Rusu Radu I, Fox Mark R, Sweis Rami, Zeki Sebastian, Dunn Jason M, Anggiansah Angela, Jafari Jafar, Learoyd Annastazia, Wong Terry
Esophageal Physiology Laboratory, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland; Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Center for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.
Clin Gastroenterol Hepatol. 2024 Dec 16. doi: 10.1016/j.cgh.2024.11.009.
BACKGROUND & AIMS: The Lyon 2.0 consensus recommends 96-hour wireless pH studies for gastroesophageal reflux disease (GERD) diagnosis; however, the optimal length of pH measurement has not been established. Further, it is uncertain if, and under what circumstances, shorter recording times are sufficient for a conclusive diagnosis.
Data from 944 patients with 4-day recordings was reviewed. Patients were classified at 24, 48, and 72 hours against the 96-hour reference standard. Acid exposure time (AET) <4% was conclusively negative, and AET >6% was conclusively positive for GERD. Esophagitis was an independent marker of disease. The effect of utilizing average day, worst day, and dominant-pattern analysis (≥2 negative or positive days) was compared. Groups defined by AET thresholds from 1% to 7% at 24 and 48 hours were followed to assess when short recording periods were sufficient for conclusive diagnosis.
Diagnostic accuracy improved with study duration (P < .00001). The proportion of patients with inconclusive results (AET 4%-6%) reduced from 113 of 944 at 24 hours to 40 of 113 at 96 hours (35% of subgroup; P = .02), with similar results for dominant pattern analysis. Diagnostic sensitivity for 24-, 48-, and 72-hour pH-monitoring for AET 6% threshold increased with study duration from 62.5% to 76.6% and 88.2%, respectively, when compared with the 96-hour reference standard.
The results of this analysis validate the recommendation that prolonged reflux studies of at least 72 hours duration provide optimal AET measurements for GERD diagnosis. Prolonging studies can also resolve inconclusive results based on 24- and 48-hour studies.
《里昂2.0共识》推荐采用96小时无线pH监测来诊断胃食管反流病（GERD）；然而，pH测量的最佳时长尚未确定。此外，尚不确定较短的记录时间在何种情况下足以做出确定性诊断。
回顾了944例患者4天记录的数据。将患者在24、48和72小时时的情况与96小时的参考标准进行分类。酸暴露时间（AET）<4%为明确阴性，AET>6%为明确阳性GERD。食管炎是疾病的独立标志物。比较了采用平均日、最差日和优势模式分析（≥2个阴性或阳性日）的效果。对24和48小时时AET阈值为1%至7%所定义的组进行随访，以评估短记录期何时足以做出确定性诊断。
诊断准确性随研究时长提高（P<.00001）。结果不确定（AET 4%-6%）的患者比例从24小时时944例中的113例降至96小时时113例中的40例（亚组的35%；P=.02），优势模式分析结果相似。与96小时参考标准相比，AET 6%阈值下24、48和72小时pH监测的诊断敏感性随研究时长分别从62.5%增至76.6%和88.2%。
该分析结果验证了以下建议，即至少72小时的延长反流研究可为GERD诊断提供最佳AET测量。延长研究还可解决基于24和48小时研究得出的不确定结果。
