Division of Thoracic Foregut Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.
Surg Endosc. 2011 Jul;25(7):2219-23. doi: 10.1007/s00464-010-1529-5. Epub 2011 Feb 27.
The Bravo capsule allows monitoring of esophageal acid exposure over a two-day period. Experience has shown that 24-32% of patients will have abnormal esophageal acid exposure detected on only one of the 2 days monitored. This variation has been explained by the effect of endoscopy and sedation. The aim of this study was to assess the day-to-day discrepancy following transnasal placement of the Bravo capsule without endoscopy or sedation and to determine factors related to this variability.
Bravo pH monitoring was performed by transnasal placement of the capsule in 310 patients. Patients were divided into groups based on the composite pH score: both days normal, both days abnormal and only one of the 2 days abnormal. Lower esophageal sphincter (LES) characteristics were compared between groups.
Of the 310 patients evaluated, 60 (19%) showed a discrepancy between the 2 days. A total of 127 patients had a normal pH score on both days and 123 had an abnormal pH score on both days. Of the 60 patients with a discrepancy, 27 were abnormal the first day and 33 (55%) were abnormal the second day. Patients with abnormal esophageal acid exposure on both days had higher degrees of esophageal acid exposure and were more likely to have a defective LES compared to those with an abnormal score on only one day (35 vs. 83%, p=0.027).
Patients with a discrepancy between days of Bravo pH monitoring have lower esophageal acid exposure. Variability between the 2 days represents early deterioration of the gastroesophageal barrier and indicates less advanced reflux disease.
Bravo 胶囊可监测两天内的食管酸暴露情况。经验表明，在监测的两天中，有 24%-32%的患者仅在其中一天检测到食管酸暴露异常。这种差异可以通过内镜检查和镇静的影响来解释。本研究旨在评估 Bravo 胶囊经鼻放置后无需内镜检查和镇静的情况下，每日差异，并确定与这种可变性相关的因素。
310 例患者经鼻置入 Bravo pH 监测胶囊。根据复合 pH 评分将患者分为两组：两天均正常、两天均异常和仅一天异常。比较两组之间的食管下括约肌（LES）特征。
在 310 例评估的患者中，有 60 例（19%）出现了两天之间的差异。共有 127 例患者两天的 pH 评分均正常，123 例患者两天的 pH 评分均异常。在 60 例有差异的患者中，第一天异常的有 27 例，第二天异常的有 33 例（55%）。两天食管酸暴露异常的患者食管酸暴露程度较高，且 LES 功能不全的可能性较仅一天异常的患者更大（35%比 83%，p=0.027）。
Bravo pH 监测两天之间有差异的患者食管酸暴露程度较低。两天之间的差异代表胃食管屏障的早期恶化，并表明反流性疾病进展程度较轻。
