阻抗技术用于胃食管反流

1、阻抗技术用于胃食管反流,阻抗-pH 检测VS单纯pH检测,单纯pH检测是以病人主诉为基础的检查方法。有主观性。 联合阻抗- pH检测的意义是可以客观确诊各种反流,单纯pH检测不能辨别酸性食物造成的假象。 单纯pH检测不能发现非酸性反流。 单纯pH检测不能发现不是反流。 单纯pH检测不能评判胃底折叠术效果,Agrawal et al: Dig Dis Sci 2005; 50: 1916,阻抗可以通过食团运动反向辨别酸性食物造成的假象。 阻抗可以发现非酸反流。 阻抗可以发现不是反流的病人。 阻抗可以评判胃底折叠术效果,阻抗-pH 检测VS单纯pH检测,联合阻抗-pH检测,单纯pH检测,联合阻抗-

2、pH检测可以客观和准确提供更多信息,阻抗的作用：全面监测反流,58,35,7 ,阻抗-pH 导管,监测原理,利用阻抗检测反流 利用pH区分酸碱度,24小时pH-阻抗检测系统,重要意义 利用阻抗检测反流 利用pH区分酸碱度 判定是否发生返流 鉴别返流性质（酸性或非酸性返流） 返流高度 检测食团和化学物质的排空情况,检测内容 返流时间、返流次数 最长返流持续时间 酸清除时间（pH4的时间） 酸返流时间、返流时间百分比 返流性质（气体返流/液体返流/混合性返流） 返流高度 综合评分,为什么要联合使用pH-阻抗,99例持续典型症状的病人,在99例有典型胃食管反流症状的病人中，经检测发现48%没有反流，

3、41%为非酸性反流，只用11%为酸性反流,服药期间做联合阻抗-pH 检测,有典型症状的病人 N=58,45 ,45 ,10 ,No Reflux Association,Nonacid Association,Acid Association,Inder Mainie, R. Tutuian October 2004,典型症状: 烧心、打嗝、胸痛,非典型症状的病人 N=43,2 ,23 ,75 ,Acid Association,Nonacid Association,No Reflux Association,Inder Mainie, R. Tutuian October 2004,非典型

4、症状: Cough咳嗽 声嘶 打嗝, 吞咽困难, globus, 腹部症状 Sharma, Agrawal, Freeman, Vela 6:xxx,35 ,3.5 ,3.5 ,58 ,在服抗酸药期间做联合阻抗-pH检测,An Analysis of Persistent Symptoms in Acid-Suppressed Patients Undergoing Impedance-pH Monitoring; Sharma, Agrawal, Freeman, Vela 6:xxx,42 ,58 ,症状指数阳性,症状指数阴性,42 ,58 ,200例病人在检测期间有症状,症状指数 50,

5、218名PPI治疗后症状持续的患者,An Analysis of Persistent Symptoms in Acid-Suppressed Patients Undergoing Impedance-pH Monitoring; Sharma, Agrawal, Freeman, Vela 6:xxx,24 ,17 ,16,13 ,10 ,9 ,7 ,4 ,症状发作,成人病人,服药期间做联合阻抗-pH检测,125 例在服药期间有持续症状的病人,101 例病人在研究期间有症状,酸性反流 7 % (7 patients,Inder Mainie, R. Tutuian October 2004

6、,pH-阻抗联合测试的意义,可以鉴别反酸性和非反酸性胃食管返流性疾病，排除有反流症状的非反流病人。 可以测量返流性质和返流高度。 可以检测咽喉反流。 可以测量食团和化学物排空，可以测量食团上下运动。 可以检查反流物的性质：液体、气体、混合等。 结合阻抗和压力波以动画技术动态显示食团传送和食管蠕动,联合阻抗-pH指导治疗,Clinical Trial: Persistent Gastro-Oesophageal Reflux Symptoms Despite Standard Therapy with Proton Pump Inhibitors A Follow-up Study of Int

7、raluminal-Impedance Guided Therapy; Becker et al; Alimentary Pharmacology Becker et al; Alimentary Pharmacology Mainie et al; British Journal of Surgery; 10.1002/bjs.5493; 2006,需要考虑的问题,病人有无 GERD? 症状的原因是什么,适当的抗酸治疗 与症状相关因素 酸性反流 非酸性反流 反流频率,阻抗-pH 检测报告,pH 反酸时间 酸反流成分评分 阻抗 反流性质：酸反流、非酸反流 反流次数,选择合适的报告格式,打印报告

