Savarino Edoardo, Zentilin Patrizia, Tutuian Radu, Pohl Daniel, Casa Domenico D, Frazzoni Marzio, Cestari Renzo, Savarino Vincenzo
Di.M.I. Cattedra di Gastroenterologia, Università di Genova, Genova, Italy.
Am J Gastroenterol. 2008 Nov;103(11):2685-93. doi: 10.1111/j.1572-0241.2008.02119.x. Epub 2008 Sep 4.
Nonerosive reflux disease (NERD) is the most common form of gastroesophageal reflux disease. While the role of acid reflux has been established, the relevance of nonacid reflux in generating symptoms in NERD is unknown.
To evaluate the diagnostic utility of impedance-pH monitoring in NERD patients.
Patients with typical reflux symptoms (heartburn and/or regurgitation) and normal endoscopy (NERD) underwent a combined impedance-pH monitoring off proton pump inhibitor (PPI) therapy. Previously investigated 48 healthy volunteers served as controls. Distal esophageal acid exposure (% time pH < 4), number of acid and nonacid reflux episodes, 2-min window symptom index (SI; positive if > or = 50%), and symptom association probability (SAP; positive if > or = 95%) were calculated.
Between June 2004 and June 2007, 150 NERD patients (82 women, mean age 48 yr, range 18-78 yr) reported symptoms during the impedance-pH monitoring. NERD patients had more reflux episodes (median [25th-75th percentile]) compared with healthy volunteers (total: 46 [26-65] vs 32 [18-43], P < 0.05; acid: 29 [14-43] vs 17 [8.5-31.0], P < 0.05; and nonacid: 20 [15-27] vs 18 [13.5-26.0], P = NS). Sixty-three (42%) patients had abnormal % time pH < 4. Among 87 patients with normal % time pH < 4., 22 (15%) had a positive SAP for acid, 19 (12%) for nonacid reflux, and 7 (5%) for both. Classifying patients with symptomatic nonacid reflux as having a hypersensitive esophagus reduced the number of patients with functional heartburn from 65 (43%) to 39 (26%).
Monitoring for nonacid reflux in NERD patients reduces the proportion of patients classified as having "functional heartburn." Studies assessing the clinical implications of these findings are warranted.
非糜烂性反流病（NERD）是胃食管反流病最常见的形式。虽然酸反流的作用已得到证实，但非酸反流在NERD症状产生中的相关性尚不清楚。
评估阻抗-pH监测在NERD患者中的诊断效用。
有典型反流症状（烧心和/或反流）且内镜检查正常（NERD）的患者在停用质子泵抑制剂（PPI）治疗后进行联合阻抗-pH监测。先前研究的48名健康志愿者作为对照。计算食管远端酸暴露（pH<4的时间百分比）、酸和非酸反流发作次数、2分钟窗口症状指数（SI；若≥50%则为阳性）以及症状关联概率（SAP；若≥95%则为阳性）。
2004年6月至2007年6月期间，150例NERD患者（82名女性，平均年龄48岁，范围18 - 78岁）在阻抗-pH监测期间报告有症状。与健康志愿者相比，NERD患者有更多的反流发作（中位数[第25 - 75百分位数]）（总计：46[26 - 65]对32[18 - 43]，P<0.05；酸反流：29[14 - 43]对17[8.5 - 31.0]，P<0.05；非酸反流：20[15 - 27]对18[13.5 - 26.0]，P =无显著差异）。63例（42%）患者的pH<4时间百分比异常。在87例pH<4时间百分比正常的患者中，22例（15%）酸反流的SAP为阳性，19例（12%）非酸反流的SAP为阳性，7例（5%）两者均为阳性。将有症状性非酸反流的患者归类为食管过敏，使功能性烧心患者的数量从65例（43%）减少至39例（26%）。
监测NERD患者的非酸反流可减少被归类为“功能性烧心”的患者比例。有必要开展评估这些发现临床意义的研究。
