C Prakash Gyawali, Benjamin D Rogers, Rena Yadlapati, Sabine Roman, Dustin A Carlson, John Pandolfino
{"title":"质子泵抑制剂治疗的pH阻抗监测影响确诊胃食管反流患者的治疗决策，但对未确诊胃食管反流患者没有影响。","authors":"C Prakash Gyawali, Benjamin D Rogers, Rena Yadlapati, Sabine Roman, Dustin A Carlson, John Pandolfino","doi":"10.1016/j.cgh.2025.02.032","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Ambulatory reflux monitoring off proton pump inhibitors (PPIs) is useful in unproven gastroesophageal reflux disease (GERD). In this prospective clinical trial, we evaluated if on-PPI pH-impedance monitoring provides value in unproven GERD.</p><p><strong>Methods: </strong>Patients with typical reflux symptoms with incomplete PPI response were studied both off PPI (wireless pH monitoring) and on PPI (pH-impedance monitoring) at 2 tertiary care centers. Patients and investigators were blinded to reflux testing findings, and patients were asked to self-resume PPI for uncontrolled symptoms despite rescue antacids. Data analysis determined if on-PPI pH-impedance findings correlated with off-PPI acid exposure time (AET) or influenced PPI-related decision making.</p><p><strong>Results: </strong>Of 79 patients, all 26 (32.9%) with refractory GERD metrics on-PPI had proven GERD off-PPI. In 60 patients with proven GERD off-PPI, 56.7% had no ongoing GERD on PPI. No on-PPI pH-impedance findings predicted PPI decision making among conclusive, borderline, or no reflux (P = .872); AET (P = .107); reflux episodes numbers (P = .113); mean nocturnal baseline impedance (P = .621); and reflux-symptom association categories (P = .363). In multivariable linear and logistic regression models, off-PPI AET modestly predicted refractory GERD (odds ratio, 1.34; 95% confidence interval, 1.11-1.63; P = .003), and reflux episode numbers were borderline in predicting conclusive GERD off-PPI (odds ratio, 1.00; 95% confidence interval, 1.00-1.10; P = .04).</p><p><strong>Conclusions: </strong>A minority of symptomatic patients will have refractory GERD evidence on pH-impedance monitoring on PPI; this strategy risks missing over half of the cohort with proven GERD if testing off PPI is unavailable. Our findings support documenting GERD off PPI first in PPI nonresponders and restricting on-PPI pH-impedance monitoring to identify refractory GERD only in patients with proven GERD with persisting symptoms.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT03202537.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6000,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"pH Impedance Monitoring on Proton Pump Inhibitor Therapy Impacts Management Decisions in Proven GERD but not in Unproven GERD.\",\"authors\":\"C Prakash Gyawali, Benjamin D Rogers, Rena Yadlapati, Sabine Roman, Dustin A Carlson, John Pandolfino\",\"doi\":\"10.1016/j.cgh.2025.02.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Ambulatory reflux monitoring off proton pump inhibitors (PPIs) is useful in unproven gastroesophageal reflux disease (GERD). In this prospective clinical trial, we evaluated if on-PPI pH-impedance monitoring provides value in unproven GERD.</p><p><strong>Methods: </strong>Patients with typical reflux symptoms with incomplete PPI response were studied both off PPI (wireless pH monitoring) and on PPI (pH-impedance monitoring) at 2 tertiary care centers. Patients and investigators were blinded to reflux testing findings, and patients were asked to self-resume PPI for uncontrolled symptoms despite rescue antacids. Data analysis determined if on-PPI pH-impedance findings correlated with off-PPI acid exposure time (AET) or influenced PPI-related decision making.</p><p><strong>Results: </strong>Of 79 patients, all 26 (32.9%) with refractory GERD metrics on-PPI had proven GERD off-PPI. In 60 patients with proven GERD off-PPI, 56.7% had no ongoing GERD on PPI. No on-PPI pH-impedance findings predicted PPI decision making among conclusive, borderline, or no reflux (P = .872); AET (P = .107); reflux episodes numbers (P = .113); mean nocturnal baseline impedance (P = .621); and reflux-symptom association categories (P = .363). In multivariable linear and logistic regression models, off-PPI AET modestly predicted refractory GERD (odds ratio, 1.34; 95% confidence interval, 1.11-1.63; P = .003), and reflux episode numbers were borderline in predicting conclusive GERD off-PPI (odds ratio, 1.00; 95% confidence interval, 1.00-1.10; P = .04).