Arts J, Sifrim D, Rutgeerts P, Lerut A, Janssens J, Tack J
Department of Gastroenterology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Dig Dis Sci. 2007 Sep;52(9):2170-7. doi: 10.1007/s10620-006-9695-y. Epub 2007 Apr 12.
Several studies have demonstrated that radiofrequency energy delivery at the gastroesophageal junction (the Stretta procedure) induces symptom relief in gastroesophageal reflux disease (GERD), although improvement of acid exposure on pH monitoring was usually limited. A role for decreased esophageal sensitivity has been suggested. Our aim was to evaluate the influence of Stretta on symptoms, acid exposure, and sensitivity to esophageal acid perfusion in GERD. Thirteen patients with established proton pump inhibitor (PPI)-dependent GERD (three males; mean age, 51+/-10 years) participated in the study. Before and 6 months after the procedure symptom score, pH monitoring and Bernstein acid perfusion test were performed. The latter was done by infusing HCl (pH 0.1) at a rate of 6 ml/min 15 cm proximal to the gastroesophageal junction for a maximum of 30 min or until the patients experienced heartburn. Results were compared by Student's t-test. Stretta procedure time was 51+/-4 min and no complications occurred. After 6 months, the symptom score was significantly improved (12.5+/-2.0 to 7.5+/-2.1; P<0.05), seven patients no longer needed daily PPI, and acid exposure was significantly decreased (11.6%+/-1.6% to 8.5%+/-1.8% of time pH<4; P<0.05). The time needed to induce heartburn during acid perfusion decreased from 9.5+/-2.3 to 18.1+/-3.4 min (P=0.01), and five patients became insensitive to 30-min acid perfusion, versus none at baseline (P=0.04). In conclusion, the Stretta procedure induces subjective improvement of GERD symptoms and decreases esophageal acid exposure. In addition, esophageal acid sensitivity is decreased 6 months after the Stretta procedure. The mechanism underlying this finding and its relevance to symptom control require further studies.
多项研究表明，在胃食管交界处进行射频能量传递（Stretta手术）可缓解胃食管反流病（GERD）的症状，尽管pH监测显示酸暴露的改善通常有限。有研究提出食管敏感性降低可能起到了一定作用。我们的目的是评估Stretta手术对GERD患者症状、酸暴露及食管对酸灌注敏感性的影响。13例确诊为依赖质子泵抑制剂（PPI）的GERD患者（3例男性；平均年龄51±10岁）参与了本研究。在手术前及术后6个月，分别进行症状评分、pH监测和伯恩斯坦酸灌注试验。后者是通过在胃食管交界处近端15 cm处，以6 ml/min的速率注入HCl（pH 0.1），持续30分钟或直至患者出现烧心感。采用学生t检验比较结果。Stretta手术时间为51±4分钟，未发生并发症。6个月后，症状评分显著改善（从12.5±2.0降至7.5±2.1；P<0.05），7例患者不再需要每日服用PPI，酸暴露显著降低（pH<4的时间从11.6%±1.6%降至8.5%±1.8%；P<0.05）。酸灌注诱发烧心所需时间从9.5±2.3分钟增至18.1±3.4分钟（P=0.01），5例患者对30分钟酸灌注变得不敏感，而基线时无患者出现这种情况（P=0.04）。总之，Stretta手术可使GERD症状主观上得到改善，并减少食管酸暴露。此外，Stretta手术后6个月食管酸敏感性降低。这一发现的潜在机制及其与症状控制的相关性有待进一步研究。
