Mauro Aurelio, Franchina Marianna, Elvevi Alessandra, Pugliese Delia, Tenca Andrea, Conte Dario, Penagini Roberto
Gastroenterology and Endoscopy Unit Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; Department of Pathophysiology and Transplantation - Università degli Studi di Milano, Italy.
Department of Gastroenterology, Helsinki University Hospital, University of Helsinki, Finland.
United European Gastroenterol J. 2017 Oct;5(6):789-795. doi: 10.1177/2050640616681366. Epub 2016 Nov 22.
Gastro-oesophageal reflux disease (GORD) is a long-term complication of achalasia treatments. The aim of our study was to evaluate the yield of prolonged wireless pH monitoring in patients with successfully treated achalasia and its influence on proton pump inhibitor (PPI) use.
Twenty-five patients with achalasia who underwent prolonged wireless pH monitoring after a successful treatment with pneumatic dilation were enrolled. pH variables were analysed in the first 24 hours of monitoring to determine if tracings were indicative of GORD; the same variables were analysed in the following 24-hour period in order to obtain a worst-day diagnosis of GORD. PPI therapy before and after the test was recorded.
Five out of 25 patients had GORD diagnosis during the first day of monitoring and four of them had oesophagitis at endoscopy. During the following days of monitoring four more patients had a diagnosis of GORD. Out of the 25 patients, PPIs were started after the test in six asymptomatic GORD-positive ones, whereas prescription of PPIs was stopped without detrimental effect on symptoms in three GORD-negative patients.
Prolonged wireless pH monitoring is a useful test to be added to endoscopy in order to evaluate GORD and to optimise antisecretory treatment in successfully treated achalasia patients.
胃食管反流病（GORD）是贲门失弛缓症治疗的一种长期并发症。我们研究的目的是评估成功治疗的贲门失弛缓症患者长时间无线pH监测的结果及其对质子泵抑制剂（PPI）使用的影响。
纳入25例经气囊扩张成功治疗后接受长时间无线pH监测的贲门失弛缓症患者。在监测的最初24小时内分析pH变量，以确定记录是否提示GORD；在接下来的24小时内分析相同变量，以获得GORD的最严重日诊断。记录测试前后的PPI治疗情况。
25例患者中有5例在监测的第一天被诊断为GORD，其中4例在内镜检查时有食管炎。在接下来的监测日中，又有4例患者被诊断为GORD。在25例患者中，6例无症状GORD阳性患者在测试后开始使用PPI，而3例GORD阴性患者停止使用PPI且症状无不良影响。
长时间无线pH监测是一种有用的检查，可补充内镜检查，以评估GORD并优化成功治疗的贲门失弛缓症患者的抗分泌治疗。
