Reddy Chanakyaram A, Watts Lydia, Baker Jason R, Chen Joan W
Division of Gastroenterology, University of Michigan Hospitals-Michigan Medicine, 3912 Taubman Center, 1500 E Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109, USA.
Dig Dis Sci. 2021 Apr;66(4):994-998. doi: 10.1007/s10620-020-06348-6. Epub 2020 May 23.
Increased nonacid reflux is diagnosed in a subgroup of patients with gastroesophageal reflux disease who often present with reflux symptoms refractory to proton-pump inhibitor therapy. Despite the prevalence of this condition, the management approach for patients with increased nonacid reflux can often be varied and unclear.
Our primary aim was to investigate physician management patterns for patients who had received a diagnosis of increased nonacid reflux on impedance-pH studies.
Reflux studies in patients with increased nonacid reflux per Lyon Consensus criteria and management approaches were retrospectively reviewed. Reflux symptom survey, manometry findings, reflux symptom association (RSA) on reflux testing, immediate posttesting management information, and managing provider information were assessed.
A total of 43 subjects in total were analyzed. Management plan after a diagnosis of increased nonacid reflux was decided by a gastroenterologist in over 95% of cases and varied greatly with no changes being the most common. Even among subjects with + RSA on reflux monitoring, no change in management was the most common action, although this occurred much less frequently compared to subjects with - RSA (28.6% vs. 78.6%, p < 0.01). When change in therapy occurred, medical treatment with baclofen was the most common choice (21.4%). Other management changes included medications for visceral hypersensitivity and antireflux surgery, although these changes occurred rarely.
Abnormally increased nonacid reflux is frequently encountered on impedance-pH studies; however, management decisions vary significantly among gastroenterologists. When treatment change is implemented, they are variable and can include lifestyle modifications, medication trials, or antireflux surgery. Future development of standardized management algorithms for increased nonacid reflux is needed.
在一部分胃食管反流病患者中诊断出非酸性反流增加，这些患者常出现对质子泵抑制剂治疗难治的反流症状。尽管这种情况很常见，但对于非酸性反流增加的患者，管理方法往往各不相同且不明确。
我们的主要目的是调查在阻抗 - pH研究中被诊断为非酸性反流增加的患者的医生管理模式。
回顾性分析符合里昂共识标准的非酸性反流增加患者的反流研究及管理方法。评估反流症状调查、测压结果、反流测试中的反流症状关联（RSA）、测试后立即的管理信息以及管理医生信息。
总共分析了43名受试者。超过95%的病例中，非酸性反流增加诊断后的管理计划由胃肠病学家决定，且差异很大，最常见的是无变化。即使在反流监测中RSA为阳性的受试者中，最常见的行动也是管理无变化，尽管与RSA为阴性的受试者相比，这种情况发生的频率要低得多（28.6%对78.6%，p<0.01）。当治疗发生变化时，最常见的选择是使用巴氯芬进行药物治疗（21.4%）。其他管理变化包括用于内脏高敏感性的药物和抗反流手术，尽管这些变化很少发生。
在阻抗 - pH研究中经常遇到非酸性反流异常增加的情况；然而，胃肠病学家之间的管理决策差异很大。当实施治疗改变时，它们是可变的，可能包括生活方式改变、药物试验或抗反流手术。需要为增加的非酸性反流制定标准化的管理算法。
