阻抗-pH 监测对典型 GERD 患者预测 PPI 反应的前瞻性验证。
Prospective validation of reflux monitoring by impedance-pH in predicting PPI response in typical GERD.
机构信息
Department of Digestive Diseases, Campus Bio Medico University of Rome, Via Alvaro del Portillo 200 - 00128, Roma, Italy.
Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy.
出版信息
Dig Liver Dis. 2023 Jun;55(6):721-726. doi: 10.1016/j.dld.2022.12.004. Epub 2022 Dec 24.
BACKGROUND
The Lyon Consensus proposed a hierarchical approach to GERD diagnosis based on conventional and new impedance-pH metrics, namely acid exposure time (AET), number of reflux episodes, post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedance (MNBI).
AIMS
To define the value of conventional and new impedance-pH parameters as predictors of response to label-dose PPI in typical GERD.
METHODS
Consecutive adult patients with typical esophageal symptoms were prospectively studied with impedance-pH monitoring and treated with 8-week label-dose PPI. At the end of the PPI course, symptoms response was assessed.
RESULTS
Among 255 patients who entered the study, 168 (65.9%) reported symptom remission. At ROC analysis, both MNBI and PSPW index were significantly associated to PPI responsiveness with AUC of 0.783 and 0.801, respectively. Cut-off values of 1747Ω for MNBI and 50% for PSPW index were identified as discriminators between response and non-response to label-dose PPI. At multivariate analysis, MNBI, PSPW index, and AET >6% were efficient predictors of PPI responses (OR 3, 5.4 and 2.3, respectively). Number of reflux episodes did not predict PPI response.
CONCLUSIONS
The novel MII-pH variables together with pathological are highly predictive of response of the typical GERD syndrome to label-dose PPI.
背景
里昂共识提出了一种基于传统和新阻抗-pH 指标的 GERD 诊断分层方法，即酸暴露时间（AET）、反流事件次数、反流后吞咽诱导蠕动波（PSPW）指数和平均夜间基础阻抗（MNBI）。
目的
确定传统和新阻抗-pH 参数作为典型 GERD 对标签剂量 PPI 反应的预测因子的价值。
方法
连续的成人患者进行了阻抗-pH 监测，并接受了 8 周的标签剂量 PPI 治疗。在 PPI 疗程结束时，评估症状反应。
结果
在 255 名进入研究的患者中，168 名（65.9%）报告症状缓解。在 ROC 分析中，MNBI 和 PSPW 指数均与 PPI 反应性显著相关，AUC 分别为 0.783 和 0.801。MNBI 的截断值为 1747Ω，PSPW 指数的截断值为 50%，可区分对标签剂量 PPI 的反应和无反应。多变量分析显示，MNBI、PSPW 指数和 AET >6% 是 PPI 反应的有效预测因子（OR 分别为 3、5.4 和 2.3）。反流次数不能预测 PPI 反应。
结论
新型 MII-pH 变量与病理性变量一起高度预测典型 GERD 综合征对标签剂量 PPI 的反应。
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