Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.
Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Dis Esophagus. 2020 Dec 7;33(12). doi: 10.1093/dote/doaa063.
Esophageal baseline impedance (BI) acquired during esophageal contraction (contractile segment impedance [CSI]) is proposed to improve BI accuracy in gastroesophageal reflux disease (GERD). We evaluated associations between CSI and conventional and novel GERD metrics. We analyzed high-resolution impedance manometry (HRIM) and ambulatory pH-impedance studies from 51 patients (58.6 ± 1.5 years; 26% F) with GERD symptoms studied off antisecretory therapy. Patients with achalasia or absent contractility were excluded. CSI (averaged across 10 swallows) and BI-HRIM (from the resting landmark phase) were acquired from the distal impedance sensors (distal sensor and 5 cm above the lower esophageal sphincter). Acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) were calculated. Associations between CSI, BI-HRIM, MNBI, and AET were evaluated using correlation (Pearson) and receiver operating characteristic (ROC) analysis. Presenting symptoms included heartburn (67%), regurgitation (12%), cough (12%), and chest pain (10%). CSI-distal and CSI-5 each correlated with BI-HRIM, AET, and distal MNBI. Associations with AET were numerically stronger for CSI-distal (r = -0.46) and BI-HRIM-distal (r = -0.44) than CSI-5 (r = -0.33), BI-HRIM-5 (r = -0.28), or distal MNBI (r < -0.36). When compared to AET <4%, patients with AET >6% had significantly lower CSI-distal and BI-HRIM-distal values but not CSI-5, BI-HRIM-5, or MNBI. ROC areas under the curve for AET >6% were numerically higher for CSI-distal (0.81) than BI-HRIM-distal (0.77), distal MNBI (0.68-0.75), CSI-5 (0.68), or BI-HRIM-5 (0.68). CSI from HRIM studies inversely correlates with pathologic AET and has potential to augment the evaluation of GERD.
食管基础阻抗(BI)在食管收缩期间获得(收缩段阻抗[CSI]),用于提高胃食管反流病(GERD)中 BI 的准确性。我们评估了 CSI 与传统和新型 GERD 指标之间的相关性。我们分析了 51 名 GERD 症状患者(58.6±1.5 岁;26%为女性)的高分辨率阻抗测压(HRIM)和动态 pH-阻抗研究,这些患者在抗分泌治疗之外接受了研究。排除贲门失弛缓和无收缩力的患者。CSI(在 10 次吞咽中平均)和 BI-HRIM(从静息标志阶段)从远端阻抗传感器(远端传感器和食管下括约肌上方 5cm)获得。计算酸暴露时间(AET)和平均夜间基础阻抗(MNBI)。使用相关性(Pearson)和接收器操作特征(ROC)分析评估 CSI、BI-HRIM、MNBI 和 AET 之间的相关性。主要症状包括烧心(67%)、反流(12%)、咳嗽(12%)和胸痛(10%)。CSI-远端和 CSI-5 均与 BI-HRIM、AET 和远端 MNBI 相关。CSI-远端(r=-0.46)和 BI-HRIM-远端(r=-0.44)与 AET 的相关性比 CSI-5(r=-0.33)、BI-HRIM-5(r=-0.28)或远端 MNBI(r<-0.36)更强。与 AET<4%相比,AET>6%的患者 CSI-远端和 BI-HRIM-远端值明显较低,但 CSI-5、BI-HRIM-5 或 MNBI 则不然。AET>6%的 ROC 曲线下面积在数值上 CSI-远端(0.81)高于 BI-HRIM-远端(0.77)、远端 MNBI(0.68-0.75)、CSI-5(0.68)或 BI-HRIM-5(0.68)。HRIM 研究中的 CSI 与病理性 AET 呈负相关,有可能增强 GERD 的评估。
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