Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Gastroenterol. 2018 Jan;113(1):31-38. doi: 10.1038/ajg.2017.263. Epub 2017 Sep 12.
Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary aim in this study was to identify factors associated with symptom perception among PPI non-responder phenotypes.
This prospective observational cohort study was performed from September 2014 to January 2017 at a single academic medical center and included PPI non-responders who underwent 24-h impedance-pH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress. Participants were separated into cohorts based on impedance-pH results: on PPI: -acid exposure time (AET)/-symptom-reflux association (SRA), +AET, and -AET/+SRA; off PPI: functional (-AET/-SRA), gastroesophageal reflux disease (GERD) (+AET), and reflux hypersensitivity (RHS) (-AET/+SRA). The primary outcome was abnormal GERD symptom severity defined by GerdQ≥8.
One hundred and ninety-two participants were included. Impedance-pH on PPI was performed on 125: 72 (58%) -AET/-SRA, 42 (34%) +AET, and 11 (9%) -AET/+SRA. Among the -AET/-SRA group, younger age, higher dysphagia scores, QOL impairment, and higher brief symptom index were associated with GerdQ≥8. Among the +AET group, higher number of reflux-associated symptoms and lower distal contractile integral was associated with GerdQ≥8. Impedance-pH off PPI was performed on 67 participants: 39 (58%) functional, 16 (24%) GERD, and 12 (18%) RHS. Among the functional group, higher QOL impairment and dysphagia scores were seen with GerdQ≥8.
Perceptions of reflux symptoms are associated with psychosocial distress, reduced QOL, and sensation of dysphagia among PPI non-responders with normal impedance-pH. Among PPI refractory GERD patients, patient-reported symptom severity is associated with physiological differences, as opposed to psychosocial factors.
多达 50%的反流症状患者对质子泵抑制剂 (PPI) 治疗没有表现出满意的症状反应。我们本研究的主要目的是确定与 PPI 无反应表型的症状感知相关的因素。
这项前瞻性观察性队列研究于 2014 年 9 月至 2017 年 1 月在一家学术医疗中心进行，纳入了接受 24 小时阻抗-pH 监测并完成了一套测量患者报告的症状严重程度、生活质量 (QOL) 和心理社会困扰的问卷的 PPI 无反应者。参与者根据阻抗-pH 结果分为以下队列：PPI 上：-酸暴露时间 (AET)/-症状反流关联 (SRA)、+AET 和 -AET/+SRA；PPI 下：功能性 (-AET/-SRA)、胃食管反流病 (GERD) (+AET) 和反流过度敏感 (RHS) (-AET/+SRA)。主要结局是通过 GerdQ≥8 定义的异常 GERD 症状严重程度。
共纳入 192 名参与者。125 名参与者进行了 PPI 上的阻抗-pH 检查：72 名 (-AET/-SRA)、42 名 (+AET) 和 11 名 (-AET/+SRA)。在 -AET/-SRA 组中，年龄较小、吞咽困难评分较高、QOL 受损和较短的症状指数与 GerdQ≥8 相关。在 +AET 组中，与反流相关的症状较多和远端收缩积分较低与 GerdQ≥8 相关。67 名参与者进行了 PPI 下的阻抗-pH 检查：39 名 (58%)功能性、16 名 (24%)GERD 和 12 名 (18%)RHS。在功能性组中，GerdQ≥8 与较高的 QOL 受损和吞咽困难评分相关。
在正常阻抗-pH 的 PPI 无反应者中，反流症状的感知与心理社会困扰、生活质量降低和吞咽困难有关。在 PPI 难治性 GERD 患者中，患者报告的症状严重程度与生理差异相关，而不是与心理社会因素相关。
