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1、5-06-08 2008阻抗技术用于胃食管反流丁文京博士 北美医学基金会 www.ast-作者使用Sandhill公司产品阻抗-pH 检测VS单纯pH检测单纯pH阻抗- pH酸反流YesYes非酸反流NoYes餐后反流50 %100%酸性症状YesYes非酸性症状NoYes 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;
2、50: 1916食物最低pH值 Cola1.9 Lemonade2.0 Strawberry2.3White Wine2.6 Red Wine2.8Ketchup2.9 Apple Juice3.1 Orange Juice3.4Coffee3.8Tea3.9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-pH检测可以客观和准确提供更多信息。An Analysis of Persistent Symptoms in Acid-Supp
3、ressed Patients Undergoing Impedance-pH Monitoring; Sharma, Agrawal, Freeman, Vela Clinical Gastroenterology and Hepatology 2008;6:xxx阻抗的作用：全面监测反流抗反流治疗寻找其它原因抑酸治疗58%35%7 %Impedance at 17 cmImpedance at 15 cmImpedance at 9 cmImpedance at 7 cmImpedance at 5 cmImpedance at 3 cmpH at 5 cm阻抗-pH 导管监测原理利用阻抗
4、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（pH 50%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 Clinical Gastroenter
5、ology and Hepatology 2008;6:xxx24 %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非酸性反流36 % (36 patients)没有反流57 % (58 patients)101 例病人在研究期间有症状酸性反流7 % (7 patients)Inder Mainie, R. Tutuian Medical College of SC; Symptoms on PPI Therapy Associated with Nonacid, Acid or No Reflux; ACG
6、Presentation; October 2004pH-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。 最佳 GERD 治疗方案 可能有 GERD 症状症状缓解抗酸治疗 Acid Reduction Therapy服药期间做联合阻抗-pH检测症状持续寻找最佳抗酸治疗严重酸反流抗反流治疗非酸性反流找其它原因不是反流 Donald O. Caste
7、ll, MD; Medical University of South Carolina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 Intraluminal-Impedance Guided Therapy; Becker et al; Alimentary Pharmacology Becker et al; Alimentary Pharma
8、cology Mainie et al; British Journal of Surgery; 10.1002/bjs.5493; 2006烧心-2 反流-3 咳嗽-7 清喉-1 声嘶-1烧心-1烧心-3 恶心-1Hoarse ness?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自动分析 自动出报告Impedance-pH Monitoring Data SummaryAcid Exposure (
9、pH) Upright Recumbent Acid ExposureUprightNormalRecumbent Normal TotalTime2.1 min0.0 min 2.1 minPercent Time0.4%( 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 s
10、ymptom event) 2. Delete any impedance measurement areas preceding symptoms which are not true retrograde bolus movement (i.e. not impedance reflux) 3. Delete any pH measurement areas corresponding to the deleted impedance measurement areasAdult Editing Guideline; Donald Castell, MD; Medical Universi
11、ty of South Carolina Data and page formatting are examplesExample OnePreliminary DataPatient Name:Acid GERD Patient Number:123456Normal Acid Exposure Percent Time Upright39.3%(6.3%) Acid Exposure Percent Time Recumbent5.6%(1.2%)Reflux Symptom Index SymptomAcidNonacidAll RefluxNormalHeartburn93 %15 %
12、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 measurement areas preceding symptoms which are not true retrograde bol
13、us movement (i.e. not impedance reflux) 3. Delete any pH measurement areas corresponding to the deleted impedance measurement areasAdult Editing Guideline; Donald Castell, MD; Medical University of South Carolina Data and page formatting are examplesAbnormal Acid ExposureExample OnePreliminary DataP
14、atient Name:Acid GERD Patient Number:123456Normal Acid Exposure Percent Time Upright39.3%(6.3%) Acid Exposure Percent Time Recumbent5.6%(1.2%)Reflux Symptom Index SymptomAcidNonacidAll RefluxNormalHeartburn93 %15 %98 %( 75 %: No Editing related to that specific symptom All Reflux symptom index 50-75
15、% 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 (i.e. not impedance reflux) 3. Delete any pH measurement areas correspondi
16、ng to the deleted impedance measurement areasAdult Editing Guideline; Donald Castell, MD; Medical University of South Carolina Data and page formatting are examplesAbnormal Heartburn Symptom IndexExample OnePreliminary DataPatient Name:Acid GERD Patient Number:123456Normal Acid Exposure Percent Time Upright39.3%(6.3%) Acid Exposure Percent Time Recumbent5.6%(1.2%)Reflux Sympto
