胃食管反流病pH联合阻抗监测与单纯pH监测效果的对比研究

Abstract
Figure/Table
References
Related Citation (13)

Download: PDF (1393 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore the advantages of multiple channel intraluminal pH-impedance reflux monitoring (MII-pH) over single pH monitoring for the diagnosis of gastroesophageal reflux disease (GERD), and the characteristics of reflux episodes in patients with gastroesophageal reflux disease. Methods The data of adult GERD patients under MII-pH monitoring for the first time in our center between June 2015 and June 2017 was included. The positive rate of the main indicators of the pH channel and impedance channel of MII-pH monitoring, and the statistical relationships between the reflux indicators were analyzed. Results A total of 1780 patients with GERD were included, 889 of whom were males and 891 females, (51.6±12.9) years old. There were 1026, 1045, 462, 258, 448, 370, and 540 cases of acid reflux, heart burning, belching, chest pain, cough, asthma, and globus sensation symptom, respectively. The positive rate of the pH channel was 26.3%, of which the positive rate of DeMeester score was 25.4%, and that of acid exposure time (AET) was 25.4%. The positive rate of the impedance channel was 69%, where the positive rate of total reflux volume was 21.5%, the numbers of liquid acid reflux episodes and non acid reflux episodes were statistically different (P<0.001), and there was statistically significant difference between the number of liquid acid reflux episodes and that of gas reflux episodes (P<0.001). The positive rate of bolus exposure time (BET) was 40.3%, and the positive rate of symptom reflux association was 53%. The total positive rate of MII-pH monitoring was 71.3%. There was statistically significant difference (P＜0.001) and a statistically significant correlation (r=0.904＞0.9,P＜0.001) between the number of acid reflux episodes of the impedance channel and that of the pH channel. The difference in McNemar chi square test of the positive rate of total reflux volume and symptom reflux association was statistically significant (P<0.001, Kappa=0.15), so was the difference in McNemar chi square test of the positive rate of pH channel and symptom reflux association (P<0.001, Kappa=0.120). Conclusions MII-pH monitoring is highly consistent and more sensitive for detecting acid reflux episodes compared with single pH monitoring. Non-acid reflux and gas reflux episodes detected by the impedance channel of MII-pH monitoring can significantly improve the detection rate of GERD. Analysis of symptom reflux association can improve the detection rate of GERD and even reflux hypersensitivity (esophagus and airway).

Key words： gastroesophageal reflux disease pH monitoring impedance monitoring acid reflux non-acid reflux symptom reflux association

Received: 20 August 2018

ZTFLH:

R571

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	HU Zhiwei
	XU Hui
	WANG Zhonggao
	WU Jimin
	ZHAN Ying
	XIN Ronghua
	LIANG Yan
	ZHANG Yu
	ZHAN Xiulan
	and MAO Jianxin

Cite this article:

HU Zhiwei,XU Hui,WANG Zhonggao等. Comparative study of multiple channel intraluminal pH-impedance reflux monitoring and single pH monitoring for gastroesophageal reflux disease[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(1): 8-14.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2019/V30/I1/8

