Nasi Ary, Queiroz Natália Sousa Freitas, Michelsohn Nelson H
Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo, SP, Brasil.
Centro Médico de Diagnóstico Fleury, Motilidade Digestiva, São Paulo, SP, Brasil.
Arq Gastroenterol. 2018 Nov;55Suppl 1(Suppl 1):76-84. doi: 10.1590/S0004-2803.201800000-47. Epub 2018 Oct 4.
Prolonged monitoring increased our knowledge on gastroesophageal reflux (GER), and the disease became known as gastroesophageal reflux disease (GERD). Prolonged reflux monitoring permits the diagnosis of GERD when endoscopic findings are not enough to characterize it.
The objective of this paper is to review the current knowledge on impedance-pH monitoring, taking into account the published literature and the authors experience with 1,200 exams.
The different types of prolonged reflux monitoring, namely: conventional pHmetry, catheter-free pHmetry and impedance-pHmetry will be briefly described. The new possibilities of evaluation with impedance-pHmetry are emphasized, namely: the study of symptomatic patients in use of proton pump inhibitors (PPIs); evaluation of patients with symptoms suggestive of GERD although with normal endoscopy and normal pHmetry, diagnostic elucidation of patients with atypical symptoms or supra-esophageal symptoms, mainly chronic cough, study of patients complaining of belch, differentiating gastric and supra-gastric belching, and the proper work-up before anti-reflux surgery.
When impedance was associated to pH monitoring, an impressive technological evolution became apparent, when compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements can be made: the ability of the esophagus in transporting the bolus, the measurement of basal mucosal impedance and the evaluation of primary peristalsis post reflux.
Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The authors suggest the importance of careful evaluation of each reflux episode by the physician responsible for the examination, necessary for the correct interpretation of the tracings.
长时间监测增加了我们对胃食管反流（GER）的认识，这种疾病后来被称为胃食管反流病（GERD）。当内镜检查结果不足以明确诊断时，长时间反流监测有助于GERD的诊断。
本文旨在结合已发表的文献以及作者1200例检查的经验，综述目前关于阻抗-pH监测的知识。
将简要描述不同类型的长时间反流监测，即：传统pH监测、无导管pH监测和阻抗-pH监测。重点强调阻抗-pH监测的新评估可能性，即：对使用质子泵抑制剂（PPI）的有症状患者的研究；对内镜检查和pH监测均正常但有GERD症状提示的患者的评估；对有非典型症状或食管外症状（主要是慢性咳嗽）患者的诊断性阐明；对主诉嗳气患者的研究，区分胃内嗳气和胃上嗳气；以及抗反流手术前的适当检查。
与单独的pH监测相比，当阻抗与pH监测相结合时，一项令人瞩目的技术进步显而易见。阻抗-pH监测的主要优点包括：能够检测所有类型的反流：酸性、非酸性、液体、气体。此外，还可以进行其他重要测量：食管输送食团的能力、基础黏膜阻抗的测量以及反流后原发性蠕动的评估。
阻抗-pH监测是一种很有前景的方法，比传统pH监测具有很大优势。在这两种监测类型之间进行选择时应非常谨慎。作者强调负责检查的医生仔细评估每一次反流事件的重要性，这对于正确解读记录是必要的。
