Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2019 May;17(6):1073-1080.e1. doi: 10.1016/j.cgh.2018.06.018. Epub 2018 Jun 18.
BACKGROUND & AIMS: As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring.
Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy.
Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group.
We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
多达 45%的胃食管反流病（GERD）患者在接受每日一次质子泵抑制剂（PPI）治疗后仍有症状。我们旨在通过联合阻抗-pH 监测比较对每日一次 PPI 治疗有反应和无反应的患者的反流特征和模式。
报告每周至少有两次烧心和/或反流症状持续 3 个月的患者接受标准剂量 PPI 治疗，将其分配到 PPI 失败组（n=16）。报告在至少 4 周内每天一次 PPI 治疗后症状完全缓解的患者被分配到 PPI 成功组（n=13）。我们收集了人口统计学数据，患者完成了简短形式 36 项和 GERD 健康相关生活质量问卷。然后，患者在接受 PPI 治疗的同时进行上消化道内镜检查和联合食管阻抗-pH 监测。
在 PPI 成功组的 4 名患者（31%）和 PPI 失败组的 4 名患者（25%）中，pH 测试结果异常（P=1.00）。大多数 PPI 失败组（75%）的患者被发现患有功能性烧心或 GERD 反流过敏。PPI 失败组和成功组之间的阻抗和 pH 参数无显著差异。
我们发现 GERD 患者中，每日一次 PPI 治疗成功和失败的患者之间的反流特征没有差异。PPI 失败组的大多数患者（75%）存在功能性食管疾病。