[1]	汪忠镐, 胡志伟. 胃食管反流病及其食管外反流:一个常被忽视的重大公共卫生问题[J]. 临床外科杂志,2016, 24(1): 5-11.
[2]	胡志伟, 吴继敏, 汪忠镐. 胃食管反流气道反流性疾病的诊断学概述[J]. 中国医学文摘(耳鼻咽喉科学),2018, 33(1): 47-52.
[3]	Mermelstein J, Chait Mermelstein A, Chait M M. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions[J]. Clin Exp Gastroenterol,2018, 11: 119-134.
[4]	Katz P O, Gerson L B, Vela M F. Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol,2013, 108 (3) :308-328
[5]	Savarino E, Tutuian R, Zentilin P, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy[J]. Am J Gastroenterol, 2010, 105(5): 1053-1061.
[6]	Ang D, Ang T L, Teo E K, et al. Is impedance pH monitoring superior to the conventional 24-h pH meter in the evaluation of patients with laryngorespiratory symptoms suspected to be due to gastroesophageal reflux disease?[J]. J Digest Dis, 2011, 12(5): 341-348.
[7]	Nian Y Y, Feng C, Jing F C, et al. Reflux characteristics of 113 GERD patients with abnormal 24-h multichannel intraluminal impedance-pH tests[J]. J Zhejiang Univ B, 2015, 16(9):805-810.
[8]	安瑛, 范红, 李岩, 等. 24 h食管多通道腔内阻抗-pH监测在胃食管反流性疾病中的应用及其临床意义[J]. 中国综合临床, 2013, 29(6): 564-567.
[9]	Subramanian C R, Triadafilopoulos G. Refractory gastroesophageal reflux disease[J]. Gastroenterol Rep, 2015, 3(1): 41-53.
[10]	Pavic I, Babic I, Cepin Bogovic J, et al. The importance of combined 24-hour multichannel intraluminal impedance-pH monitoring in the evaluation of children with suspected laryngopharyngeal reflux[J]. Clin Otolaryngol, 2017, 42(3): 544-549.
[11]	Suzuki T, Seki Y, Okamoto Y, et al. Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms[J]. Surg Endosc,2017. 32 (5) :1-11
[12]	Zhang C, Wu J, Hu Z, et al. Diagnosis and anti-reflux therapy for GERD with respiratory symptoms: a study using multichannel intraluminal impedance-pH monitoring[J]. PLoS One,2016, 11(8): e0160139.
[13]	Wang F, Li P, Ji G Z, et al. An analysis of 342 patients with refractory gastroesophageal reflux disease symptoms using questionnaires, high-resolution manometry, and impedance-pH monitoring[J]. Medicine (Baltimore),2017, 96(5): e5906.
[14]	Roman S, Gyawali C P, Savarino E, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group[J]. Neurogastroenterol Motil, 2017, 29:4-28.
[15]	Patel A, Sayuk G S, Gyawali C P. Parameters on esophageal pH-Impedance monitoring that predict outcomes of patients with gastroesophageal reflux Disease[J]. Clin Gastroenterol Hepatol,2015,13(5):884-891.
[16]	肖英莲, 林金坤, 彭穗, 等. 联合食管多通道腔内阻抗-pH监测在诊断胃食管反流病中的价值[J]. 中华消化杂志,2009, 29(9): 513-516.
[17]	王伟岸, 张晓, 刘海峰, 等. 基于24 h pH-阻抗监测的难治性胃食管反流病的病理生理分型研究[J]. 胃肠病学和肝病学杂志,2015, 24(12): 1453-1456.
[18]	Yamasaki T, Fass R. Reflux hypersensitivity: a new functional esophageal disorder[J]. J Neurogastroenterol Motil, 2017, 23(4): 495-503.
[19]	王晓辉, 崔立红, 弓三东, 等. 24h食管pH阻抗监测在胃食管反流性咳嗽中的临床应用[J]. 胃肠病学和肝病学杂志, 2016, 25(8): 913-916.
[20]	Choksi Y, Slaughter J C, Sharda R, et al. Symptom association probability does not reliably distinguish functional heartburn from reflux hypersensitivity[J]. Aliment Pharmacol Ther,2018, 47(7): 958-965.
[21]	El-Serag H B, Havemann B D, Henderson C A. The association between gastro-oesophageal reflux disease and asthma: a systematic review[J]. Gut, 2007, 56(12): 1654-1664.
[22]	Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough[J].Lung,2010,188(1):81-86.
[23]	Abou-Ismail A, Vaezi M F. Evaluation of patients with suspected laryngopharyngeal reflux: a practical approach[J]. Curr Gastroenterol Rep,2011, 13(3): 213-218.
[24]	Wu J C. Combined multichannel intraluminal impedance and pH monitoring for patients with suspected laryngopharyngeal reflux: Is it ready to use?[J]. J Neurogastroenterol Motil,2010, 16(2): 108-109.
[25]	Rosen R, Amirault J, Heinz N, et al. The sensitivity of acoustic cough recording relative to intraesophageal pressure recording and patient report during reflux testing[J]. Neurogastroenterol Motil,2014,26(11):1635-1641.
[26]	Herregods T V K, Pauwels A, Jafari J, et al. Ambulatory pH-impedance-pressure monitoring as a diagnostic tool for the reflux-cough syndrome[J]. Dis Esophagus,2018, 31(1): 1-7.
[27]	王嘉森, 李进让, 李晓雨, 等. 24h多通道腔内阻抗联合pH监测诊断咽喉反流的初步应用[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(7): 564-568.
[28]	胡志伟, 田书瑞, 吴继敏, 等. 胃食管反流病的普通胃镜学特点:4086例统计分析[J]. 解放军医学杂志, 2018, 43(1): 41-47.
[29]	Lee S W, Chang C M, Chang C S, et al. Comparison of presentation and impact on quality of life of gastroesophageal reflux disease between young and old adults in a Chinese population[J]. World J Gastroenterol, 2011, 17(41): 4614-4618.
[30]	Bashashati M, Sarosiek I, McCallum R W. Epidemiology and mechanisms of gastroesophageal reflux disease in the elderly: a perspective[J]. Ann N Y Acad Sci, 2016, 1380(1): 230-234.