8、,自动分析 自动出报告,Impedance-pH Monitoring Data Summary Acid Exposure (pH) Upright Recumbent Acid ExposureUprightNormalRecumbent Normal Total Time2.1 min0.0 min 2.1 min Percent Time0.4%( 6.3 %)0.0% ( 1.2 %) 0.2% Acid Reflux Composite Score Analysis (DeMeester) (pH) Patient ValuePatient ScoreNormal Threshol

9、d Upright Time In Reflux0.4%0.2 8.4 Recumbent Time In Reflux0.0%0.4 3.5 Total Time In Reflux0.2%0.1 4.5 Episodes Over 5 min.0.00.3 3.5 Longest Episode1.1 min0.3 19.8 Total Episodes6.80.0 46.9 Composite Score1.2 14.7 NOTE: Composite Score Normalized for 24 Hours,Impedance-pH Monitoring Data Summary (

10、page 2) Reflux Episode Activity UprightRecumbent Total Total Normal Acid50 5 Nonacid421 43 All Reflux471 48 ( 73) Symptom Correlation to Reflux AcidNonacidAll Reflux SymptomOccurrencesRelatedRelatedRelatedUnrelated Heartburn32130 Regurgitate17016161 Reflux Symptom Index SymptomAcidNonacidAll Reflux

11、Heartburn66.67%33.33%100.00% Regurgitate0.00%94.12%94.12% Reflux Symptom Association Probability SymptomAcidNonacidAll Reflux Heartburn99.93%66.51%99.72% Regurgitate0.00%99.75%99.46,Impedance-pH Monitoring Data Summary Acid Exposure (pH) Upright Recumbent Total Acid Exposure Upright NormalRecumbent

12、Normal TotalNormal Time 1.0 min (on PPI) 0.0 min (on PPI) 1.0 min (on PPI) Percent Time 0.2%( 1.5 %)0.0% ( 0.5 %) 0.1% (1.3%) Mean Acid Clearance Time 20 sec0 sec 20 sec Acid Reflux Composite Score Analysis (DeMeester) (pH) Patient ValuePatient Score Normal Threshold Upright Time In Reflux 0.2%0.1 8

13、.4 Recumbent Time In Reflux 0.0%0.4 3.5 Total Time In Reflux 0.1%0.0 4.5 Episodes Over 5 min. 0.00.3 3.5 Longest Episode 0.6 min0.2 19.8 Total Episodes 5.10.0 46.9 Composite Score1.0 14.7 NOTE: Composite Score Normalized for 24 Hours,Acid (chemical) Exposure Data From pH Sensor,Adult or Pediatric Co

14、mposite Score From pH Sensor,Impedance-pH Monitoring Data Summary Reflux Episode Acidity (Impedance) UprightRecumbentTotal Total Normal Acid303 (on PPI) Nonacid454085 All Reflux484088 ( 48) Symptom Association Data AcidNonacid All Reflux Symptom Occurrences RelatedRelated Related Unrelated Heartburn

15、 3 2 1 3 0 Regurgitate 17 0 16 16 1 Reflux Symptom Index SymptomAcidNonacidAll Reflux Heartburn67%33%100 Regurgitate0%94%94% Reflux Symptom Association Probability SymptomAcidNonacidAll Reflux Heartburn99%66%99% Regurgitate0%99%99,Number of Acid Donald Castell, MD; Medical University of South Caroli

16、na Data and page formatting are examples,Example One,Preliminary Data Patient Name:Acid GERD Patient Number:123456 Normal Acid Exposure Percent Time Upright39.3%(6.3%) Acid Exposure Percent Time Recumbent5.6%(1.2%) Reflux Symptom Index SymptomAcidNonacidAll RefluxNormal Heartburn93 %15 %98 %( 75 %:

17、No Editing related to that specific symptom All Reflux symptom index 50-75% for a symptom: Edit as follows 1. Review impedance reflux episodes preceding symptoms (5 min. prior to symptom event) 2. Delete any impedance measurement areas preceding symptoms which are not true retrograde bolus movement

18、(i.e. not impedance reflux) 3. Delete any pH measurement areas corresponding to the deleted impedance measurement areas Adult Editing Guideline; Donald Castell, MD; Medical University of South Carolina Data and page formatting are examples,Preliminary Data Patient Name:Acid GERD Patient Number:12345

19、6 Normal Acid Exposure Percent Time Upright39.3%(6.3%) Acid Exposure Percent Time Recumbent5.6%(1.2%) Reflux Symptom Index SymptomAcidNonacidAll RefluxNormal Heartburn93 %15 %98 %( 75 %: No Editing related to that specific symptom All Reflux symptom index 50 -75% for a symptom: Edit as follows 1. Review impedance reflux episodes preceding symptoms (5 min. prior to symptom event) 2. Delete any impedance measure