Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
J Formos Med Assoc. 2020 Nov;119(11):1575-1580. doi: 10.1016/j.jfma.2019.08.007. Epub 2019 Sep 18.
Current diagnostic testing for gastroesophageal reflux disease (GERD) include endoscopy, ambulatory pH and intraluminal impedance monitoring. However, they are suboptimal and do not measure chronicity of reflux. Recently, a mucosal impedance (MI) device has been developed to measure esophageal epithelial conductivity changes, a marker of chronic GERD. The aim of this review is to summarize the use of MI testing (MIT) for the evaluation and management of esophageal disease. MIT is a minimally invasive and simple through-the-scope procedure performed during endoscopy. It allows for a rapid derivation of MI values within seconds without an uncomfortable overnight pH- impedance catheter. The MI values can correlate with histological findings of epithelial barrier dysfunction, normalize with effective treatment, and show promise for differentiating GERD from non-GERD conditions such as eosinophilic esophagitis (EoE). In conclusion, endoscopic MIT measurement can differentiate esophageal disorders instantly during endoscopy. It may not only serve as an important tool in diagnosing of GERD but also help guide therapy in clinically difficult situations as a surrogate to predict the treatment response.
目前用于胃食管反流病（GERD）的诊断检测包括内镜检查、动态 pH 值和腔内阻抗监测。然而，这些方法并不理想，无法衡量反流的慢性程度。最近，一种黏膜阻抗（MI）设备已被开发出来，用于测量食管上皮的电导率变化，这是慢性 GERD 的一个标志物。本综述的目的是总结 MI 检测（MIT）在食管疾病评估和管理中的应用。MIT 是一种在内镜检查期间进行的微创、简单的经内镜程序。它允许在几秒钟内快速得出 MI 值，而无需进行不舒服的过夜 pH-阻抗导管检测。MI 值可以与上皮屏障功能障碍的组织学发现相关，经过有效治疗后可以恢复正常，并有望区分 GERD 与非 GERD 疾病，如嗜酸性食管炎（EoE）。总之，内镜 MIT 测量可以在进行内镜检查的同时即时区分食管疾病。它不仅可以作为 GERD 诊断的重要工具，还可以帮助指导临床困难情况下的治疗，作为预测治疗反应的替代指标。
