Digestion. 2018;98(3):194-200. doi: 10.1159/000488530. Epub 2018 Jun 5.
The present study examined the pathogenesis of potassium-competitive acid blocker (P-CAB)-resistant non-erosive reflux disease (NERD).
Forty-three patients with NERD, who had persistent reflux symptoms despite the administration of P-CAB, were included in this study. After excluding eosinophilic esophagitis and primary esophageal motility disorders, esophageal impedance-pH monitoring was performed. In symptom index (SI)-positive patients, the mechanism of SI-positivity and percent time with intragastric pH > 4 and with esophageal pH < 4 were investigated according to the presence or absence of Helicobacter pylori infection.
One (2.3%) of 43 patients had a primary esophageal motility disorder (Jackhammer esophagus). Eighteen (41.9%) and 3 (7%) patients were SI-positive for liquid and gas-only reflux, respectively, and the remaining 21 patients who were SI-negative (48.8%) had functional heartburn. All patients SI-positive for liquid reflux were SI-positive for weakly acidic reflux. Gastric acid was sufficiently suppressed by P-CAB, regardless of the presence or absence of H. pylori infection.
The pathogenesis of -P-CAB-resistant NERD was elucidated in 51% of patients. Symptoms in all patients SI-positive for liquid reflux were related to weakly acidic reflux, and symptoms related to acid reflux may be ruled out by the administration of P-CAB.
本研究旨在探讨钾竞争性酸阻滞剂（P-CAB）抵抗型非糜烂性反流病（NERD）的发病机制。
纳入 43 例 P-CAB 治疗后仍持续存在反流症状的 NERD 患者。排除嗜酸性粒细胞性食管炎和原发性食管动力障碍后，进行食管阻抗-pH 监测。在症状指数（SI）阳性患者中，根据是否存在幽门螺杆菌感染，研究 SI 阳性的机制以及胃内 pH 值>4 和食管 pH 值<4 的时间百分比。
43 例患者中，1 例（2.3%）存在原发性食管动力障碍（痉挛性食管）。18 例（41.9%）和 3 例（7%）患者液体反流和仅气体反流的 SI 分别为阳性，其余 21 例 SI 阴性（48.8%）的患者为功能性烧心。所有液体反流 SI 阳性的患者均为弱酸性反流 SI 阳性。无论是否存在幽门螺杆菌感染，P-CAB 均能充分抑制胃酸。
51%的 P-CAB 抵抗型 NERD 患者的发病机制得到阐明。所有液体反流 SI 阳性的患者的症状均与弱酸性反流有关，通过 P-CAB 的给药可排除与酸反流相关的症状。
