Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan,
Digestion. 2020;101(4):375-381. doi: 10.1159/000500133. Epub 2019 Jul 29.
Weakly acidic reflux has been reported as the major cause of symptom occurrence in patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study is aimed at clarifying whether the pH value of weakly acidic reflux affects the induction of symptoms.
We retrospectively evaluated the records of combined multichannel intraluminal impedance and pH monitoring in 57 patients with PPI-refractory NERD. Weakly acidic refluxes were divided into 3 categories based on the pH value of the refluxate: pH 4-5, 5-6, and 6-7.
A total of 29 patients were positive in the symptom index. The symptom provocation rate in reflux of pH 4-5 (19%) was much higher than in that of pH 5-6 (11%) and pH 6-7 (12%). In the reflux at pH 4-5, the symptom provocation rate in the proximal reflux was higher than that in the distal reflux (p < 0.05), whereas the reflux at pH 5-6 and pH 6-7 was not significantly different in the symptom provocation rate between the proximal and distal refluxes.
Reflux at pH <5 reaching the proximal esophagus was the main factor in the induced symptoms of patients with PPI-refractory NERD.
弱酸性反流被报道为质子泵抑制剂（PPI）难治性非糜烂性反流病（NERD）患者症状发生的主要原因。本研究旨在阐明弱酸性反流的 pH 值是否会影响症状的诱发。
我们回顾性评估了 57 例 PPI 难治性 NERD 患者联合多通道腔内阻抗和 pH 监测的记录。根据反流物的 pH 值将弱酸性反流分为 3 类：pH 值为 4-5、5-6 和 6-7。
共有 29 名患者的症状指数呈阳性。pH 值为 4-5 的反流（19%）的症状诱发率明显高于 pH 值为 5-6（11%）和 pH 值为 6-7（12%）的反流。在 pH 值为 4-5 的反流中，近端反流的症状诱发率高于远端反流（p<0.05），而 pH 值为 5-6 和 pH 值为 6-7 的反流在近端和远端反流之间的症状诱发率没有显著差异。
pH 值<5 的反流到达近端食管是 PPI 难治性 NERD 患者症状诱发的主要因素。
