Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Centre for Esophageal Diseases, Guy's and St. Thomas Hospital, London, UK.
Am J Gastroenterol. 2023 May 1;118(5):794-801. doi: 10.14309/ajg.0000000000002173. Epub 2023 Jan 12.
The Lyon Consensus designates Los Angeles (LA) grade C/D esophagitis or acid exposure time (AET) >6% on impedance-pH monitoring (MII-pH) as conclusive for gastroesophageal reflux disease (GERD). We aimed to evaluate proportions with objective GERD among symptomatic patients with LA grade A, B, and C esophagitis on endoscopy.
Demographics, clinical data, endoscopy findings, and objective proton-pump inhibitor response were collected from symptomatic prospectively enrolled patients from 2 referral centers. Off-therapy MII-pH parameters included AET, number of reflux episodes, mean nocturnal baseline impedance, and postreflux swallow-induced peristaltic wave index. Objective GERD evidence was compared between LA grades.
Of 155 patients (LA grade A: 74 patients, B: 61 patients, and C: 20 patients), demographics and presentation were similar across LA grades. AET >6% was seen in 1.4%, 52.5%, and 75%, respectively, in LA grades A, B, and C. Using additional MII-pH metrics, an additional 16.2% with LA grade A and 47.5% with LA grade B esophagitis had AET 4%-6% with low mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index; there were no additional gains using the number of reflux episodes or symptom-reflux association metrics. Compared with LA grade C (100% conclusive GERD based on endoscopic findings), 100% of LA grade B esophagitis also had objective GERD but only 17.6% with LA grade A esophagitis ( P < 0.001 compared with each). Proton-pump inhibitor response was comparable between LA grades B and C (74% and 70%, respectively) but low in LA grade A (39%, P < 0.001).
Grade B esophagitis indicates an objective diagnosis of GERD.
里昂共识将洛杉矶（LA）C/D 级食管炎或阻抗-pH 监测（MII-pH）酸暴露时间（AET）>6%指定为胃食管反流病（GERD）的结论性诊断。我们旨在评估内镜下 LA 分级 A、B 和 C 食管炎的有症状患者中客观 GERD 的比例。
从 2 个转诊中心前瞻性纳入的有症状患者中收集人口统计学、临床数据、内镜检查结果和质子泵抑制剂客观反应。治疗后 MII-pH 参数包括 AET、反流事件次数、夜间基线阻抗平均值和反流后吞咽诱发蠕动波指数。比较 LA 分级之间的客观 GERD 证据。
在 155 名患者中（LA 分级 A：74 名患者，B：61 名患者，C：20 名患者），LA 分级之间的人口统计学和表现相似。LA 分级 A、B 和 C 中分别有 1.4%、52.5%和 75%的患者 AET>6%。使用额外的 MII-pH 指标，LA 分级 A 中有 16.2%和 LA 分级 B 中有 47.5%的患者 AET 为 4%-6%，且夜间基线阻抗和反流后吞咽诱发蠕动波指数较低；使用反流次数或症状-反流关联指标没有额外获益。与 LA 分级 C（基于内镜发现的 100%明确 GERD）相比，LA 分级 B 食管炎的患者也有 100%的客观 GERD，但只有 LA 分级 A 食管炎的患者有 17.6%（与每一级相比，P<0.001）。LA 分级 B 和 C 的质子泵抑制剂反应相当（分别为 74%和 70%），但 LA 分级 A 的反应较低（39%，P<0.001）。
B 级食管炎提示 GERD 的客观诊断。
