Stanford Esophageal Multidimensional Program in Innovation and Research Excellence (SEMPIRE), Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Dis Esophagus. 2023 Jul 3;36(7). doi: 10.1093/dote/doac102.
Ambulatory esophageal pH monitoring is a diagnostic tool in patients with heartburn and regurgitation. The aim of this study is to evaluate 96-hour esophageal pH monitoring in patients with gastroesophageal reflux disease (GERD), at baseline and under diet that impedes GER. We hypothesized that diet would potentially reduce pathologic acid exposure time (AET). Retrospective series of 88 patients with GERD undergoing wireless 96-hour pH monitoring. Two-day (48 hours) tandem periods, one on liberal, followed by another on restricted diet assessed esophageal AET. Primary end point was >30% reduction in AET while on anti-GER diet. Of the 88 patients, 16 were excluded because of probe migration. Endoscopy and biopsies assessed erosive esophagitis (EE) and Barrett's esophagus (BE), or normal esophagus. Abnormal AET (% pH < 4.0 ≥ 6) further defined nonerosive reflux disease (NERD), whereas normal AET (% pH < 4.0 < 6) with normal endoscopy defined patients as functional heartburn (FH). There were 6 patients with EE (n = 5) and BE (n = 1), 23 with NERD and 43 with FH. Anti-GER diet led to >30% reduction in AET in EE and NERD patients, but not in those with FH. Most patients (n = 43/72; 60%) had FH and could have avoided acid suppression. Furthermore, (14/23; 61%) of patients with NERD completely normalized AET with diet, potentially negating acid suppression. Ninety-six-hour esophageal pH distinguishes GERD patients from those with FH. Fifty percent of EE/BE patients and 61% of those with NERD completely normalize AET with diet. If pathologic AET occurs despite diet, acid suppression is indicated.
门诊食管 pH 监测是烧心和反流患者的一种诊断工具。本研究旨在评估胃食管反流病 (GERD) 患者的 96 小时食管 pH 监测，包括基线时和抗 GER 饮食下的监测。我们假设饮食可能会降低病理性酸暴露时间 (AET)。回顾性系列研究了 88 例接受无线 96 小时 pH 监测的 GERD 患者。连续 2 天（48 小时）进行串联期，一期接受自由饮食，另一期接受限制饮食，评估食管 AET。主要终点是抗 GER 饮食时 AET 减少>30%。在 88 例患者中，有 16 例因探头迁移而被排除。内镜和活检评估糜烂性食管炎 (EE) 和 Barrett 食管 (BE) 或正常食管。异常 AET（% pH < 4.0 ≥ 6）进一步定义为非糜烂性反流病 (NERD)，而正常 AET（% pH < 4.0 < 6）和正常内镜定义为功能性烧心 (FH)。有 6 例 EE（n = 5）和 1 例 BE，23 例 NERD 和 43 例 FH。抗 GER 饮食可使 EE 和 NERD 患者的 AET 减少>30%，但 FH 患者则不行。大多数患者（n = 43/72；60%）为 FH，可避免酸抑制。此外，（14/23；61%）的 NERD 患者通过饮食完全正常化 AET，可能不需要酸抑制。96 小时食管 pH 可区分 GERD 患者和 FH 患者。50%的 EE/BE 患者和 61%的 NERD 患者通过饮食完全正常化 AET。如果饮食后仍存在病理性 AET，则需要进行酸抑制。
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