Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-Dong, Seocho-Gu, Seoul, 137-040, Korea,
Dig Dis Sci. 2013 Oct;58(10):2933-9. doi: 10.1007/s10620-013-2728-4. Epub 2013 Jun 14.
It is difficult to differentiate functional heartburn from proton pump inhibitor (PPI) failure. The aims of this study were to assess the role of early wireless esophageal pH monitoring in patients referred with gastroesophageal reflux disease (GERD) and to identify differences in the clinical spectrum among GERD subtypes.
We enrolled consecutive referred patients with suspected GERD. After endoscopy on the first visit, all underwent wireless esophageal pH monitoring when off the PPI.
Two hundred thirty patients were enrolled. These patients were classified into a reflux esophagitis group (20, 8.7 %) and a normal endoscopic findings group (210, 91.3 %). Among the 210 patients in the normal endoscopic findings group, 63 (27.4 %) were diagnosed with pathological reflux, 35 (15.2 %) with hypersensitive esophagus, 87 (37.8 %) with normal acid exposure with negative symptom association, and 25 (10.9 %) with test failure. These groups did not differ in age, body mass index, smoking habit, alcohol consumption, symptom severity, quality of life, presence of atypical symptoms, overlap with irritable bowel syndrome, and the frequency of somatization, depression, and anxiety. PPI responses were evaluated in 135 patients. Fifty patients (37.0 %) were not responsive to the 4-week treatment; 26 (19.3 %) were diagnosed with refractory non-erosive gastroesophageal disease, and 24 (17.8 %) with functional heartburn. The demographics and clinical and psychological characteristics did not differ between the two groups.
Demographic characteristics and symptom patterns alone cannot differentiate functional heartburn from various subtypes of GERD. Wireless esophageal pH monitoring should be considered for the initial evaluation of GERD in the tertiary referral setting.
功能性烧心与质子泵抑制剂（PPI）失败之间的鉴别存在困难。本研究旨在评估胃食管反流病（GERD）患者中早期无线食管 pH 监测的作用，并确定 GERD 各亚型之间的临床谱差异。
我们连续纳入疑似 GERD 的就诊患者。首次就诊时行内镜检查后，所有患者均在停用 PPI 时行无线食管 pH 监测。
共纳入 230 例患者。这些患者被分为反流性食管炎组（20 例，8.7%）和内镜正常组（210 例，91.3%）。在内镜正常组的 210 例患者中，63 例（27.4%）被诊断为病理性反流，35 例（15.2%）为高敏感食管，87 例（37.8%）为酸暴露正常但症状关联阴性，25 例（10.9%）为试验失败。这些组在年龄、体重指数、吸烟习惯、饮酒、症状严重程度、生活质量、非典型症状存在、与肠易激综合征重叠、躯体化、抑郁和焦虑的发生频率方面无差异。在 135 例患者中评估了 PPI 反应。50 例（37.0%）对 4 周治疗无反应；26 例（19.3%）被诊断为难治性非糜烂性胃食管反流病，24 例（17.8%）为功能性烧心。两组在人口统计学特征和临床及心理特征方面无差异。
仅依靠人口统计学特征和症状模式无法区分功能性烧心与 GERD 的各种亚型。在三级转诊环境中，应考虑进行无线食管 pH 监测以对 GERD 进行初步评估。
