Bajbouj Monther, Becker Valentin, Neuber Martin, Schmid Roland M, Meining Alexander
II. Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universitat Munchen, Munchen, Germany.
Digestion. 2007;76(3-4):223-8. doi: 10.1159/000112728. Epub 2007 Dec 21.
Globus sensations, hoarseness and chronic cough are suggested to be atypical manifestations of Gastroesophageal Reflux Disease (GERD). The aim of the study was to investigate whether combined pH-metry and multichannel intraluminal impedance monitoring increases the diagnostic yield.
41 patients with atypical GERD symptoms were included in the study. Globus sensation was the dominant symptom in 23 patients (56.1%). The remaining 18 patients (43.9%) complained mainly about hoarseness or chronic cough. All patients were examined by endoscopy, dual-channel pH-metry and impedance monitoring off-therapy with proton pump inhibitors (PPI). Diagnostic yield of the respective method was determined.
A total of 26 patients (63.4%) had pathological findings in any method. The highest diagnostic yield was achieved by combined 24-h pH-metry/impedance measurement (61.0%), followed by solely impedance measurement (48.8%), distal pH-metry (29.3%), endoscopy (22.8%) and proximal pH-metry (17.1%). All patients with a positive PPI-test and 25% of patients (5/20) with a negative PPI-test had a pathological result in pH-metry/impedance.
Multichannel intraluminal impedance monitoring increases the diagnostic yield for objective detection of atypical manifestation of GERD. Combined 24-h pH-metry/impedance measurement has the best diagnostic yield for detection of gastroesophageal reflux and has therefore the potential to represent a new diagnostic gold standard.
咽喉部异物感、声音嘶哑和慢性咳嗽被认为是胃食管反流病（GERD）的非典型表现。本研究的目的是探讨联合pH测定和多通道腔内阻抗监测是否能提高诊断率。
41例有GERD非典型症状的患者纳入本研究。23例患者（56.1%）以咽喉部异物感为主要症状。其余18例患者（43.9%）主要主诉为声音嘶哑或慢性咳嗽。所有患者均接受了内镜检查、双通道pH测定以及在停用质子泵抑制剂（PPI）治疗的情况下进行的阻抗监测。确定了各自方法的诊断率。
共有26例患者（63.4%）在任何一种检查方法中发现病理结果。联合24小时pH测定/阻抗测量的诊断率最高（61.0%），其次是单纯阻抗测量（48.8%）、远端pH测定（29.3%）、内镜检查（22.8%）和近端pH测定（17.1%）。所有PPI试验阳性的患者以及25%的PPI试验阴性患者（5/20）在pH测定/阻抗检查中有病理结果。
多通道腔内阻抗监测提高了GERD非典型表现客观检测的诊断率。联合24小时pH测定/阻抗测量对检测胃食管反流具有最佳诊断率，因此有可能成为一种新的诊断金标准。
