERD)病情程度的诊断价值。方法:选取2020年8月至2023年7月我院确诊GERD的182例患者为研究对象,依据DeMeester积分分为轻度组(≤50分)、中度组(51~100分)、重度组(>100分),比较HRM指标与24h阻抗-pH监测指标,分析这些指标与GERD病情程度的相关性及其诊断价值。结果:3组腹段食管下括约肌(LES)长度比较,轻度组>中度组>重度组(P<0.05);3组气体反流次数、平均酸清除时间、酸反流次数比较,轻度组<中度组<重度组(P<0.05);GERD病情程度与腹部LES长度呈负相关,与气体反流次数、平均酸清除时间、酸反流次数呈正相关(P<0.05)。气体反流次数、平均酸清除时间、酸反流次数、腹部LES长度单独诊断GERD的ROC曲线下面积均小于HRM与24h阻抗-pH监测联合诊断(P<0.05)。结论:HRM联合24h阻抗-pH监测GERD,可有效判断GERD病情程度,有助于临床制定针对性治疗方案。

食管癌术中喉返神经损伤因素的研究进展

食管癌患者淋巴结转移率高,其中双侧喉返神经旁淋巴结转移率高达19.8%~37.6%。在食管癌根治性淋巴结清扫过程中,喉返神经旁淋巴结的清扫可改善预后,同样也会增加喉返神经损伤风险,导致患者术后出现声音嘶哑及肺炎等并发症,降低术后生活质量。需要术者注重喉返神经的保护,完善术前检查,确定手术流程,合理使用术中仪器,提高术中操作水平。本文就术中神经检测、手术方式、淋巴结清扫范围、术者个人因素、喉返神经旁淋巴结的检查方式等对术中喉返神经损伤的影响展开综述。

反流性食管炎患者食管动力学临床研究

目的 :探讨反流性食管炎 (RE)患者的食管动力学方面的改变。 方法 :对胃镜确诊的 45例 RE患者 ,采用 X线透视下观察食管的形态学、蠕动以及反流情况 ,并注意与其他胃肠疾病的关系 ,同时监测 2 4h食管 p H值和食管括约肌 (L ES)压力。 结果 :45例患者 X线表现形态上均有食管粘膜增粗 ,2 2例可见食管痉挛 ,2 4例出现食管反流现象 ,以抽吸型为主 ,占44 .44 % ,廓清以被动廓清为主 ,占 5 5 .5 6 % ,而食管裂孔疝合并 RE患者表现尤甚。 2 4h食管 p H值 <4的总的、卧位和立位反流时间百分比均显著高于对照组 (P<0 .0 1) ,食管裂孔疝合并 RE组 L ES静息压显著低于其他各组 (P<0 .0 5 ) ;L ES的长度各组间无明显差异 ,X线食管钡餐动态观察下的反流情况和反流量与 L ES静息压降低呈正相关性。结论 :RE患者 L ES静息压降低 ,临床上出现反流 ,吸气末加重 ,L ES压力降低可能在 RE发病中起重要的作用。

高分辨率食管测压联合双通道24h食管pH监测在胃食管反流病发病机制研究中的应用

目的应用高分辨率食管测压联合双通道24 h食管pH监测技术了解不同类型胃食管反流病(GERD)患者的食管动力学特征及酸反流情况,探讨食管动力障碍和酸反流在GERD发病中的作用。方法选取2011年10月—2013年12月在海军总医院消化科就诊的具有典型胃食管反流症状的GERD患者67例和健康体检者25例(对照组),分别行电子胃镜检查、高分辨率食管测压和双通道24 h食管pH监测。依据内镜下有无食管黏膜糜烂将GERD患者分为糜烂性食管炎(EE)组(n=36)及非糜烂性反流病(NERD)组(n=31),比较3组食管动力及酸反流的差异。结果与对照组比较,EE组、NERD组均存在食管动力障碍,表现为食管远端收缩积分(DCI)、收缩前沿速度(CFV)显著降低(P<0.01),EE组DCI、CFV较NERD组降低更为显著(P<0.05)。与对照组比较,EE组、NERD组各项酸反流指标均显著增高(P<0.01),EE组各项酸反流指标较NERD组增高更为显著(P<0.05)。结论高分辨率食管测压联合双通道24 h食管pH监测结果更清晰地揭示了食管动力障碍及酸反流是GERD发病的重要机制,不同类型的GERD患者之间存在食管动力及酸反流差异,EE患者的食管动力障碍及酸反流更明显。

非糜烂性反流病与反流性食管炎症状及食管酸暴露情况

目的比较非糜烂性反流病(NERD)与反流性食管炎(RE)的临床症状及食管酸暴露情况。方法具有反流症状的患者155例,进行胃镜检查和食管24 h pH动态监测。结果 155例患者中诊断RE 76例(49.0%),其中A、B、C、D级分别为40、24、8和4例;诊断NERD 79例(51.0%);RE组中pH监测阳性57例(75.0%),NERD组26例(32.9%),差异有统计学意义(P<0.05);NERD组食管外症状发生率较RE组高,差异有统计学意义(P<0.05),而典型的反流症状发生率两组比较差异无统计学意义(P>0.05);RE组各项酸反流指标均大于NERD组,差异有统计学意义(P<0.05);轻度RE(LA-A)组各项酸反流指标低于中度RE(LA-B)和重度RE(LA-C+D),差异有统计学意义(P<0.05),但中度RE(LA-B)与重度RE(LA-C+D)之间的差异无统计学意义(P>0.05);79例NERD中,依据监测当日症状计算SI值,pH阴性SI阳性(NERD pH-SI+)15例,pH阴性SI阴性(NERD pH-SI-)28例,NERD pH-SI+组的pH<4.0(%)和酸反流次数明显高于NERD pH-SI-组,差异有统计学意义(P<0.05)。结论胃酸反流是RE形成的重要因素,其中胃酸的浓度及长反流与食管黏膜接触的次数是直接造成食管黏膜损伤的重要因素;酸反流的程度与RE的严重程度之间可能相关;NERD根据酸反流与症状的关系可分为不同的亚型,病理性酸反流所占比例相对较低,酸反流的强弱在其发病机制中可能未起到决定性作用。