Liu Jie, Yin Mengqing, Lv Chaolan, Wang Wei, Huang Yizhou, Tian Jiashuang, Wang Bo, Song Gengqing, Yu Yue
Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
J Gastroenterol Hepatol. 2024 Nov;39(11):2402-2408. doi: 10.1111/jgh.16718. Epub 2024 Aug 8.
Post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been shown to influence proton pump inhibitor (PPI) response in GERD patients. However, currently, little data concerning these variables in patients with reflux hypersensitivity (RH) are available. In this study, we aimed to evaluate, in RH patients, the prevalence of PPI responders and nonresponders and investigate the predictive value of impedance-pH variables, including PSPW and MNBI, on responses to PPI.
A total of 108 RH patients who met ROME IV criteria were prospectively recruited from June 2018 to December 2022. The prevalence of PPI responders/nonresponders was calculated, and impedance-pH variables were compared between the response and nonresponse groups. Multiple logistic regression was used to investigate predictors for PPI response.
Among 108 patients with RH, 60 patients (55.56%) were the PPI responders, and 48 (44.44%) were the nonresponders. Compared with the nonresponders, the PPI responders had a lower PSPW index (47.05 ± 4.43 vs 51.33 ± 3.50, P = 0.004) and a decreased value of MNBI (1866.68 ± 390.62 vs 2181.14 ± 338.42, P = 0.017). Multivariate logistic regression revealed that only the pathologic PSPW index (OR: 2.064) and MNBI (OR: 1.800) significantly influenced PPI response.
Nearly half of RH patients were PPI nonresponders. Impedance-pH monitoring was more valuable than pH-only monitoring in associating PPI response to reflux in RH patients owing to the appraisal of the PSPW index and MNBI.
反流后吞咽诱发蠕动波（PSPW）指数和夜间平均基线阻抗（MNBI）已被证明会影响胃食管反流病（GERD）患者对质子泵抑制剂（PPI）的反应。然而，目前关于反流高敏（RH）患者中这些变量的数据很少。在本研究中，我们旨在评估RH患者中PPI反应者和无反应者的患病率，并研究包括PSPW和MNBI在内的阻抗-pH变量对PPI反应的预测价值。
2018年6月至2022年12月前瞻性招募了108例符合罗马IV标准的RH患者。计算PPI反应者/无反应者的患病率，并比较反应组和无反应组之间的阻抗-pH变量。采用多因素logistic回归分析PPI反应的预测因素。
108例RH患者中，60例（55.56%）为PPI反应者，48例（44.44%）为无反应者。与无反应者相比，PPI反应者的PSPW指数较低（47.05±4.43对51.33±3.50，P=0.004），MNBI值降低（1866.68±390.62对2181.14±338.42，P=0.017）。多因素logistic回归显示，只有病理性PSPW指数（OR：2.064）和MNBI（OR：1.800）显著影响PPI反应。
近一半的RH患者是PPI无反应者。由于对PSPW指数和MNBI的评估，阻抗-pH监测在将PPI反应与RH患者的反流相关联方面比单纯pH监测更有价值。
