Patel Dhyanesh A, Harb Ali H, Vaezi Michael F
Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Curr Gastroenterol Rep. 2016 Mar;18(3):12. doi: 10.1007/s11894-016-0486-0.
The prevalence of gastroesophageal reflux disease (GERD) has been increasing since the 1990 s, with up to 27.8 % of people in North America affected by this disorder. The healthcare burden of patients who primarily have extra-esophageal manifestations of GERD (atypical GERD) is estimated to be 5 times that of patients with primarily heartburn and regurgitation due to lack of a gold standard diagnostic test, poor responsiveness to PPI therapy, and delay in recognition. Empiric twice daily PPI therapy for 1-2 months is currently considered the best diagnostic test, but due to poor responsiveness to PPIs in patients with atypical GERD in multiple randomized controlled trials, newer modes of diagnostic procedures such as oropharyngeal pH monitoring have gained significantly more traction. The utility of oropharyngeal pH monitoring systems such as Restech Dx-pH is currently limited due to lack of consensus on normal and abnormal cutoff values. Recent studies suggest its utility as a prognostic tool and its ability to predict responsiveness to medical and surgical therapy. However, routine use of oropharyngeal pH monitoring is still not widespread due to the lack of well-controlled prospective studies.
自20世纪90年代以来，胃食管反流病（GERD）的患病率一直在上升，北美高达27.8%的人受此疾病影响。由于缺乏金标准诊断测试、对质子泵抑制剂（PPI）治疗反应不佳以及诊断延迟，主要有食管外表现的GERD患者（非典型GERD）的医疗负担估计是主要有烧心和反流症状患者的5倍。目前，经验性每日两次PPI治疗1 - 2个月被认为是最佳诊断测试，但由于在多项随机对照试验中，非典型GERD患者对PPI反应不佳，较新的诊断程序模式，如口咽pH监测，已获得显著更多关注。由于对正常和异常临界值缺乏共识，Restech Dx-pH等口咽pH监测系统的实用性目前有限。最近的研究表明其作为一种预后工具的效用以及预测药物和手术治疗反应的能力。然而，由于缺乏严格对照的前瞻性研究，口咽pH监测的常规使用仍然不普遍。
