Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
Dig Dis. 2022;40(3):261-265. doi: 10.1159/000517987. Epub 2021 Jun 29.
Recently, Lyon consensus and ROME IV were published as there was a need to create a more objective evaluation for gastroesophageal reflux disease (GERD) in order to better predict treatment outcomes. However, with classical pH-impedance measures, some patients would still have diagnostic uncertainty, and new metrics, such as mean nocturnal basal impedance (MNBI), have emerged to corroborate with GERD diagnosis. The aim of the present study was to describe the prevalence of GERD, functional heartburn (FH), reflux hypersensitivity (RH), and undetermined diagnosis using current consensuses and to evaluate if MNBI could be considered a supportive measure for the diagnosis of GERD.
Patients who underwent pH-multichannel intraluminal impedance (MII-pH) for suspected GERD between 2013 and 2018 were included. Subjects with previous diagnosis of GERD (e.g., esophagitis grade C or D according to Los Angeles classification, Barrett's esophagus, or peptic stricture), atypical symptoms, major esophageal motor disorder, eosinophilic esophagitis, or under proton pump inhibitor were excluded from the analysis.
We included 75 patients. The prevalence of GERD, FH, RH and undetermined diagnosis was 44%, 14.7%, 12%, and 29.3%, respectively. MNBI was lower in patients with GERD (GERD: 1,307.5 ± 817.9 Ω vs. FH: 3,039.6 ± 1,040.8 Ω, RH: 2,617.1 ± 1,342.2 Ω, undetermined: 2,351.9 ± 1,018.2, p < 0.001), although it was similar between patients with FH and RH (p = 0.44) or between undetermined diagnosis and FH/RH (p = 0.15). More patients with a GERD diagnosis had a MNBI under 2,292 Ω (GERD: 93.9% vs. non-GERD: 31.7%, p < 0.001).
In our study, using MII-pH criteria, less than half of the patients had a GERD diagnosis. MNBI showed additional value as another metric for the diagnosis of GERD.
最近，发布了里昂共识和罗马 IV，因为需要为胃食管反流病（GERD）创建更客观的评估，以便更好地预测治疗结果。然而，使用经典的 pH 阻抗测量，一些患者仍存在诊断不确定性，并且出现了新的指标，如平均夜间基础阻抗（MNBI），以支持 GERD 的诊断。本研究旨在描述当前共识下 GERD、功能性烧心（FH）、反流过度敏感（RH）和不确定诊断的患病率，并评估 MNBI 是否可作为 GERD 诊断的支持性指标。
纳入 2013 年至 2018 年间因疑似 GERD 行 pH 多通道腔内阻抗（MII-pH）检查的患者。排除有 GERD 既往诊断（如洛杉矶分类 C 或 D 级食管炎、巴雷特食管或消化性狭窄）、非典型症状、主要食管动力障碍、嗜酸性食管炎或质子泵抑制剂治疗的患者。
共纳入 75 例患者。GERD、FH、RH 和不确定诊断的患病率分别为 44%、14.7%、12%和 29.3%。GERD 患者的 MNBI 较低（GERD：1307.5 ± 817.9 Ω vs. FH：3039.6 ± 1040.8 Ω，RH：2617.1 ± 1342.2 Ω，不确定诊断：2351.9 ± 1018.2 Ω，p < 0.001），但 FH 和 RH 患者之间的 MNBI 相似（p = 0.44），不确定诊断与 FH/RH 患者之间的 MNBI 也相似（p = 0.15）。更多 GERD 诊断患者的 MNBI 低于 2292 Ω（GERD：93.9% vs. 非 GERD：31.7%，p < 0.001）。
在我们的研究中，使用 MII-pH 标准，不到一半的患者被诊断为 GERD。MNBI 作为 GERD 诊断的另一项指标具有额外的价值。
