Xiao Yinglian, Liang Mengya, Peng Sui, Zhang Ning, Chen Minhu
Department of Gastroenterology and Hepatolgy.
Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Gastroenterol Hepatol. 2016 Feb;31(2):350-4. doi: 10.1111/jgh.13049.
About 30% of patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI). The reason for the PPI failure in Asian GERD patients has rarely been studied, and the therapy remained unclear. The aims were to explore the possible reasons for PPI failure and to treat these patients with the guidance of 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring.
Thirty-nine consecutive patients with refractory GERD were enrolled; 24-h MII-pH monitoring was performed on PPI. The refractory GERD patients were grouped into acid overexposure, non-acid reflux, and functional heartburn after the MII-pH monitoring. Double dose of either PPI or paroxetine was administered to refractory GERD patients within different groups.
The number of patients in groups of acid overexposure, non-acid reflux, and functional heartburn was 6, 12, and 21, respectively. The acid overexposure group had the most acid reflux events. Among the acid overexposure group, five (5/6) patients accomplish symptom relief with double dose of esomeprazole. For the patients in non-acid reflux group, double dose of esomeprazole made half (6/12) of the patients obtain symptom relief. For the patients in functional heartburn group, the paroxetine had relieved the symptoms in 14 patients among all the 21 patients. In total, with the guidance of MII-pH monitoring, 64.1% (25/39) of refractory GERD patients accomplished symptom relief.
Acid overexposure, non-acid reflux, and functional heartburn were the common reasons for persistent reflux symptoms despite PPI. With the guidance of MII-pH, a tailored therapy could resolve the persistent reflux symptoms among two-third of patients.
约30%的胃食管反流病（GERD）患者对质子泵抑制剂（PPI）治疗无效。亚洲GERD患者PPI治疗失败的原因鲜有研究，治疗方法仍不明确。本研究旨在探讨PPI治疗失败的可能原因，并在24小时多通道腔内阻抗-pH（MII-pH）监测的指导下对这些患者进行治疗。
连续纳入39例难治性GERD患者；对正在接受PPI治疗的患者进行24小时MII-pH监测。MII-pH监测后，将难治性GERD患者分为酸暴露过度、非酸反流和功能性烧心组。对不同组别的难治性GERD患者给予双倍剂量的PPI或帕罗西汀。
酸暴露过度组、非酸反流组和功能性烧心组的患者人数分别为6例、12例和21例。酸暴露过度组的酸反流事件最多。在酸暴露过度组中，5例（5/6）患者使用双倍剂量的埃索美拉唑后症状缓解。对于非酸反流组的患者，双倍剂量的埃索美拉唑使一半（6/12）的患者症状缓解。对于功能性烧心组的患者，帕罗西汀使21例患者中的14例症状缓解。总体而言，在MII-pH监测的指导下，64.1%（25/39）的难治性GERD患者症状缓解。
酸暴露过度、非酸反流和功能性烧心是尽管使用PPI但反流症状仍持续存在的常见原因。在MII-pH监测的指导下，个体化治疗可使三分之二的患者解决持续的反流症状。
