Vardar Rukiye, Keskin Muharrem
Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
Department of Gastroenterology, Necmettin Erbakan University School of Medicine, Konya, Turkey
Turk J Gastroenterol. 2017 Dec;28(Suppl 1):S16-S21. doi: 10.5152/tjg.2017.06.
Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. The sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. The use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is predominantly normal in patients with non-acid reflux, ineffective esophageal motility is often monitored in patients with acid reflux. In the literature, there are contradictory and an insufficient number of studies regarding radiological methods for the diagnosis of GERD. There are inconsistent values for sensitivity and specificity among the barium studies. There are inadequate studies in the literature involving scintigraphic examinations in the diagnosis of GERD, and a majority of existing studies have been conducted in the pediatric group. The results of a few studies do not provide sufficient contribution toward the implementation in clinical practice.
动态食管pH监测是诊断非糜烂性反流病（NERD）患者的重要方法。食管内pH监测对于药物治疗无效的患者以及有食管外症状的患者，尤其是在手术干预前的NERD患者中非常重要。借助无线胶囊pH监测，可在更接近生理状态的条件下进行测量，并且由于患者对该检查的耐受性更好，因此可以进行更长时间的记录。17% - 31.4%的内镜检查确诊的食管炎患者动态食管pH监测结果可在正常范围内；因此，pH监测结果正常不能排除胃食管反流病（GERD）的诊断。多通道腔内阻抗pH（MII-pH）技术已得到发展，是目前评估典型和非典型反流症状患者最敏感的工具。与MII-pH监测相比，pH导管检测酸反流的敏感性为58%；此外，与MII-pH监测相比，其检测弱酸反流的敏感性为28%。对于有反流症状的患者，尤其是正在接受质子泵抑制剂（PPI）治疗的患者，在pH导管中加入阻抗后发现，与仅使用pH导管相比，可获得更高的诊断率和症状分析结果。食管测压用于评估功能性吞咽困难和不明原因的非心源性胸痛患者以及抗反流手术前的患者。食管测压适用于检测食管运动模式和极端运动异常（如贲门失弛缓症和极度运动减弱）。食管测压和动态pH监测常用于腹腔镜抗反流手术前的评估以及药物治疗无效的反流症状患者。尽管非酸反流患者的食管动力大多正常，但酸反流患者常监测到无效食管动力。在文献中，关于GERD诊断的放射学方法的研究相互矛盾且数量不足。钡剂造影研究的敏感性和特异性值不一致。文献中关于GERD诊断的闪烁显像检查的研究不足，且大多数现有研究是在儿科组进行的。少数研究结果对临床实践的应用贡献不足。
