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首页> 外文期刊>Surgical Endoscopy >Refractory gastroesophageal reflux disease as diagnosed by impedance-pH monitoring can be cured by laparoscopic fundoplication
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Refractory gastroesophageal reflux disease as diagnosed by impedance-pH monitoring can be cured by laparoscopic fundoplication

机译：通过阻抗pH监测诊断出的难治性胃食管反流病可以通过腹腔镜胃底折叠术治愈

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Background: Some patients with typical (heartburn/regurgitation) symptoms of gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI) therapy. Impedance-pH monitoring can identify PPI-refractory patients who could benefit from laparoscopic fundoplication, but outcome data are scarce. We aimed to assess whether PPI-refractory GERD as diagnosed by impedance-pH monitoring can be cured by laparoscopic fundoplication. Methods: Forty-four consecutive GERD patients with heartburn/regurgitation refractory to high-dose PPI therapy entered a 3-year outcome assessment following robot-assisted laparoscopic fundoplication. Preoperative on-PPI impedance-pH diagnostic criteria consisted of positive symptom association probability (SAP)/symptom index (SI), and/or abnormal percentage esophageal acid exposure time (%EAET), and/or abnormal number of total refluxes. GERD cure was defined by 3-year postoperative off-PPI normal impedance-pH findings with persistent symptom remission. Results: Preoperatively, 24 of 38 (63 %) patients who completed the outcome assessment had a positive SAP/SI, 20 of 38 (53 %) for weakly acidic refluxes; 3 of 38 (8 %) patients had an abnormal %EAET, 11 of 38 (29 %) an abnormal number of total refluxes only. Postoperatively, heartburn/regurgitation recurred in 3 patients; abnormal impedance-pH findings were found in two of them, and they responded to PPI therapy. GERD cure was achieved in 34 of 38 (89 %) patients, 11 of 11 with an abnormal number of total refluxes as the only preoperative abnormal impedance-pH finding. Postoperatively, there was a significant decrease of the %EAET (1 vs. 0.1 %, P = 0.002) and of the number of total refluxes (68 vs. 8, P = 0.001), with the latter finding mainly due to a decrease in the number of weakly acidic refluxes. Conclusions: Normal reflux parameters and persistent symptom remission at 3-year follow-up can be achieved with laparoscopic fundoplication in the majority of patients with PPI-refractory GERD as diagnosed by impedance-pH monitoring. On-PPI impedance-pH diagnostic criteria should include SAP/SI positivity, an abnormal %EAET, and an abnormal number of total refluxes. Weakly acidic refluxes have a major role in the pathogenesis of PPI-refractory GERD.
机译：背景：一些典型的（胃灼热/反流）胃食管反流病（GERD）症状患者对质子泵抑制剂（PPI）治疗无效。阻抗pH监测可以识别可以从腹腔镜胃底折叠术中受益的PPI难治性患者，但结果数据很少。我们旨在评估通过阻抗-pH监测诊断出的PPI难治性GERD是否可以通过腹腔镜胃底折叠术治愈。方法：连续44例GERD患者因高剂量PPI治疗而难治性胃灼热/反流，在机器人辅助的腹腔镜胃底折叠术后进入3年结局评估。术前PPI阻抗-pH诊断标准包括阳性症状关联概率（SAP）/症状指数（SI）和/或异常的食管酸暴露时间百分比（％EAET）和/或异常的总反流次数。 GERD治愈的定义是术后3年非PPI正常阻抗pH值发现并伴有症状持续缓解。结果：术前，完成结果评估的38名患者中有24名（63％）的SAP / SI阳性，弱酸性反流患者中38名中有20名（53％）; 38名患者中有3名（8％）的％EAET异常，而38名患者中有11名（29％）仅发生了总反流次数异常。术后3例患者再次出现胃灼热/反流。在其中两个中发现了异常的阻抗-pH结果，并且它们对PPI治疗有反应。 GERD治愈在38名患者中的34名（89％）中实现，11名患者中有11名总反流次数异常，这是术前唯一发现异常阻抗pH值的情况。术后，％EAET（1 vs. 0.1％，P = 0.002）和总反流次数（68 vs. 8，P = 0.001）显着降低，后者的发现主要是由于弱酸性回流的数量。结论：大多数通过阻抗-pH监测诊断为PPI难治性GERD的患者，通过腹腔镜胃底折叠术可以实现3年随访时正常的反流参数和持续的症状缓解。 PPI阻抗-pH的诊断标准应包括SAP / SI阳性，％EAET异常和总反流次数异常。弱酸性反流在PPI难治性GERD的发病机理中起主要作用。

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