Shi Y, Tan N, Zhang N, Xiong L, Peng S, Lin J, Chen M, Xiao Y
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
Department of Gastroenterology, Shanxi Cancer Hospital, Taiyuan, Shanxi Province, China.
Neurogastroenterol Motil. 2016 May;28(5):674-9. doi: 10.1111/nmo.12763. Epub 2016 Jan 14.
Approximately one-third of gastroesophageal reflux disease (GERD) patients have symptoms resistant to proton pump inhibitor (PPI). We used the high-resolution manometry (HRM) and multichannel intraluminal impedance-pH (MII-pH) monitoring to investigate potential predictors of PPI failure in non-erosive reflux disease (NERD) patients.
One hundred and seventeen NERD patients were included, within which there were 44 PPI failure patients. The symptomatic questionnaire GerdQ, HRM and 24-hour MII-pH monitoring were performed before PPI therapy. PPI failure was defined as persistent reflux symptoms for more than 1 day during the last week on esomeprazole (20 mg twice daily) for continuous 4 weeks. The predictors for PPI failure were investigated by multivariable logistic regression analysis.
Proton pump inhibitor failure patients had lower body mass index (BMI) and more concomitant functional dyspepsia (FD) symptoms. PPI failure patients had a higher percentage of type I esophagogastric junction (EGJ) morphology (p = 0.005), increased EGJ augmentation (p = 0.000), higher prevalence of esophageal motility disorders (p = 0.005) and a higher ratio of negative symptom index (SI, p = 0.000). Multivariable regression analysis showed that concomitance of FD symptoms, EGJ augmentation and negative SI were independent risk factors for PPI failure in NERD.
CONCLUSIONS & INFERENCES: Approximately half of PPI failure patients were found to have esophageal motility disorders in HRM. The independent risk factors for PPI failure in NERD were concomitant FD symptoms, increased EGJ augmentation and negative SI.
约三分之一的胃食管反流病（GERD）患者对质子泵抑制剂（PPI）治疗反应不佳。我们采用高分辨率测压法（HRM）和多通道腔内阻抗-pH监测（MII-pH）来研究非糜烂性反流病（NERD）患者中PPI治疗失败的潜在预测因素。
纳入117例NERD患者，其中44例为PPI治疗失败患者。在PPI治疗前进行症状问卷GerdQ、HRM和24小时MII-pH监测。PPI治疗失败定义为在连续4周每天两次服用埃索美拉唑（20 mg）的最后一周内，持续反流症状超过1天。通过多变量逻辑回归分析研究PPI治疗失败的预测因素。
PPI治疗失败的患者体重指数（BMI）较低，同时伴有功能性消化不良（FD）症状的比例更高。PPI治疗失败的患者I型食管胃交界（EGJ）形态比例更高（p = 0.005），EGJ扩张增加（p = 0.000），食管动力障碍的患病率更高（p = 0.005），症状指数阴性（SI）的比例更高（p = 0.000）。多变量回归分析显示，FD症状、EGJ扩张和SI阴性是NERD患者PPI治疗失败的独立危险因素。
在HRM检查中，约一半PPI治疗失败的患者存在食管动力障碍。NERD患者PPI治疗失败的独立危险因素为合并FD症状、EGJ扩张增加和SI阴性。
