Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Gastrointestin Liver Dis. 2009 Mar;18(1):11-5.
Gastroesophageal reflux disease (GERD) is a chronic condition that affects a large proportion of population. The aim of our study was to determine what percentages of patients with persistent heartburn on acid suppressive therapy have evidence of reflux disease while off acid suppressive therapy.
In a prospective study 48 patients with refractory heartburn from Taleghani Hospital were enrolled who had been on a double dose of proton pump inhibitor (PPI) for 8 weeks without improvement. Because of low index of suspicion for GERD as an etiology, all the patients underwent 24h pH-metry while off PPI. The variables of pH-metry such as the fraction time of pH <4 were evaluated by comparing to normal volunteers.
The mean "number of acid refluxes" was 49.98 in upright position and 6.29 in supine position. The mean "longest acid reflux" duration was 2.98 minutes in upright and 3.13 minutes in supine position. The total time fraction of pH <4 was 2.97% in upright position, 1.2 % in supine position and 2.74% in postprandial state. The mean DeMeester score was 10.06 (SD=10.48). However, the difference in the total fraction of time with pH <4 was not significant.
Our study showed that most of the patients with refractory heartburn did not have acid reflux. Patients with refractory heartburn often do not have evidence of reflux disease on pH monitoring, thus evaluating these patients should be performed while on acid suppressive therapy (using impedance-pH monitoring) in order to clarify the relationship between symptoms and acid and non-acid reflux.
胃食管反流病（GERD）是一种影响很大一部分人群的慢性疾病。我们研究的目的是确定在停止抑酸治疗后，持续性烧心的患者中有多少比例存在反流疾病的证据。
在一项前瞻性研究中，我们招募了来自 Taleghani 医院的 48 例难治性烧心患者，这些患者已经接受了双倍剂量质子泵抑制剂（PPI）治疗 8 周，但没有改善。由于对 GERD 作为病因的怀疑指数较低，所有患者在停止 PPI 后都进行了 24 小时 pH 监测。通过与正常志愿者进行比较，评估 pH 监测的变量，如 pH<4 的时间分数。
直立位时“酸反流次数”的平均值为 49.98，仰卧位时为 6.29。直立位时“最长酸反流持续时间”为 2.98 分钟，仰卧位时为 3.13 分钟。pH<4 的总时间分数在直立位时为 2.97%，仰卧位时为 1.2%，餐后状态时为 2.74%。平均 DeMeester 评分为 10.06（SD=10.48）。然而，pH<4 的总时间分数差异无统计学意义。
我们的研究表明，大多数难治性烧心患者没有酸反流。难治性烧心患者在 pH 监测中通常没有反流疾病的证据，因此应该在抑酸治疗（使用阻抗-pH 监测）时评估这些患者，以明确症状与酸和非酸反流之间的关系。
