为什么用阻抗技术检测胃食管反流文档

为什么用阻抗技术检测胃食管反流1为什么用阻抗技术检测胃食管反流文档5/8/2024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。2为什么用阻抗技术检测胃食管反流文档5/8/2024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。Agrawaletal:DigDisSci2005;50:1916食物最低pH值Cola1.9Lemonade2.0Strawberry2.3WhiteWine2.6RedWine2.8Ketchup2.9AppleJuice3.1OrangeJuice3.4Coffee3.8Tea3.9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。3为什么用阻抗技术检测胃食管反流文档5/8/2024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。4为什么用阻抗技术检测胃食管反流文档5/8/2024AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;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%5为什么用阻抗技术检测胃食管反流文档5/8/2024Impedanceat17cmImpedanceat15cmImpedanceat9cmImpedanceat7cmImpedanceat5cmImpedanceat3cmpHat5cm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6为什么用阻抗技术检测胃食管反流文档5/8/202424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<4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7为什么用阻抗技术检测胃食管反流文档5/8/2024为什么要联合使用pH-阻抗？AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:139841%48%11%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，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8为什么用阻抗技术检测胃食管反流文档5/8/2024InderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004

服药期间做联合阻抗-pH检测148例在服药期间有持续症状的病人研究期间有121例病人有症状48%42%10%NoRefluxAssociationNonacidAssociationAcidAssociation非酸反流19%没有反流77%没有反流48%非酸反流42%酸性反流10%

有典型症状的病人N=69

有不典型症状的病人N=52典型症状:

烧心

反胃

胸痛不典型症状:

咳嗽

声嘶

打嗝,吞咽困难,globus&acidtaste4%酸性反流9为什么用阻抗技术检测胃食管反流文档5/8/2024AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:1398172例在服药期间有持续症状的病人48%42%10%NoRefluxAssociationNonacidAssociationAcidAssociation非酸性反流19%没有反流78%没有反流41%非酸性反流48%酸性反流11%

有典型症状的病人N=99

有非典型症状的病人N=73典型症状:

烧心

反胃

胸痛非典型症状:咳嗽

声嘶

打嗝,吞咽困难a,globus&acidtaste3%酸性反流服药期间做联合阻抗-pH检测10为什么用阻抗技术检测胃食管反流文档5/8/2024有典型症状的病人N=5845%45%10%NoRefluxAssociationNonacidAssociationAcidAssociationInderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004典型症状:烧心、打嗝、胸痛11为什么用阻抗技术检测胃食管反流文档5/8/202499例持续非典型症状的病人78%19%3%服药期间做联合阻抗-pH检测AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:1398非典型症状:

咳嗽

声嘶

打嗝,吞咽困难,globus&acidtaste12为什么用阻抗技术检测胃食管反流文档5/8/2024非典型症状的病人N=432%23%75%AcidAssociationNonacidAssociationNoRefluxAssociationInderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004非典型症状:Cough咳嗽

声嘶

打嗝,吞咽困难,globus,腹部症状&acidtaste13为什么用阻抗技术检测胃食管反流文档5/8/2024联合阻抗-pH检测期间有症状的病人N=200AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx35%3.5%3.5%58%这些病人单纯pH检测为阴性14为什么用阻抗技术检测胃食管反流文档5/8/2024在服抗酸药期间做联合阻抗-pH检测AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx42%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%15为什么用阻抗技术检测胃食管反流文档5/8/2024218名PPI治疗后症状持续的患者AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx24%17%16%13%10%9%7%4%症状发作16为什么用阻抗技术检测胃食管反流文档5/8/2024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%(36patients)没有反流57%(58patients)101例病人在研究期间有症状酸性反流7%(7patients)InderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October200417为什么用阻抗技术检测胃食管反流文档5/8/2024pH-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。18为什么用阻抗技术检测胃食管反流文档5/8/2024最佳GERD治疗方案