</p><p><strong>Conclusions: </strong>A minority of symptomatic patients will have refractory GERD evidence on pH-impedance monitoring on PPI; this strategy risks missing over half of the cohort with proven GERD if testing off PPI is unavailable. Our findings support documenting GERD off PPI first in PPI nonresponders and restricting on-PPI pH-impedance monitoring to identify refractory GERD only in patients with proven GERD with persisting symptoms.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT03202537.</p>\",\"PeriodicalId\":10347,\"journal\":{\"name\":\"Clinical Gastroenterology and Hepatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":11.6000,\"publicationDate\":\"2025-05-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Gastroenterology and Hepatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cgh.2025.02.032\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cgh.2025.02.032","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：动态监测质子泵抑制剂（PPIs）对未经证实的胃食管反流病（GERD）是有用的。在这项前瞻性临床试验中，我们评估了非ppi ph -阻抗监测是否对未经证实的胃食管反流有价值。方法：在两个三级保健中心研究了PPI（无线pH监测）和PPI （pH-阻抗监测）两种不完全PPI反应的典型反流症状患者。患者和研究人员对反流检测结果不知情，尽管有抗酸药，但仍要求患者自行恢复PPI。数据分析确定ppi上的pH阻抗结果是否与ppi外的酸暴露时间（AET）相关或影响ppi相关决策。结果：79例患者中，所有26例（32.9%）在ppi治疗时出现难治性胃食管反流指标，在ppi治疗后出现胃食管反流。在60例经证实未使用ppi的胃食管反流患者中，56.7%的患者在使用ppi后没有持续的胃食管反流。在结论性、边缘性或无反流（p=0.872）、AET （p=0.107）、反流发作次数（p=0.113）、平均夜间基线阻抗（p=0.621）和反流症状相关类别（p=0.363）中，PPI上的pH阻抗结果不能预测PPI决策。在多变量线性和逻辑回归模型中，非ppi AET适度预测难治性GERD (OR 1.34, CI 1.11-1.63, p=0.003)，反流发作次数在非ppi AET预测结结性GERD方面具有边缘性（OR 1.00, CI 1.00-1.10, p=0.04）。结论：少数有症状的患者在ppi监测时出现难治性胃食管反流证据；如果无法检测非ppi，该策略可能会错过超过一半的确诊胃食管反流患者。我们的研究结果支持首先记录非PPI的胃食管反流，并限制非PPI的ph阻抗监测，以识别难治性胃食管反流，仅在证实有持续症状的胃食管反流患者中。www.Clinicaltrials: gov NCT03202537。
pH Impedance Monitoring on Proton Pump Inhibitor Therapy Impacts Management Decisions in Proven GERD but not in Unproven GERD.
Background and aims: Ambulatory reflux monitoring off proton pump inhibitors (PPIs) is useful in unproven gastroesophageal reflux disease (GERD). In this prospective clinical trial, we evaluated if on-PPI pH-impedance monitoring provides value in unproven GERD.
Methods: Patients with typical reflux symptoms with incomplete PPI response were studied both off PPI (wireless pH monitoring) and on PPI (pH-impedance monitoring) at 2 tertiary care centers. Patients and investigators were blinded to reflux testing findings, and patients were asked to self-resume PPI for uncontrolled symptoms despite rescue antacids. Data analysis determined if on-PPI pH-impedance findings correlated with off-PPI acid exposure time (AET) or influenced PPI-related decision making.
Results: Of 79 patients, all 26 (32.9%) with refractory GERD metrics on-PPI had proven GERD off-PPI. In 60 patients with proven GERD off-PPI, 56.7% had no ongoing GERD on PPI. No on-PPI pH-impedance findings predicted PPI decision making among conclusive, borderline, or no reflux (P = .872); AET (P = .107); reflux episodes numbers (P = .113); mean nocturnal baseline impedance (P = .621); and reflux-symptom association categories (P = .363). In multivariable linear and logistic regression models, off-PPI AET modestly predicted refractory GERD (odds ratio, 1.34; 95% confidence interval, 1.11-1.63; P = .003), and reflux episode numbers were borderline in predicting conclusive GERD off-PPI (odds ratio, 1.00; 95% confidence interval, 1.00-1.10; P = .04).
Conclusions: A minority of symptomatic patients will have refractory GERD evidence on pH-impedance monitoring on PPI; this strategy risks missing over half of the cohort with proven GERD if testing off PPI is unavailable. Our findings support documenting GERD off PPI first in PPI nonresponders and restricting on-PPI pH-impedance monitoring to identify refractory GERD only in patients with proven GERD with persisting symptoms.
期刊介绍：
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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