96 小时无线食管 pH 研究显示 GERD 患者限制饮食可减少食管酸暴露。

Ninety-Six Hour Wireless Esophageal pH Study in Patients with GERD Shows that Restrictive Diet Reduces Esophageal Acid Exposure.

机构信息

Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA.

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street 3rd Floor, MC6341, Redwood City, CA, 94063, USA.

出版信息

Dig Dis Sci. 2020 Aug;65(8):2331-2344. doi: 10.1007/s10620-019-05940-9. Epub 2019 Nov 16.

DOI:10.1007/s10620-019-05940-9

PMID:31734874

Abstract

BACKGROUND

Prolonged (96 h) pH monitoring may explore the effect of diet on pH and symptoms in patients with GERD.

AIMS

To assess the usefulness of a 96 h esophageal pH study in patients with GER symptoms under different diets (pro- and anti-GER).

METHODS

Prospective study of 66 patients with GERD undergoing wireless 96 h pH monitoring. Two-day periods, one on liberal (pro-reflux) and another on restricted (anti-reflux) diet assessed esophageal acid exposure and symptoms. The primary end point was normalization of acid exposure time while on restricted diet. Secondary end point was a > 50% reduction in symptoms with restricted diet.

RESULTS

Normal (pH time < 4 of < 6%) was found in 34 patients (51.5%) while on the initial 48 h (liberal) diet [median % time < 4: 3.2 (95% CI, 1.9, 4.0)] and remained normal while on restricted diet [median % time < 4: 2.6 (95% CI, 0.8, 3.4)]. Abnormal acid exposure (% pH time < 4: > 6%) was found in 32 patients (48.5%) while on initial 48 h liberal diet [median % time < 4: 10.5, (95% CI 8.9, 12.6)], and decreased significantly with restricted diet [median % time < 4: 4.5 (95% CI 3.1, 7.3)] (p = 0.001), and normalized with anti-GERD diet in 21 patients (65.6%). Only 11/66 patients were candidates for proton pump inhibitor (PPI) use; 34 had either normal pH studies or normalized them with restricted diet (n = 21). Symptoms did not improve with restricted diet.

CONCLUSIONS

The 96-h esophageal pH study tests for GERD under pro- and anti-GER diets and allows minimization of PPI therapy to only 16.6% of patients.

摘要

背景

延长（96 小时）pH 监测可以探究饮食对 GERD 患者 pH 值和症状的影响。

目的

评估在不同饮食（促胃反流和抗胃反流）下，96 小时食管 pH 研究对 GER 症状患者的作用。

方法

对 66 例 GERD 患者进行无线 96 小时 pH 监测的前瞻性研究。采用两种为期两天的饮食方式，一种是自由饮食（促反流），另一种是限制饮食（抗反流），评估食管酸暴露和症状。主要终点是在限制饮食时酸暴露时间正常化。次要终点是限制饮食时症状缓解超过 50%。

结果

在初始 48 小时（自由）饮食时，34 例患者（51.5%）正常（pH 时间 < 4 的时间< 6%）[中位数%时间 < 4：3.2（95%CI，1.9，4.0)]，且在限制饮食时仍保持正常[中位数%时间 < 4：2.6（95%CI，0.8，3.4)]。在初始 48 小时自由饮食时，32 例患者（48.5%）存在异常酸暴露（% pH 时间 < 4：> 6%）[中位数%时间 < 4：10.5（95%CI 8.9，12.6)]，且随着限制饮食，酸暴露显著减少[中位数%时间 < 4：4.5（95%CI 3.1，7.3）]（p=0.001），且在 21 例患者（65.6%）中用抗 GERD 饮食使其正常化。仅有 11/66 例患者适合质子泵抑制剂（PPI）治疗；34 例患者 pH 研究正常或通过限制饮食正常化（n=21）。限制饮食不能改善症状。