可能有GERD症状症状缓解抗酸治疗AcidReductionTherapy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DonaldO.Castell,MD;MedicalUniversityofSouthCarolina19为什么用阻抗技术检测胃食管反流文档5/8/2024联合阻抗-pH指导治疗ClinicalTrial:PersistentGastro-OesophagealRefluxSymptomsDespiteStandardTherapywithProtonPumpInhibitors–AFollow-upStudyofIntraluminal-ImpedanceGuidedTherapy;Beckeretal;AlimentaryPharmacology&Therapeutics26,1355–1360服用PPI期间持续有烧心反胃的病人N=143PPI治疗期间用联合阻抗-pH检测联合阻抗-pH检测39%的病人有病理性变化调整PPI用量或做胃底折叠术91%的病人症状消失20为什么用阻抗技术检测胃食管反流文档5/8/2024阻抗-pH检测系统构成3-20-09©2009性能齐全的记录器功能强大的软件种类丰富的固态导管21为什么用阻抗技术检测胃食管反流文档5/8/2024独特的食管括约肌定位器确保导管放置位置，保证检查结果的准确性、一致性、可重复性。食管括约肌定位器对研究结果至关重要22为什么用阻抗技术检测胃食管反流文档5/8/2024儿童阻抗–pH导管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES11cmaboveLES13cmaboveLES6ImpedanceSensors1pHSensor23为什么用阻抗技术检测胃食管反流文档5/8/2024成人阻抗–pH导管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensors1pHSensor24为什么用阻抗技术检测胃食管反流文档5/8/2024成人阻抗–pH+胃pH导管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensorsEsophagealpHSensorGastricpHSensor25为什么用阻抗技术检测胃食管反流文档5/8/2024成人咽喉反流-胃食管反流导管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensors1pHSensor1cmaboveUES1pHSensor26为什么用阻抗技术检测胃食管反流文档5/8/2024单支咽喉返流监测导管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensorsEsophagealpHSensorNonaAcidAcid1cmaboveUESPharyngealpHSensorAcidLPRMonitoringProbe27为什么用阻抗技术检测胃食管反流文档5/8/2024-1123456-13-12-11-10-9-8-7-6-5-41718190-2-3-2-1016-3-7双分支咽喉返流监测导管左侧分支检测咽喉反流右侧分支检测胃食管反流优点：可以分别精确定位上、下食管括约肌可以同时监测咽喉反流和胃食管反流可以准确放置导管28为什么用阻抗技术检测胃食管反流文档5/8/2024阻抗-pH客观评价反流29为什么用阻抗技术检测胃食管反流文档5/8/202430AcidGEREpisode30酸性非酸性pH4.0是阈值酸性和非酸性反流30为什么用阻抗技术检测胃食管反流文档5/8/2024AcidRefluxNonacidReflux快速鉴别酸性和非酸性反流

3cm

5cm

7cm

9cm

15cm

17cm4pHEsophagealGastric431为什么用阻抗技术检测胃食管反流文档5/8/2024ClearanceSwallows阻抗随食团变化pH下降典型酸性胃食管反流32为什么用阻抗技术检测胃食管反流文档5/8/202433AcidGEREpisode食团从下向上反向运动食团进入后pH低于4酸性胃食管反流pH4.0为阈值Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm3333为什么用阻抗技术检测胃食管反流文档5/8/2024酸性胃食管反流显示方式34为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm酸性反流物清除食团清除10秒35为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cmAcidGERClearancePhasesAcidClearance38secondsImpedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm36为什么用阻抗技术检测胃食管反流文档5/8/2024AcidGERClearanceSwallowClearanceSwallow37为什么用阻抗技术检测胃食管反流文档5/8/2024DistalEsophagealGERProximalEsophagealGERLPR酸性胃食管反流和咽喉反流38为什么用阻抗技术检测胃食管反流文档5/8/202439RetrogradeBolusMovementpHRemainsAbove4.0NonacidGEREpisodepH4.0threshold39Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm39为什么用阻抗技术检测胃食管反流文档5/8/2024非酸性胃食管反流显示方式40为什么用阻抗技术检测胃食管反流文档5/8/2024智能建立分析模型PPI模板Joshson-DeMeesterpH评分模板Joshson-DeMeester阻抗-pH评分模板Joshson-DeMeester/PPI阻抗-pH评分模板Biox-Ochoa阻抗-pH评分模板Biox-OchoapH评分模板Vandenplas评分模板41为什么用阻抗技术检测胃食管反流文档5/8/2024结论大量临床研究证明，只有联合pH—阻抗技术才能真正快速鉴别胃食管反流患者。进行监测的目的是否有效抑酸？症状与反流的关系：酸、弱酸、非酸、弱碱、碱反流频率反流高度42为什么用阻抗技术检测胃食管反流文档5/8/2024每小时总反流次数

未用PPI在用PPI非酸

酸(ZapataCetal:MUSC,Charleston,SC)43为什么用阻抗技术检测胃食管反流文档5/8/2024据MII-pH监测指导治疗ClinicalTrial:PersistentGastro-OesophagealRefluxSymptomsDespiteStandardTherapywithProtonPumpInhibitors–AFollow-upStudyofIntraluminal-ImpedanceGuidedTherapy;Beckeretal;AlimentaryPharmacology&Therapeutics26,1355–1360PPI治疗中烧心/反流症状持续的患者N=143行治疗过程中的MII-pH监测39%患者在MII-pH监测中存在病理性反流治疗升级PPI剂量调整或胃底折叠术91%患者症状缓解44为什么用阻抗技术检测胃食管反流文档5/8/2024胃底折叠术结果

