Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
Dig Liver Dis. 2011 Jul;43(7):542-7. doi: 10.1016/j.dld.2011.01.016. Epub 2011 Mar 3.
Functional heartburn is defined by Rome III criteria as an endoscopy-negative condition with normal oesophageal acid exposure time, negative symptom association to acid reflux and unsatisfactory response to proton pump inhibitors. These criteria underestimated the role of non-acid reflux.
To assess the contribution of impedance-pH with symptom association probability (SAP) analysis in identifying endoscopy-negative patients with reflux disease and separating them from functional heartburn.
Consecutive endoscopy-negative patients treated with proton pump inhibitors (n=219) undergoing impedance-pH monitoring off-therapy were analysed. Distal acid exposure time, reflux episodes, SAP and symptomatic response to proton pump inhibitors were measured.
Based on impedance-pH/SAP, 67 (31%) patients were pH+/SAP+, 6 (2%) pH+/SAP-, 83 (38%) hypersensitive oesophagus and 63 (29%) functional heartburn. According to pH-metry alone/response to proton pump inhibitors, 62 (28%) were pH+/SAP+, 11 (5%) pH+/SAP-, 61 (28%) hypersensitive oesophagus and 85 (39%) functional heartburn. In the normal-acid exposure population the contribution of impedance-pH/SAP compared to pH-metry alone/response to proton pump inhibitors in identifying patients with reflux disease and functional heartburn resulted to be 10%. In patients with abnormal-acid exposure, the contribution of impedance-pH/SAP increased by 3%.
Comparing impedance-pH testing with pH-metry alone plus the response to proton pump inhibitor therapy demonstrated that the latter ones cause underestimation of reflux disease patients and overestimation of functional heartburn patients.
根据罗马 III 标准，功能性烧心被定义为内镜阴性，食管酸暴露时间正常，酸反流与症状无关联，质子泵抑制剂治疗效果不佳。这些标准低估了非酸性反流的作用。
评估阻抗-pH 与症状关联概率（SAP）分析在识别内镜阴性反流病患者中的作用，并将其与功能性烧心区分开来。
分析了连续接受质子泵抑制剂（PPI）治疗的内镜阴性患者（n=219），这些患者在停药期间进行阻抗-pH 监测。测量远端酸暴露时间、反流事件、SAP 和质子泵抑制剂的症状反应。
根据阻抗-pH/SAP，67（31%）例患者为 pH+/SAP+，6（2%）例 pH+/SAP-，83（38%）例为高敏感食管，63（29%）例为功能性烧心。根据 pH 监测/质子泵抑制剂的反应，62（28%）例为 pH+/SAP+，11（5%）例 pH+/SAP-，61（28%）例为高敏感食管，85（39%）例为功能性烧心。在正常酸暴露人群中，与 pH 监测/质子泵抑制剂的反应相比，阻抗-pH/SAP 对识别反流病和功能性烧心患者的贡献增加了 10%。在酸暴露异常的患者中，阻抗-pH/SAP 的贡献增加了 3%。
与 pH 监测/质子泵抑制剂的反应相比，阻抗-pH 检测更能准确识别反流病患者，而低估了功能性烧心患者。
