Department of Medicine, Division of General Medicine.
Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY.
J Clin Gastroenterol. 2023 Oct 1;57(9):886-889. doi: 10.1097/MCG.0000000000001793.
Gastric physiological characteristics such as fundus accommodation, gastric distention, emptying/transit time, and basal acid output may contribute to the pathogenesis of gastroesophageal reflux disease (GERD). Wireless motility capsule (WMC) uses pH data to determine gastric transit time but has not been used in the evaluation of GERD. Certain metrics such as acidification time, nadir pH, and gastric transit time may provide insight into the mechanisms of GERD related to gastric physiology, allowing WMC to be a complementary tool in the diagnosis of GERD. We aimed to determine whether pH data and transit time on WMC tests correlated with the presence of GERD on ambulatory reflux testing.
This was a retrospective study of 28 patients who had undergone both WMC and reflux testing via wireless pH or pH/impedance. Acidification time (time from capsule ingestion to pH<2), nadir postprandial pH, and gastric transit time were manually determined from the WMC capsule proprietary software. Spearman correlation was used to compare these metrics with gastric transit time, percent esophageal acid exposure, and DeMeester score.
Acidification time moderately correlated with gastric transit time, R : 0.44, P =0.02, but not nadir pH, percent esophageal acid exposure, or DeMeester score. Patients with an abnormal reflux test had a significantly longer median acidification time (135.5 vs. 78.5 min, P =0.021). After stratifying by patients with normal versus prolonged gastric transit time, there was a trend toward longer acidification time in patients with positive reflux testing in both groups, but this was not statistically significant. Patients with prolonged gastric transit time >300 minutes were not more likely to have a positive reflux test (38% vs. 35%, P =1).
The acidification time on WMC was significantly longer in patients with proven GERD and acidification time positively correlated with gastric transit time. Larger studies are needed to determine whether WMC could be used as a complementary tool in investigating patients with GERD symptoms.
胃的生理特征，如胃底顺应性、胃扩张、排空/转运时间和基础酸分泌，可能与胃食管反流病（GERD）的发病机制有关。无线动力胶囊（WMC）使用 pH 值数据来确定胃转运时间，但尚未用于 GERD 的评估。某些指标，如酸化时间、最低 pH 值和胃转运时间，可能有助于深入了解与胃生理相关的 GERD 机制，使 WMC 成为 GERD 诊断的补充工具。我们旨在确定 WMC 测试的 pH 值数据和转运时间是否与动态反流测试中 GERD 的存在相关。
这是一项回顾性研究，纳入了 28 例同时接受 WMC 和无线 pH 或 pH/阻抗反流测试的患者。从 WMC 胶囊专有软件中手动确定酸化时间（从胶囊摄入到 pH<2 的时间）、餐后最低 pH 值和胃转运时间。使用 Spearman 相关分析比较这些指标与胃转运时间、食管酸暴露百分比和 DeMeester 评分的相关性。
酸化时间与胃转运时间中度相关，R：0.44，P=0.02，但与最低 pH 值、食管酸暴露百分比或 DeMeester 评分无关。异常反流测试患者的中位酸化时间明显更长（135.5 分钟比 78.5 分钟，P=0.021）。按胃转运时间正常与延长分层后，两组中阳性反流测试患者的酸化时间均有延长趋势，但无统计学意义。胃转运时间>300 分钟的患者阳性反流测试的可能性并不更高（38%比 35%，P=1）。
在已确诊的 GERD 患者中，WMC 的酸化时间明显更长，且酸化时间与胃转运时间呈正相关。需要更大规模的研究来确定 WMC 是否可作为 GERD 症状患者的补充工具。
