Scarpulla Giuseppe, Camilleri Salvatore, Galante Pietro, Manganaro Miohele, Fox Mark
Gastroenterology Division, M. Raimondi Hospital, San Cataldo (CL), Italy.
Am J Gastroenterol. 2007 Dec;102(12):2642-7. doi: 10.1111/j.1572-0241.2007.01461.x. Epub 2007 Sep 10.
Prolonged, 4-day (96 h) measurement by the wireless Bravo system provides an opportunity to assess the variance, diagnostic reproducibility, and yield of 24- and 48-h pH and symptom association studies.
Retrospective analysis of 83 patients with suspected reflux symptoms undergoing wireless pH monitoring with the intention of 96-h measurement. Study periods were classified based on esophageal acid exposure, the DeMeester score (DMS), and the association of reflux events and symptoms (symptom index). The technical success of prolonged pH recording and diagnostic accuracy of 24-, 48-, and 72-h pH studies compared to the 96-h "gold standard" were assessed.
Prolonged Bravo pH studies were possible and well tolerated in routine clinical practice. Complete 96-h recordings were available for 34/83 (41%) patients. Variation in pH measurements reduced with increasing study duration (24-h 45%vs 48-h 27%, P<0.01), but no change in reflux severity over time was observed (ANOVA, P=ns). Abnormal acid exposure was found in 7 (19%) on every test day and 21 (58%) on at least one of four test days. A diagnosis consistent with the 96-h "gold standard" was present in 22 (63%), 29 (83%), and 32 (91%) patients for 24-, 48-, and 72-h test periods, respectively, with a significant improvement of diagnostic sensitivity with study duration (P<0.01). Similar findings were present for symptom association.
Increasing the duration of pH studies progressively improves measurement variance and the diagnostic reproducibility of reflux studies. Future studies must address the impact of prolonged pH studies on clinical management.
通过无线Bravo系统进行为期4天（96小时）的长时间测量，为评估24小时和48小时pH值与症状关联研究的差异、诊断可重复性及检出率提供了契机。
对83例疑似反流症状患者进行无线pH监测，旨在进行96小时测量，并进行回顾性分析。根据食管酸暴露、DeMeester评分（DMS）以及反流事件与症状的关联（症状指数）对研究时段进行分类。评估了与96小时“金标准”相比，延长pH记录的技术成功率以及24小时、48小时和72小时pH研究的诊断准确性。
在常规临床实践中，延长的Bravo pH研究是可行的，且耐受性良好。83例患者中有34例（41%）获得了完整的96小时记录。随着研究时长增加，pH测量的变异性降低（24小时为45%，48小时为27%，P<0.01），但未观察到反流严重程度随时间的变化（方差分析，P=无统计学意义）。在每个测试日，7例（19%）患者存在异常酸暴露，在四个测试日中的至少一天，21例（58%）患者存在异常酸暴露。在24小时、48小时和72小时测试时段，分别有22例（63%）、29例（83%）和32例（91%）患者的诊断与96小时“金标准”一致，诊断敏感性随研究时长显著提高（P<0.01）。症状关联方面也有类似发现。
延长pH研究时长可逐步改善测量变异性及反流研究的诊断可重复性。未来研究必须探讨延长pH研究对临床管理的影响。
