Background & Aims

Wireless pH monitoring measures esophageal acid exposure time (AET) for up to 96 hours. We evaluated competing methods of analysis of wireless pH data.

Methods

Adult patients with persisting reflux symptoms despite acid suppression (n = 322, 48.5 ± 0.9 years, 61.7% women) from 2 tertiary centers were evaluated using symptom questionnaires and wireless pH monitoring off therapy, from November 2013 through September 2017; 30 healthy adults (control subjects; 26.9 ± 1.5 years; 60.0% women) were similarly evaluated. Concordance of daily AET (physiologic <4%, borderline 4%–6%, pathologic>6%) for 2 or more days constituted the predominant AET pattern. Each predominant pattern (physiologic, borderline, or pathologic) in relation to data from the first day, and total averaged AET, were compared with other interpretation paradigms (first 2 days, best day, or worst day) and with symptoms.

Results

At least 2 days of AET data were available from 96.9% of patients, 3 days from 90.7%, and 4 days from 72.7%. A higher proportion of patients had a predominant pathologic pattern (31.4%) than control subjects (11.1%; P = .03). When 3 or more days of data were available, 90.4% of patients had a predominant AET pattern; when 2 days of data were available, 64.1% had a predominant AET pattern (P < .001). Day 1 AET was discordant with the predominant pattern in 22.4% of patients and was less strongly associated with the predominant pattern compared with 48 hour AET (P = .059) or total averaged AET (P = .02). Baseline symptom burden was higher in patients with a predominant pathologic pattern compared with a predominant physiologic pattern (P = .02).

Conclusions

The predominant AET pattern on prolonged wireless pH monitoring can identify patients at risk for reflux symptoms and provides gains over 24 hours and 48 hours recording, especially when results from the first 2 days are discordant or borderline.

中文翻译：

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尽管进行了质子泵抑制剂治疗，但仍存在持续反流症状的患者的长期无线 pH 监测。

背景与目标

无线 pH 监测可测量长达 96 小时的食道酸暴露时间 (AET)。我们评估了无线 pH 数据分析的竞争方法。

方法

从 2013 年 11 月到 2017 年 9 月，使用症状问卷和无线 pH 监测对来自 2 个三级中心的尽管酸抑制仍存在持续反流症状的成年患者（n = 322，48.5 ± 0.9 岁，61.7% 女性）进行了评估；对 30 名健康成人（对照组；26.9 ± 1.5 岁；60.0% 女性）进行了类似的评估。2 天或更多天每日 AET 的一致性（生理 <4%，临界 4%–6%，病理 >6%）构成了主要的 AET 模式。与来自第一天的数据和总平均 AET 相关的每种主要模式（生理、临界或病理）与其他解释范式（前 2 天、最好的一天或最坏的一天）和症状进行比较。

结果

96.9% 的患者可获得至少 2 天的 AET 数据，90.7% 的患者可获得至少 3 天的 AET 数据，72.7% 的患者可获得至少 4 天的 AET 数据。与对照受试者 (11.1%; P = .03)相比，更高比例的患者具有主要的病理模式 (31.4% )。当 3 天或更多天的数据可用时，90.4% 的患者具有主要的 AET 模式；当 2 天的数据可用时，64.1% 的人具有主要的 AET 模式（P < .001）。22.4% 的患者第 1 天 AET 与主要模式不一致，与 48 小时 AET ( P = .059) 或总平均 AET ( P= .02）。与主要生理模式相比，主要病理模式患者的基线症状负担更高 ( P = .02)。

结论

长时间无线 pH 监测的主要 AET 模式可以识别有反流症状风险的患者，并提供超过 24 小时和 48 小时记录的收益，尤其是当前 2 天的结果不一致或处于临界状态时。