Karamanolis George, Vanuytsel Tim, Sifrim Daniel, Bisschops Raf, Arts Joris, Caenepeel Philip, Dewulf Dominiek, Tack Jan
Division of Gastroenterology, Department of Pathophysiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Dig Dis Sci. 2008 Sep;53(9):2387-93. doi: 10.1007/s10620-007-0186-6. Epub 2008 Mar 6.
Current management algorithms propose pH monitoring under proton pump inhibitors (PPIs) in suspected gastroesophageal reflux disease (GERD) with insufficient treatment response, but recent observations challenge this approach because of its low yield.
To perform an audit of the outcomes of pH monitoring under PPI therapy in our unit, and to study the yield of additional nonacid reflux monitoring.
All pH monitoring studies under antireflux therapy since 1997, with or without simultaneous Bilitec monitoring, were analyzed.
From 1997 to 2003, 347 patients (157 men, mean age 49.4 +/- 0.8 years) underwent pH studies on PPI therapy (28% half-, 67% full-, and 5% double-dose PPI) for persisting typical (53%) or atypical (75%) symptoms. In 184 patients, simultaneous Bilitec monitoring was performed. Esophageal pH monitoring on PPI was pathological in 105 (30%) patients. Pathological pH monitoring on PPI was associated with typical reflux symptoms (64 versus 52%, P = 0.03), and a higher prevalence of persisting esophagitis (54 versus 36%, P < 0.005) and of hiatal hernia (58 versus 27%, P < 0.005). Bilitec monitoring on PPI therapy was pathological in 114 (62%) patients, of which 74 (40%) had normal pH monitoring. Adding Bilitec increased the rate of abnormal results over pH monitoring alone, from 38% to 69% on half-dose, from 27% to 69% on full-dose, and from 0% to 38% on double-dose PPI.
The rate of abnormal pH monitoring in symptomatic GERD patients while on PPI therapy is relatively low, especially in those on double-dose PPI. Combined pH and Bilitec monitoring significantly increased the rate of ongoing pathological reflux compared to pH alone in refractory to PPI therapy GERD patients.
当前的管理算法建议，对于疑似胃食管反流病（GERD）且治疗反应不足的患者，在质子泵抑制剂（PPI）治疗期间进行pH监测，但最近的观察结果对这种方法提出了质疑，因为其阳性率较低。
对本单位PPI治疗期间pH监测的结果进行审核，并研究额外进行非酸性反流监测的阳性率。
分析了自1997年以来所有在抗反流治疗期间进行的pH监测研究，包括是否同时进行Bilitec监测。
1997年至2003年，347例患者（157例男性，平均年龄49.4±0.8岁）在PPI治疗期间（28%为半量、67%为全量、5%为双倍剂量PPI）接受了pH研究，以评估持续存在的典型症状（53%）或非典型症状（75%）。184例患者同时进行了Bilitec监测。在PPI治疗期间，105例（30%）患者的食管pH监测结果异常。PPI治疗期间pH监测结果异常与典型反流症状相关（64%对52%，P = 0.03），食管炎持续存在的患病率更高（54%对36%，P < 0.005），食管裂孔疝的患病率也更高（58%对27%，P < 0.005）。在PPI治疗期间，114例（62%）患者的Bilitec监测结果异常，其中74例（40%）患者的pH监测结果正常。增加Bilitec监测后，仅pH监测的异常结果率有所提高，半量PPI时从38%提高到69%，全量PPI时从27%提高到69%，双倍剂量PPI时从0%提高到38%。
有症状的GERD患者在PPI治疗期间pH监测异常的发生率相对较低，尤其是在使用双倍剂量PPI的患者中。与单独进行pH监测相比，联合pH和Bilitec监测显著提高了PPI治疗难治性GERD患者持续存在的病理性反流发生率。
