Jiang Yuanxi, Dong Zhiyu, Chen Ying, Sun Huihui, Wang Junwen, Wang Zhenxiang, Meng Qianqian, Lin Han, Zhang Qingwei, Chen Shengliang, Ge Zhizheng, Wang Luowei, Xu Shuchang
Department of Gastroenterology, Tongji Hospital，School of Medicine, Tongji University, Shanghai, China.
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Dig Endosc. 2025 May;37(5):501-511. doi: 10.1111/den.14963. Epub 2024 Dec 4.
To evaluate the effects of endoscopic radiofrequency ablation (RFA) on proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD) in a Chinese population, and to explore the factors associated with favorable efficacy.
A multicenter, single-armed prospective cohort study was conducted. PPI-dependent GERD patients were enrolled and underwent RFA. The primary outcome was improvement of GERD health-related quality of life (GERD-HRQL). Secondary outcomes were symptom improvement, satisfaction, PPI use, and the indicators of 24-h pH-impedance monitoring. A nomogram to predict complete remission was constructed.
In total, 66 patients were included. The GERD-HRQL score was significantly reduced at the 3 month (mean difference, 14.7 [12.6-16.9]), 6 month (mean difference, 15.9 [13.8-18.1]), 12 month (mean difference, 16.7 [14.4-18.9]), 24 month (mean difference, 18.4 [16.2-20.1]), 36 month (mean difference, 18.2 [16.3-20.4]), and 48 month follow-up (mean difference, 16.1 [14.2-18.3]), all P < 0.001. The esophageal and extra-esophageal symptom scores were all significantly decreased. The proportion of satisfaction and no PPI use were significantly higher. With regard to the indicators of 24-h pH-impedance monitoring, acid exposure time (AET), and DeMeester score, but not lower esophageal sphincter (LES) pressure, decreased significantly at the 12 month follow-up. A nomogram based on age, body mass index (BMI), baseline AET, and LES pressure was then constructed and showed good discrimination in the prediction of complete remission following RFA.
This study demonstrated that RFA improved life quality as well as symptoms in PPI-dependent GERD patients in a Chinese population. Younger age, higher BMI, lower baseline AET, and higher baseline LES pressure indicate favorable efficacy of RFA.
评估内镜下射频消融术（RFA）对中国人群中质子泵抑制剂（PPI）依赖的胃食管反流病（GERD）的疗效，并探讨与良好疗效相关的因素。
进行了一项多中心、单臂前瞻性队列研究。纳入PPI依赖的GERD患者并接受RFA治疗。主要结局是GERD健康相关生活质量（GERD-HRQL）的改善。次要结局包括症状改善、满意度、PPI使用情况以及24小时pH阻抗监测指标。构建了一个预测完全缓解的列线图。
共纳入66例患者。GERD-HRQL评分在3个月（平均差值，14.7[12.6-16.9]）、6个月（平均差值，15.9[13.8-18.1]）、12个月（平均差值，16.7[14.4-18.9]）、24个月（平均差值，18.4[16.2-20.1]）、36个月（平均差值，18.2[16.3-20.4]）和48个月随访时均显著降低，所有P<0.001。食管和食管外症状评分均显著降低。满意度和不使用PPI的比例显著更高。关于24小时pH阻抗监测指标，酸暴露时间（AET）和DeMeester评分在12个月随访时显著降低，但食管下括约肌（LES）压力未降低。然后构建了一个基于年龄、体重指数（BMI）、基线AET和LES压力的列线图，该列线图在预测RFA后的完全缓解方面显示出良好的辨别力。
本研究表明，RFA改善了中国人群中PPI依赖的GERD患者的生活质量和症状。年龄较小、BMI较高、基线AET较低和基线LES压力较高表明RFA疗效良好。
