Birmingham Baptist Internal Medicine Residency Program, Birmingham, Alabama 35222, USA.
Dis Esophagus. 2012 Nov-Dec;25(8):682-6. doi: 10.1111/j.1442-2050.2011.01310.x. Epub 2012 Jan 31.
Over half of patients with gastroesophageal reflux disease (GERD) report nocturnal symptoms. Proton pump inhibitors (PPIs) are the main medications used to treat GERD. Multichannel intraluminal impedance with pH (MII-pH) monitoring is the most sensitive method for detection and characterization of GERD. The aim of this study was to assess and compare reflux frequency in patients with refractory GERD symptoms on and off PPI therapy during the nocturnal recumbent period, as assessed by MII-pH testing. We analyzed 24-hour MII-pH studies performed in 200 patients monitored either on twice-daily (n = 100) or off (n = 100) PPI therapy. Demographic analysis of the on-therapy group revealed a mean age of 52 years (24-78 years) with 37% males, and the off-therapy group revealed a mean age of 49 years (18-84 years) with 40% males. All studies were interpreted to assess and characterize the number of acid and nonacid reflux episodes in the nocturnal recumbent period identified by each patient on an overnight recorder (Zephyr, Sandhill Scientific, Inc., Highlands Ranch, CO, USA). The nocturnal recumbent period was the period documented by patients during which they lie in the recumbent period at night to sleep with average periods lasting 456 and 453 minutes for patients on and off PPI therapy. There were more mean recumbent reflux episodes in the on-therapy group in comparison with the off-therapy group (3.76 mean reflux episodes [mre] per patient in the recumbent vs. 2.82 mre); the difference was not statistically significant (P = 0.187). When the reflux events are classified into acid and non-acid reflux episodes, the relative occurrence of acid reflux events is less in the on-therapy group (P = 0.047), while the off-therapy group have fewer nonacid reflux episodes (P = 0.003). PPIs decrease the acidity of esophageal refluxate but do not decrease the relative frequency of reflux episodes in the recumbent position in patients with refractory GERD despite twice-a-day treatment with PPI therapy. The explanation for the finding of numerically increased, although not statistically significant, amount of reflux episodes in the PPI treatment group in this study, and previous studies is unclear and warrants further evaluation.
超过一半的胃食管反流病（GERD）患者报告有夜间症状。质子泵抑制剂（PPIs）是治疗 GERD 的主要药物。多通道腔内阻抗-pH（MII-pH）监测是检测和表征 GERD 的最敏感方法。本研究旨在评估和比较接受和不接受 PPI 治疗的难治性 GERD 症状患者在夜间卧位期间通过 MII-pH 检测的反流频率。我们分析了 200 例接受 24 小时 MII-pH 监测的患者，这些患者要么接受每日两次（n=100）的 PPI 治疗，要么不接受 PPI 治疗（n=100）。治疗组的人口统计学分析显示，平均年龄为 52 岁（24-78 岁），其中 37%为男性，而不治疗组的平均年龄为 49 岁（18-84 岁），其中 40%为男性。所有研究均通过每个患者在夜间记录器上记录的夜间卧位期间评估和表征酸和非酸反流事件的数量来解释（Zephyr，Sandhill Scientific，Inc.，Highlands Ranch，CO，USA）。夜间卧位期是患者记录夜间卧位以睡眠的时间，接受和不接受 PPI 治疗的患者平均持续时间分别为 456 和 453 分钟。与不接受 PPI 治疗的患者相比，接受治疗的患者夜间卧位反流次数更多（仰卧位时每位患者平均有 3.76 次反流[MRE]）；但差异无统计学意义（P=0.187）。当将反流事件分类为酸反流和非酸反流事件时，治疗组的酸反流事件相对较少（P=0.047），而不治疗组的非酸反流事件较少（P=0.003）。尽管接受了每日两次的 PPI 治疗，PPI 可降低难治性 GERD 患者食管反流物的酸度，但不能降低卧位时反流事件的相对频率。在这项研究和之前的研究中，对于接受 PPI 治疗的患者组中，尽管反流事件的数量增加，但没有统计学意义的原因尚不清楚，需要进一步评估。
