为什么用阻抗技术检测胃食管反流.ppt

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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

2、 Sci 2005; 50: 1916 食物最低pH值 Cola1.9 Lemonade2.0 Strawberry2.3 White Wine2.6 Red Wine2.8 Ketchup2.9 Apple Juice3.1 Orange Juice3.4 Coffee3.8 Tea3.9 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

3、Symptoms in Acid-Suppressed 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 cm Impedance at 15 cm Impedance at 9 cm Impedance at 7 cm Impedance at 5 cm Impedance a

4、t 3 cm pH at 5 cm 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（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, A

5、grawal, Freeman, Vela Clinical Gastroenterology and Hepatology 2008;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 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

6、PPI Therapy Associated with Nonacid, Acid or No Reflux; ACG Presentation; October 2004 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。 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

7、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. Castell, 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 Therap

8、y; Becker et al; Alimentary Pharmacology Becker et al; Alimentary Pharmacology 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-1 Hoarse 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

9、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 Summary Acid Exposure (pH) Upright Recumbent Acid ExposureUprightNormalRecumbent Normal Total Time2.1 min0.0 min 2.1 min Percent Time0.4%( 75 %: No Editing related to that specific symptom All Reflux symptom index 50-75% for a symptom: E

10、dit 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 corresponding to the deleted

11、impedance measurement areas Adult Editing Guideline; Donald Castell, MD; Medical University of South Carolina 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 Tim

12、e 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)

13、 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 areas Adult Editing Guideline; Donald Castell, MD; Medical University of South

14、Carolina Data and page formatting are examples Abnormal Acid Exposure 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

15、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 measurement areas preceding symptoms which are not tr

16、ue retrograde bolus movement (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 Abnormal Heartburn Symptom Inde

17、x 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 %: No Editing related to that specific sym

18、ptom 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 (i.e. not impedance reflux) 3. Delete

19、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 Example One Abnormal Heartburn All Symptom Index Abnormal Regurgitate All Symptom Index Reflux-Sym

20、ptom Temporal Associations Ambulatory Impedance-pH-Manometry Reflux - Cough 1 A 7440.93 S 5576.54 2 A 2697.40 S 796.22 3 A 5086.31 S 1484.97 4 A 2660.49 S 796.91 5 A 1782.45 S 817.31 6 A 1769.27 S 354.59 9 A -15.00 S 21.46 10A -10.00 S 14.29 11A 181.00 S 34.80 12A 27.00 S 10.73 14A 6.78 S 2.03 15A 5

21、.08 S 2.09 Nonacid Reflux (pH 5.6) Cough Event Median time 44 seconds Impedance pH Manometry 7 7 1 1 Weakly Acidic Reflux in Patients with Chronic Unexplained Cough During 24 Hour Pressure, pH and Impedance Monitoring; D. Sifrim et al; GUT; 2005; 54;449-454 (Range 41-51 seconds) 阻抗-pH 检测反流与症状的关系 Chr

22、onic Cough Data Summary Weakly Acidic Reflux in Patients with Chronic Unexplained Cough During 24 Hour Pressure, pH and Impedance Monitoring; D. Sifrim et al; GUT; 2005; 54;449-454 3 Nonacid Associated2 Acid & Nonacid Associated5 Acid Associated 10 SAP + Reflux-Cough 22 Patients NO! Its a Coke swallow Impedance/pH tracing