Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt Medical Center, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt Medical Center, Nashville, Tennessee.
Gastroenterology. 2015 Feb;148(2):334-43. doi: 10.1053/j.gastro.2014.10.010. Epub 2014 Oct 16.
BACKGROUND & AIMS: Current diagnostic tests for gastroesophageal reflux disease (GERD) are suboptimal and do not accurately and reliably measure chronicity of reflux. A minimally invasive device has been developed to assess esophageal mucosal impedance (MI) as a marker of chronic reflux. We performed a prospective longitudinal study to investigate MI patterns in patients with GERD and common nonreflux conditions, to assess MI patterns before and after treatment with proton pump inhibitors and to compare the performance of MI and wireless pH tests.
We evaluated MI in 61 patients with erosive esophagitis, 81 with nonerosive but pH-abnormal GERD, 93 without GERD, 18 with achalasia, and 15 with eosinophilic esophagitis. MI was measured at the site of esophagitis and at 2, 5, and 10 cm above the squamocolumnar junction in all participants. MI was measured before and after acid suppressive therapy, and findings were compared with those from wireless pH monitoring.
MI values were significantly lower in patients with GERD (erosive esophagitis or nonerosive but pH-abnormal GERD) or eosinophilic esophagitis than in patients without GERD or patients with achalasia (P < .001). The pattern of MI in patients with GERD differed from that in patients without GERD or patients with eosinophilic esophagitis; patients with GERD had low MI closer to the squamocolumnar junction, and values increased axially along the esophagus. These patterns normalized with acid suppressive therapy. MI patterns identified patients with esophagitis with higher levels of specificity (95%) and positive predictive values (96%) than wireless pH monitoring (64% and 40%, respectively).
Based on a prospective study using a prototype device, measurements of MI detect GERD with higher levels of specificity and positive predictive values than wireless pH monitoring. Clinical Trials.gov, Number: NCT01556919.
目前用于胃食管反流病（GERD）的诊断测试并不理想，无法准确可靠地衡量反流的慢性程度。一种微创设备已被开发出来，用于评估食管黏膜阻抗（MI）作为慢性反流的标志物。我们进行了一项前瞻性纵向研究，以调查 GERD 患者和常见非反流疾病患者的 MI 模式，评估质子泵抑制剂治疗前后的 MI 模式，并比较 MI 和无线 pH 测试的性能。
我们评估了 61 例糜烂性食管炎、81 例非糜烂性但 pH 异常 GERD、93 例非 GERD、18 例贲门失弛缓症和 15 例嗜酸性食管炎患者的 MI。所有参与者在食管炎部位以及在鳞柱状交界上方 2、5 和 10cm 处测量 MI。在酸抑制治疗前后测量 MI，并将结果与无线 pH 监测进行比较。
GERD（糜烂性食管炎或非糜烂性但 pH 异常 GERD）或嗜酸性食管炎患者的 MI 值明显低于非 GERD 患者或贲门失弛缓症患者（P<0.001）。GERD 患者的 MI 模式与非 GERD 患者或嗜酸性食管炎患者不同；GERD 患者在接近鳞柱状交界的位置 MI 值较低，而沿着食管轴向 MI 值增加。这些模式在酸抑制治疗后恢复正常。MI 模式比无线 pH 监测识别食管炎患者具有更高的特异性（95%）和阳性预测值（96%）（分别为 64%和 40%）。
基于使用原型设备的前瞻性研究，MI 测量比无线 pH 监测具有更高的特异性和阳性预测值来检测 GERD。临床试验.gov，编号：NCT01556919。
