Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Clin Gastroenterol Hepatol. 2012 Jun;10(6):620-5; quiz e57. doi: 10.1016/j.cgh.2012.02.012. Epub 2012 Feb 22.
BACKGROUND & AIMS: Ambulatory reflux testing is used to evaluate symptoms of gastroesophageal reflux disease (GERD) refractory to protein pump inhibitors (PPIs). We investigated the prevalence of PPI use in patients with negative results from Bravo pH or multichannel intraluminal impedance-pH (MII-pH) tests and factors that might predict the use of PPIs.
We analyzed data from patients who had undergone Bravo pH monitoring or MII-pH testing at Northwestern University, without evidence of reflux disease. Demographics, endoscopy findings, pathology results, and provider recommendations were obtained via chart review. Eligible patients (n = 90) were contacted by telephone, and a cross-sectional survey was administered with questions about symptom severity, demographics, medication use, and health behaviors. Patients were compared by current PPI use, and statistical analyses were performed by using SAS version 9.2 software.
Thirty-eight patients (42.2%) reported current PPI use despite a negative result from a pH study. Only 17 patients (18.9%) recalled being instructed to stop taking PPIs; chart review showed documented instructions to stop PPI therapy for 15 patients (16.7%). There were no significant differences in demographic or clinical characteristics among patients compared by current PPI use. Patients taking a PPI were more likely than those not taking a PPI to report troublesome symptoms that affected their daily life, as measured by a questionnaire for the diagnosis of GERD (the GerdQ).
More than 42% of patients with negative results from pH monitoring studies continue PPI therapy despite physiological data that they do not have GERD.
门诊反流测试用于评估对质子泵抑制剂（PPIs）治疗无反应的胃食管反流病（GERD）的症状。我们研究了 Bravo pH 或多通道腔内阻抗-pH（MII-pH）测试结果为阴性的患者中 PPI 使用的流行率，以及可能预测 PPI 使用的因素。
我们分析了在西北大学接受 Bravo pH 监测或 MII-pH 测试且无反流性疾病证据的患者的数据。通过病历回顾获得人口统计学、内镜检查结果、病理学结果和提供者建议。通过电话联系符合条件的患者（n=90），并进行横断面调查，调查内容包括症状严重程度、人口统计学、药物使用和健康行为。通过当前 PPI 使用情况对患者进行比较，并使用 SAS 版本 9.2 软件进行统计分析。
尽管 pH 研究结果为阴性，但 38 名患者（42.2%）报告目前正在使用 PPI。只有 17 名患者（18.9%）记得被指示停止使用 PPI；病历审查显示，有 15 名患者（16.7%）有记录的停止 PPI 治疗的医嘱。根据当前 PPI 使用情况比较患者时，在人口统计学或临床特征方面没有显著差异。与未使用 PPI 的患者相比，使用 PPI 的患者更有可能报告影响其日常生活的麻烦症状，这是通过 GERD 诊断问卷（GerdQ）来衡量的。
尽管生理数据表明他们没有 GERD，但超过 42%的 pH 监测研究结果为阴性的患者仍继续使用 PPI 治疗。