非酸反流(14)酸反流(4)与反流无关(1)19名症状指数阳性的患者(>50%)CombinedMultiChannelIntraluminalImpedance-pHMonitoringtoSelectPatientswithPersistentGastro-oesophagealRefluxforLaparoscopicNissenFundoplication;Mainieetal;BritishJournalofSurgery;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-1Hoarseness

?45为什么用阻抗技术检测胃食管反流文档5/8/2024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46为什么用阻抗技术检测胃食管反流文档5/8/2024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47为什么用阻抗技术检测胃食管反流文档5/8/2024选择合适的报告格式打印报告自动分析自动出报告48为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance-pHMonitoringDataSummaryAcidExposure(pH) Upright Recumbent AcidExposure

Upright

Normal

Recumbent

Normal

TotalTime 2.1min 0.0min 2.1minPercentTime 0.4% (<6.3%) 0.0% (<1.2%) 0.2%AcidRefluxCompositeScoreAnalysis(DeMeester)(pH)

PatientValue

PatientScore

NormalThresholdUprightTimeInReflux 0.4% 0.2 <8.4RecumbentTimeInReflux 0.0% 0.4 <3.5TotalTimeInReflux 0.2% 0.1 <4.5EpisodesOver5min. 0.0 0.3 <3.5LongestEpisode 1.1min 0.3 <19.8TotalEpisodes 6.8 0.0 <46.9CompositeScore 1.2 <14.7NOTE:CompositeScoreNormalizedfor24Hours.49为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance-pHMonitoringDataSummary(page2)RefluxEpisodeActivity

Upright

Recumbent

Total

TotalNormalAcid 5 0 5Nonacid 42 1 43AllReflux 47 1 48 (<73)SymptomCorrelationtoReflux Acid Nonacid AllRefluxSymptom

Occurrences

Related

Related

Related

UnrelatedHeartburn 3 2 1 3 0Regurgitate 17 0 16 16 1RefluxSymptomIndexSymptom

Acid

Nonacid

AllRefluxHeartburn 66.67% 33.33% 100.00%Regurgitate 0.00% 94.12% 94.12%RefluxSymptomAssociationProbabilitySymptom

Acid

Nonacid

AllRefluxHeartburn 99.93% 66.51% 99.72%Regurgitate 0.00% 99.75% 99.46%50为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance-pHMonitoringDataSummaryAcidExposure(pH) Upright Recumbent TotalAcidExposure

Upright

Normal

Recumbent

Normal

Total

NormalTime 1.0min (onPPI)

0.0min (onPPI)

1.0min(onPPI)PercentTime 0.2% (<1.5%) 0.0% (<0.5%) 0.1%(<1.3%)MeanAcidClearanceTime20sec 0sec 20sec

AcidRefluxCompositeScoreAnalysis(DeMeester)(pH)

PatientValue

PatientScore

NormalThresholdUprightTimeInReflux 0.2% 0.1 <8.4RecumbentTimeInReflux0.0% 0.4 <3.5TotalTimeInReflux 0.1% 0.0 <4.5EpisodesOver5min. 0.0 0.3 <3.5LongestEpisode 0.6min 0.2 <19.8TotalEpisodes 5.1 0.0 <46.9CompositeScore 1.0 <14.7NOTE:CompositeScoreNormalizedfor24Hours.

Acid(chemical)ExposureDataFrompHSensorAdultorPediatricCompositeScoreFrompHSensor51为什么用阻抗技术检测胃食管反流文档5/8/2024Impedance-pHMonitoringDataSummaryRefluxEpisodeAcidity(Impedance)

Upright

Recumbent

Total

TotalNormalAcid 3 0 3(onPPI)Nonacid 45 40 85AllReflux 48 40 88(<48)SymptomAssociationData Acid Nonacid AllRefluxSymptom

Occurrences

Related

Related

Related

UnrelatedHeartburn 3 2 1 3 0Regurgitate17 0 16 16 1RefluxSymptomIndexSymptom

Acid

Nonacid

AllRefluxHeartburn 67% 33% 100Regurgitate 0% 94% 94%RefluxSymptomAssociationProbabilitySymptom

Acid

Nonacid

AllRefluxHeartburn 99% 66% 99%Regurgitate 0% 99% 99%NumberofAcid&NonacidRefluxEpisodesSymptomAssociationtoReflux52为什么用阻抗技术检测胃食管反流文档5/8/2024PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesExampleOne53为什么用阻抗技术检测胃食管反流文档5/8/2024PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesAbnormalAcidExposureExampleOne54为什么用阻抗技术检测胃食管反流文档5/8/2024PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesAbnormalHeartburnSymptomIndexExampleOne55为什么用阻抗技术检测胃食管反流文档5/8/2024PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________