Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Am J Gastroenterol. 2010 May;105(5):1032-8. doi: 10.1038/ajg.2009.646. Epub 2009 Nov 17.
The value of gastroesophageal reflux disease (GERD) indicators (acid exposure time (AET), symptom association probability (SAP), and symptom index (SI)) in predicting therapeutic success in noncardiac chest pain (NCCP) has not been systematically evaluated in outcome studies.
We retrospectively identified 98 subjects with NCCP (age 51.8+/-1.2 years, 75 women, mean duration of symptoms 7.3+/-0.4 years) who underwent pH monitoring off antireflux therapy. Distal esophageal AET (abnormal if > or = 4.0%), SAP (measured as Ghillibert probability estimate, abnormal if P<0.05), and SI (abnormal if > or = 50%) were calculated; symptom severity and change after therapy were assessed on a 10-point Likert scale. Subjects were interviewed 2.8+/-0.9 years after the pH study to determine the degree of symptom change (high-degree response (HDR), with definite, sustained symptom improvement) after antireflux therapy. Regression analysis was used to determine the independent predictors of HDR.
GERD indicators were present in 61 subjects (62.2%); 52 subjects (53.1%) had abnormal AET, 26 (26.5%) had positive SAP, and 25 (25.5%) had positive SI. With therapy, mean symptom scores improved from 6.3+/-0.3 at the time of the pH study to 2.9+/-0.3 at the time of interview (P<0.001). A total of 58 subjects (59.2%) achieved HDR, and another 29.6% had moderate symptom improvement. On univariate analysis, HDR was associated with positive SAP (P=0.003) and elevated AET (P=0.015) but not with demographics, SI, or esophageal motor pattern. In regression analysis containing demographics, GERD indicators, psychiatric comorbidity, and esophageal motor pattern, positive SAP was retained as a significant predictor of HDR (P=0.003); elevated AET trended toward significance (P=0.055). Frequency of HDR was highest when subjects had all three GERD parameters abnormal (93.3% HDR) or both elevated AET and positive SAP (88.2% HDR, P<0.001 compared with only one or no GERD parameter abnormal).
Positive statistical tests of symptom association predict the therapeutic success of GERD management in NCCP. When used hierarchically, response to antireflux therapy is best predicted when GERD parameters are all abnormal and poorest when parameters are normal. These results support the importance of GERD, the relevance of symptom association testing during ambulatory pH monitoring, and the value of intensive antireflux therapy in NCCP.
胃食管反流病（GERD）指标（酸暴露时间（AET）、症状关联概率（SAP）和症状指数（SI））在预测非心源性胸痛（NCCP）治疗成功中的价值尚未在结局研究中得到系统评价。
我们回顾性地确定了 98 例 NCCP 患者（年龄 51.8+/-1.2 岁，75 名女性，症状平均持续时间 7.3+/-0.4 年），这些患者在接受抗反流治疗前进行了 pH 监测。计算远端食管 AET（异常如果>或=4.0%）、SAP（以 Ghillibert 概率估计测量，异常如果 P<0.05）和 SI（异常如果>或=50%）；在 10 分制量表上评估治疗前后的症状严重程度和变化。在 pH 研究后 2.8+/-0.9 年对受试者进行访谈，以确定抗反流治疗后症状变化的程度（高反应度（HDR），症状有明确、持续改善）。回归分析用于确定 HDR 的独立预测因素。
61 例（62.2%）存在 GERD 指标；52 例（53.1%）AET 异常，26 例（26.5%）SAP 阳性，25 例（25.5%）SI 阳性。经过治疗，平均症状评分从 pH 研究时的 6.3+/-0.3 分改善至访谈时的 2.9+/-0.3 分（P<0.001）。共有 58 例（59.2%）达到 HDR，另有 29.6%有中度症状改善。单因素分析显示，HDR 与 SAP 阳性（P=0.003）和 AET 升高（P=0.015）相关，但与人口统计学、SI 或食管动力模式无关。在包含人口统计学、GERD 指标、精神共病和食管动力模式的回归分析中，SAP 阳性被保留为 HDR 的显著预测因素（P=0.003）；AET 升高呈显著趋势（P=0.055）。当受试者的所有三种 GERD 参数异常（93.3% HDR）或 AET 升高和 SAP 阳性时，HDR 的频率最高（88.2% HDR，与仅一个或没有 GERD 参数异常相比，P<0.001）。
症状关联的阳性统计检验预测了 NCCP 中 GERD 管理的治疗成功。当按层次使用时，当 GERD 参数全部异常时，对反流治疗的反应最佳，而当参数正常时最差。这些结果支持 GERD 的重要性、动态 pH 监测期间症状关联测试的相关性以及 NCCP 中强化抗反流治疗的价值。
