Kohata Yukie, Fujiwara Yasuhiro, Yamagami Hirokazu, Tanigawa Tetsuya, Shiba Masatsugu, Watanabe Kenji, Watanabe Toshio, Tominaga Kazunari, Arakawa Tetsuo
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Gastroenterol Hepatol. 2015 Mar;30 Suppl 1:36-40. doi: 10.1111/jgh.12743.
Approximately more than half of patients with non-erosive reflux disease (NERD) do not respond to proton pump inhibitor (PPI) therapy. Although NERD is a heterogeneous entity, previous study showed that multichannel intraluminal impedance (MII)-pH monitoring could distinguish reflux-related disease from PPI-refractory NERD. The aim of this study was to examine the usefulness of baseline impedance in PPI-refractory NERD patients.
We used MII-pH monitoring to analyze reflux parameters, symptom index (SI), and baseline impedance in 37 PPI-refractory NERD patients on PPI. Reflux was divided into acid (nadir pH ≤ 4) and non-acid (nadir pH > 4). Subjects were classified as having reflux-related disease based on abnormal reflux parameters or positive SI (≥ 50%), or non-reflux-related disease, including functional heartburn, based on negative SI with normal reflux parameters.
A total of 26 of the 37 subjects were diagnosed with reflux-related disease, including eight with acid-reflux type and 18 with non-acid-reflux type, and nine with functional heartburn and two with pseudohypersalivation. There were no significant differences in the clinical characteristics of the acid-reflux type, non-acid-reflux type, and functional heartburn groups. The baseline impedance value in the acid-reflux type (1245 ± 392 Ω) was significantly lower than that in the non-acid-reflux type (2824 ± 1160 Ω) and functional heartburn (3546 ± 1353 Ω) groups. Baseline impedance values inversely correlated with reflux percent time, acid-reflux time, and acid exposure time.
Among patients with PPI-refractory NERD, acid-reflux type was associated with lower baseline impedance compared with non-acid-reflux type and functional heartburn.
约半数以上的非糜烂性反流病（NERD）患者对质子泵抑制剂（PPI）治疗无反应。尽管NERD是一种异质性疾病，但先前的研究表明，多通道腔内阻抗（MII）-pH监测可将反流相关疾病与PPI难治性NERD区分开来。本研究的目的是探讨基线阻抗在PPI难治性NERD患者中的作用。
我们使用MII-pH监测分析了37例接受PPI治疗的PPI难治性NERD患者的反流参数、症状指数（SI）和基线阻抗。反流分为酸反流（最低pH值≤4）和非酸反流（最低pH值>4）。根据反流参数异常或SI阳性（≥50%），将受试者分类为患有反流相关疾病；根据反流参数正常且SI阴性，将受试者分类为非反流相关疾病，包括功能性烧心。
37例受试者中，共有26例被诊断为反流相关疾病，其中8例为酸反流型，18例为非酸反流型，9例为功能性烧心，2例为假性唾液分泌过多。酸反流型、非酸反流型和功能性烧心组的临床特征无显著差异。酸反流型组的基线阻抗值（1245±392Ω）显著低于非酸反流型组（2824±1160Ω）和功能性烧心组（3546±1353Ω）。基线阻抗值与反流时间百分比、酸反流时间和酸暴露时间呈负相关。
在PPI难治性NERD患者中，与非酸反流型和功能性烧心相比，酸反流型与较低的基线阻抗相关。
