van Wijk M P, Sifrim D, Rommel N, Benninga M A, Davidson G P, Omari T I
Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2009 Aug;21(8):825-e55. doi: 10.1111/j.1365-2982.2009.01289.x. Epub 2009 Mar 12.
Multichannel intraluminal impedance (MII) recording allows assessment of flow through the oesophagus and differentiation between liquid and gas contents. Existing MII criteria for recognition of gas gastro-oesophageal reflux (GOR) have not been validated during known gas GOR in humans.
(i) Characterize MII patterns of known gas GOR and optimize criteria. (ii) Clarify interrelationships between magnitude of maximal impedance change, luminal diameter and electrode-mucosa contact. Ten healthy volunteers (six male, 21-37 years) were studied using an oesophageal MII-manometry catheter. After catheter placement, subjects were asked to drink 600 mL of carbonated soft drink. Recordings were made for 20 min and the protocol repeated. Reported belches confirmed manometrically (triggered by transient lower oesophageal sphincter relaxations) were included for analysis. Those episodes were compared against commonly used criteria. Another five subjects (three male, 26-52 years) underwent simultaneous MII and videofluoroscopy using the same protocol. Videofluoroscopic images were analyzed for luminal diameter and the presence of electrode-mucosa contact. All analyzed gas GOR episodes (n = 88) were associated with a pattern of impedance rise which was either retrograde (62.5%), synchronous (19.3%) or antegrade (18.2%). Depending on the exact criteria used, sensitivity ranged from 33% to 75%. A multivariate regression model including luminal diameter and the presence of electrode-mucosa contact as independent factors accounted for 53% of all variation in impedance changes. In conclusion, a significant number of gas GOR episodes does not meet criteria for their recognition. New criteria are proposed to include specific antegrade patterns of impedance rise. Luminal diameter and the extent of contact between the oesophageal mucosa and MII-electrodes influence the magnitude and patterning of impedance change.
多通道腔内阻抗（MII）记录可用于评估食管内的流动情况，并区分液体和气体成分。现有的用于识别气体性胃食管反流（GOR）的MII标准尚未在已知的人体气体性GOR期间得到验证。
（i）描述已知气体性GOR的MII模式并优化标准。（ii）阐明最大阻抗变化幅度、管腔直径和电极与黏膜接触之间的相互关系。使用食管MII测压导管对10名健康志愿者（6名男性，21 - 37岁）进行了研究。导管放置后，要求受试者饮用600 mL碳酸软饮料。记录20分钟，并重复该方案。经测压确认（由食管下括约肌短暂松弛触发）的嗳气被纳入分析。将这些发作与常用标准进行比较。另外5名受试者（3名男性，26 - 52岁）使用相同方案同时进行MII和视频透视检查。对视频透视图像进行管腔直径和电极与黏膜接触情况的分析。所有分析的气体性GOR发作（n = 88）均与阻抗上升模式相关，该模式可为逆行（62.5%）、同步（19.3%）或顺行（18.2%）。根据所使用的确切标准，敏感性范围为33%至75%。一个包含管腔直径和电极与黏膜接触情况作为独立因素的多元回归模型解释了阻抗变化中所有变异的53%。总之，大量气体性GOR发作不符合其识别标准。建议采用新的标准，包括特定的顺行性阻抗上升模式。管腔直径以及食管黏膜与MII电极之间的接触程度会影响阻抗变化的幅度和模式。
