Kwasnicki R M, Ley Greaves R, Ali R, Gummett P A, Yang G Z, Darzi A, Hoare J
Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.
Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
Dis Esophagus. 2016 Apr;29(3):255-61. doi: 10.1111/dote.12312. Epub 2015 Jan 27.
Conventional catheter-based systems used for ambulatory esophageal pH monitoring have been reported to affect patient behavior. As physical activity has been associated with gastroesophageal reflux disease (GERD), there is a risk that abnormal behavior will degrade the value of this diagnostic investigation and consequent management strategies. The aim of this study was to quantify the effect of conventional pH monitoring on behavior and to investigate the temporal association between activity and reflux. A total of 20 patients listed for 24 hours pH monitoring underwent activity monitoring using a lightweight ear-worn accelerometer (e-AR sensor, Imperial College London) 2 days prior to, and during their investigation. PH was measured and recorded using a conventional nasogastric catheter and waist-worn receiver. Daily activity levels, including subject-specific activity intensity quartiles, were calculated and compared. Physical activity was added to the standard pH output to supplement interpretation. Average patient activity levels decreased by 26.5% during pH monitoring (range -4.5 to 51.0%, P = 0.036). High-intensity activity decreased by 24.4% (range -4.0 to 75.6%, P = 0.036), and restful activity increased on average by 34% although this failed to reach statistical significance (-24.0 to 289.2%, P = 0.161). Some patients exhibited consistent associations between bouts of activity and acidic episodes. The results of this study support the previously reported reduction in activity during ambulatory esophageal pH monitoring, with the added reliability of objective data. In the absence of more pervasive pH monitoring systems (e.g. wireless), quantifying activity changes in the setting of activity-induced reflux might guide the physicians' interpretation of patient DeMeester scores resulting in more appropriate management of GERD.
据报道，用于动态食管pH监测的传统导管系统会影响患者行为。由于身体活动与胃食管反流病（GERD）有关，存在异常行为会降低这项诊断检查及后续管理策略价值的风险。本研究的目的是量化传统pH监测对行为的影响，并研究活动与反流之间的时间关联。共有20名计划进行24小时pH监测的患者在检查前2天及检查期间使用轻便的耳戴式加速度计（e-AR传感器，伦敦帝国理工学院）进行活动监测。使用传统的鼻胃管和腰部佩戴的接收器测量并记录pH值。计算并比较每日活动水平，包括特定受试者的活动强度四分位数。将身体活动添加到标准pH输出中以辅助解读。在pH监测期间，患者的平均活动水平下降了26.5%（范围为-4.5%至51.0%，P = 0.036）。高强度活动下降了24.4%（范围为-4.0%至75.6%，P = 0.036），安静活动平均增加了34%，尽管未达到统计学显著性（-24.0%至289.2%，P = 0.161）。一些患者在活动发作与酸性发作之间表现出一致的关联。本研究结果支持先前报道的动态食管pH监测期间活动减少的情况，同时客观数据具有更高的可靠性。在缺乏更普及的pH监测系统（如无线系统）的情况下，量化活动诱发反流情况下的活动变化可能会指导医生对患者DeMeester评分的解读，从而对GERD进行更恰当的管理。
