Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam, Amsterdam, the Netherlands.
GI Physiology Unit, GI Services, University College London, London, UK.
Aliment Pharmacol Ther. 2021 Jul;54(2):144-152. doi: 10.1111/apt.16447. Epub 2021 Jun 11.
Although nighttime reflux symptoms are common, the presence of nocturnal reflux is seldom confirmed with a standard 24 hours pH study.
To study patients with supine nighttime reflux symptoms using prolonged wireless pH monitoring.
In this retrospective study, patients with typical acid reflux symptoms were studied using 96-h pH monitoring. Patients with nighttime reflux symptoms were compared to those without. Night-to-night variability and diagnostic accuracy of 24-, 48- and 72-hours pH studies compared to the 96-hours "gold standard" were evaluated.
Of the 105 included patients (61.9% females; mean age 46.8 ± 14.4 years), 86 (81.9%) reported nighttime reflux symptoms, of which 67.4% had pathological supine nocturnal acid exposure in at least one night. There was high variance in night-to-night acid exposure (94% [IQR0-144]), which was larger than the variance in upright acid exposure (58% [IQR32-88]; P < 0.001). When analysing the first 24 hours of the pH study, 32% of patients were diagnosed with pathological supine nighttime acid exposure versus 51% of patients based upon the 96-hours pH-test. The diagnostic accuracy and yield improved with study duration (P < 0.001). Reflux episodes with a lower nadir pH or longer acid clearance time were more prone to provoke nightly symptoms.
The majority of patients with nocturnal reflux symptoms had pathological acid exposure in at least one night of the prolonged pH recording. A high night-to-night variability in acid exposure reduces the clinical value and diagnostic yield of pH monitoring limited to 24 hours. Prolonged testing is a more appropriate diagnostic tool for patients with nocturnal reflux symptoms.
尽管夜间反流症状很常见，但很少有标准的 24 小时 pH 研究能证实存在夜间反流。
使用延长无线 pH 监测来研究具有仰卧位夜间反流症状的患者。
在这项回顾性研究中，使用 96 小时 pH 监测对具有典型酸反流症状的患者进行研究。比较了夜间有反流症状的患者和无反流症状的患者。评估了 24 小时、48 小时和 72 小时 pH 研究与 96 小时“金标准”相比的夜间变异性和诊断准确性。
在 105 例纳入的患者（61.9%为女性；平均年龄 46.8±14.4 岁）中，86 例（81.9%）报告夜间有反流症状，其中 67.4%至少有一晚存在病理性仰卧位夜间酸暴露。夜间酸暴露的变异性很高（94%[IQR0-144]），大于直立位酸暴露的变异性（58%[IQR32-88]；P<0.001）。在分析 pH 研究的前 24 小时时，32%的患者被诊断为病理性仰卧位夜间酸暴露，而基于 96 小时 pH 测试，51%的患者被诊断为病理性仰卧位夜间酸暴露。随着研究时间的延长，诊断准确性和检出率提高（P<0.001）。具有更低 pH 最低点或更长酸清除时间的反流发作更易引起夜间症状。
大多数夜间反流症状患者在延长 pH 记录的至少一晚存在病理性酸暴露。酸暴露的夜间变异性很大，降低了限制在 24 小时内进行 pH 监测的临床价值和诊断率。延长检测是诊断夜间反流症状患者的更合适的诊断工具。
