Netzer P, Gut A, Heer R, Gries N, Pfister M, Halter F, Inauen W
Dept. of Medicine, Inselspital, University of Berne, Switzerland.
Scand J Gastroenterol. 1999 Jul;34(7):676-82. doi: 10.1080/003655299750025877.
Esophageal function testing was developed to aid diagnosis in patients with negative endoscopy. Although combined 24-h esophageal pH-manometry is now commercially available, its routine clinical effectiveness has not yet been studied.
From 1992 to 1996 we evaluated 303 consecutive patients who were first-time referrals to our unit for 24-h esophageal pH-manometry. The referral indications were gastroesophageal reflux disease, 47.2%; dysphagia, 18.5%; non-cardiac chest pain, 14.9%; connective tissue disease, 13.2%; and symptomatic patients after antireflux surgery, 6.3%.
Overall, esophageal function testing altered the diagnosis of 44% of the patients, confirmed it in 38%, and specifically changed the management of 66%. The final clinical 'diagnosis' was reflux disease, 54% (32% with non-specific esophageal motility disorder); connective tissue disease, 9.9%; achalasia, 9.6%; other specific esophageal motility disorders, 3.3%; non-specific esophageal motility disorders, 6.9%; and normal, 16.2%. The cost per testing was estimated to be US$305 and per change in management US$465.
Combined 24-h pH-manometry has been shown to be a useful and cost-effective test for the management of selected patients in whom the primary investigation was insufficient.
食管功能测试旨在辅助内镜检查结果阴性患者的诊断。尽管24小时食管pH值-测压联合检查现已商业化，但尚未对其常规临床有效性进行研究。
1992年至1996年，我们评估了303例连续首次转诊至我科进行24小时食管pH值-测压的患者。转诊指征包括胃食管反流病，占47.2%；吞咽困难，占18.5%；非心源性胸痛，占14.9%；结缔组织病，占13.2%；抗反流手术后有症状的患者，占6.3%。
总体而言，食管功能测试改变了44%患者的诊断，证实了38%患者的诊断，并特别改变了66%患者的治疗方案。最终临床“诊断”为反流病，占54%（其中32%伴有非特异性食管动力障碍）；结缔组织病，占9.9%；贲门失弛缓症，占9.6%；其他特异性食管动力障碍，占3.3%；非特异性食管动力障碍，占6.9%；正常，占16.2%。每次测试的费用估计为305美元，每次治疗方案改变的费用为465美元。
24小时pH值-测压联合检查已被证明是一种有用且具有成本效益的检查方法，可用于对初步检查不足的特定患者进行管理。
