Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.
Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.
Clin Gastroenterol Hepatol. 2015 Jun;13(6):1082-8.e1. doi: 10.1016/j.cgh.2014.11.035. Epub 2014 Dec 11.
BACKGROUND & AIMS: Esophageal impedance measurements have been proposed to indicate the status of the esophageal mucosa, and might be used to study the roles of the impaired mucosal integrity and increased acid sensitivity in patients with heartburn. We compared baseline impedance levels among patients with heartburn who did and did not respond to proton pump inhibitor (PPI) therapy, along with the pathophysiological characteristics of functional heartburn (FH). METHODS: In a case-control study, we collected data from January to December 2013 on patients with heartburn and normal findings from endoscopy who were not receiving PPI therapy and underwent impedance pH testing at hospitals in Italy. Patients with negative test results were placed on an 8-week course of PPI therapy (84 patients received esomeprazole and 36 patients received pantoprazole). Patients with more than 50% symptom improvement were classified as FH/PPI responders and patients with less than 50% symptom improvement were classified as FH/PPI nonresponders. Patients with hypersensitive esophagus and healthy volunteers served as controls. In all patients and controls, we measured acid exposure time, number of reflux events, baseline impedance, and swallow-induced peristaltic wave indices. RESULTS: FH/PPI responders had higher acid exposure times, numbers of reflux events, and acid refluxes compared with FH/PPI nonresponders (P < .05). Patients with hypersensitive esophagus had mean acid exposure times and numbers of reflux events similar to those of FH/PPI responders. Baseline impedance levels were lower in FH/PPI responders and patients with hypersensitive esophagus, compared with FH/PPI nonresponders and healthy volunteers (P < .001). Swallow-induced peristaltic wave indices were similar between FH/PPI responders and patients with hypersensitive esophagus. CONCLUSIONS: Patients with FH who respond to PPI therapy have impedance pH features similar to those of patients with hypersensitive esophagus. Baseline impedance measurements might allow for identification of patients who respond to PPIs but would be classified as having FH based on conventional impedance-pH measurements.
背景与目的：食管阻抗测量已被提出用于指示食管黏膜状况，并可能用于研究受损黏膜完整性和酸敏感性增加在烧心患者中的作用。我们比较了质子泵抑制剂（PPI）治疗有效和无效的烧心患者的基础阻抗水平，以及功能性烧心（FH）的病理生理特征。
方法：在一项病例对照研究中，我们收集了 2013 年 1 月至 12 月期间在意大利医院接受阻抗 pH 测试且未接受 PPI 治疗的无烧心内镜发现的患者的数据。阴性测试结果的患者接受 8 周的 PPI 治疗（84 例患者接受埃索美拉唑，36 例患者接受泮托拉唑）。症状改善超过 50%的患者被归类为 FH/PPI 应答者，症状改善小于 50%的患者被归类为 FH/PPI 非应答者。食管高敏感患者和健康志愿者作为对照。在所有患者和对照中，我们测量了酸暴露时间、反流事件次数、基础阻抗和吞咽诱导蠕动波指数。
结果：FH/PPI 应答者的酸暴露时间、反流事件次数和酸反流均高于 FH/PPI 非应答者（P<0.05）。食管高敏感患者的酸暴露时间和反流事件次数与 FH/PPI 应答者相似。FH/PPI 应答者和食管高敏感患者的基础阻抗水平均低于 FH/PPI 非应答者和健康志愿者（P<0.001）。FH/PPI 应答者和食管高敏感患者的吞咽诱导蠕动波指数相似。
结论：对 PPI 治疗有反应的 FH 患者的阻抗 pH 特征与食管高敏感患者相似。基础阻抗测量可能有助于识别对 PPI 有反应但根据传统阻抗-pH 测量被归类为 FH 的患者。
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