Cho Yu Kyung, Choi Myung-Gyu, Lim Chul Hyun, Nam Kwan Woo, Chang Jae Hyuck, Park Jae Myung, Lee In Seok, Kim Sang Woo, Choi Kyu Yong, Chung In-Sik
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
Scand J Gastroenterol. 2010 May;45(5):533-9. doi: 10.3109/00365521003650172.
Data supporting the use of the proton pump inhibitor (PPI) test as a diagnostic test of gastroesophageal reflux disease (GERD) in Asia are lacking. The aims of this study were to evaluate the diagnostic characteristics of the PPI test and factors associated with responsiveness to PPIs.
The PPI test was evaluated using lansoprazole (30 mg bid) for two weeks. All patients underwent endoscopy after symptom assessment. Patients without erosive esophagitis (ERD) underwent 48 h esophageal Bravo pH monitoring. Subjects were considered to be responsive to PPIs if they reported a > 50% reduction in reflux symptom score.
Seventy-three patients (M:F = 40:37, 47 +/- 13 years) were enrolled. We identified 46 patients with ERD, 18 patients with nonerosive reflux disease (NERD) and 9 patients without GERD. The PPI response rate was higher in patients with GERD than in patients without GERD (49/64, 77% vs. 4/9, 44%; p < 0.05). The sensitivity, specificity, and positive and negative predictive values were 77%, 56%, 92% and 25%, respectively. The PPI responsiveness was 80% (37/46) in the ERD group and 67% (12/18) in the NERD group. PPI response was not affected by age, sex, Helicobacter pylori, the psychological characteristics or cytochrome P2C genotypes. ERD and symptom-reflux association were the factors affecting PPI responsiveness.
The PPI test was modestly sensitive and specific for diagnosing GERD. However, it would be useful for discriminating patients with ERD. In the NERD group, patients with positive symptom-reflux association would be most benefit from PPI treatment.
在亚洲，缺乏支持将质子泵抑制剂（PPI）试验用作胃食管反流病（GERD）诊断试验的数据。本研究的目的是评估PPI试验的诊断特征以及与PPI反应性相关的因素。
使用兰索拉唑（30mg，每日两次）进行为期两周的PPI试验。所有患者在症状评估后接受内镜检查。无糜烂性食管炎（ERD）的患者接受48小时食管Bravo pH监测。如果患者报告反流症状评分降低>50%，则认为其对PPI有反应。
纳入73例患者（男:女 = 40:37，47±13岁）。我们确定了46例ERD患者、18例非糜烂性反流病（NERD）患者和9例无GERD患者。GERD患者的PPI反应率高于无GERD患者（49/64，77%对4/9，44%；p<0.05）。敏感性、特异性、阳性和阴性预测值分别为77%、56%、92%和25%。ERD组的PPI反应性为80%（37/46），NERD组为67%（12/18）。PPI反应不受年龄、性别、幽门螺杆菌、心理特征或细胞色素P2C基因型的影响。ERD和症状-反流关联是影响PPI反应性的因素。
PPI试验在诊断GERD方面具有一定程度的敏感性和特异性。然而，它对于鉴别ERD患者是有用的。在NERD组中，症状-反流关联阳性的患者将最受益于PPI治疗。
