Domingues Gerson Ricardo de Souza, Moraes-Filho Joaquim Prado P, Domingues Aline Gonçalves Leite
Laboratório de Motilidade Digestiva, Rio de Janeiro, RJ, Brazil.
Arq Gastroenterol. 2011 Jan-Mar;48(1):24-9. doi: 10.1590/s0004-28032011000100006.
Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring.
To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association.
A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included.
Successful pH data over 48-h was obtained in 95% of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4%) that would be missed if only day 1 was analyzed. Three patients (18.7%) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4%.
Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.
胃食管反流病是最常见的消化系统疾病之一，也是患者痛苦的重要原因。这种疾病的诊断可能需要动态pH监测。
确定一种48小时的无线动态pH监测系统的诊断率，该系统用于记录异常食管酸暴露的每日变化及其与症状的关联。
2004年至2009年，共有100例持续有反流症状的患者接受了无线pH胶囊放置。在通过测压确定食管下括约肌后，将无线pH胶囊放置在鳞柱状交界处近端5厘米处。从记录无线pH胶囊pH信号的接收器将数据上传到计算机后，获取48小时的pH记录。分析以下参数：（1）食管远端酸暴露的百分比时间；（2）与酸反流相关的症状关联概率。比较第一天和第二天的结果，并纳入第二天监测时的诊断率。
95%的患者获得了48小时的成功pH数据。近四分之一的患者出现了从异物感胸痛等症状。与单独分析第1天和第2天相比，48小时pH数据分析具有统计学意义。第2天的研究发现，如果仅分析第1天，7例患者（30.4%）会被漏诊。在两天食管酸暴露均正常的16例患者中，有3例（18.7%）显示出阳性症状关联概率，这使诊断率提高了43.4%。
无线胶囊食管pH监测安全、耐受性好，无需镇静。延长至48小时的研究提高了胃食管反流病患者的诊断率。
