Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world

被引：73

作者：

Sifrim, Daniel ^{[1
]}

Roman, Sabine ^{[2
]}

Savarino, Edoardo ^{[3
]}

Bor, Serhat ^{[4
]}

Bredenoord, Albert J. ^{[5
]}

Castell, Donald ^{[6
]}

Cicala, Michele ^{[7
]}

de Bortoli, Nicola ^{[8
]}

Frazzoni, Marzio ^{[9
]}

Gonlachanvit, Sutep ^{[10
,11
]}

Iwakiri, Katsuhiko ^{[12
]}

Kawamura, Osamu ^{[13
]}

Krarup, Anne ^{[14
,15
]}

Lee, Yeong Yeh ^{[16
,17
]}

Soon Ngiu, Chai ^{[18
]}

Ndebia, Eugene ^{[19
]}

Patcharatraku, Tanisa ^{[20
]}

Pauwels, Ans ^{[21
]}

Perez de la Serna, Julio ^{[22
,23
]}

Ramos, Rosa ^{[24
]}

Remes-Troche, Jose Maria ^{[25
]}

Ribolsi, Mentore ^{[7
]}

Sammon, Alastair ^{[19
]}

Simren, Magnus ^{[26
]}

Tack, Jan ^{[27
]}

Tutuian, Radu ^{[28
]}

Valdovinos, Miguel ^{[29
]}

Xiao, Yinglian ^{[30
]}

Zerbib, Frank ^{[31
]}

Gyawali, C. Prakash ^{[32
]}

机构：

[1] Queen Mary Univ London, Barts & London Sch Med & Dent, London, England

[2] Univ Lyon, Hosp Civils Lyon, Digest Physiol, Hop E Herriot, Lyon, France

[3] Univ Padua, Dept Surg Oncol & Gastroenterol, Gastroenterol Unit, Padua, Italy

[4] Ege Univ, Sch Med, Izmir, Turkey

[5] Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[6] Med Univ South Carolina, Charleston, SC 29425 USA

[7] Univ Campus Bio Med, Digest Dis, Rome, Italy

[8] Univ Pisa, Gastroenterol Unit, Pisa, Italy

[9] Baggiovara Hosp, Digest Pathophysiol Unit, Modena, Italy

[10] Chlalongkorn Univ, Dept Med, Bangkok, Thailand

[11] King Chulalongkorn Mem Hosp, Thai Red Cross, Bangkok, Thailand

[12] Chiba Hokusoh Hosp, Dept Gaastroenterol, Nippon Med Sch, Chiba, Japan

[13] Gunma Univ Hosp, Maebashi, Gumma, Japan

[14] North Danish Reg Hosp, Dept Med, Sect Gastroenterol & Hepatol, Hjorring, Denmark

[15] North Danish Reg Hosp, Dept Neurogastroenterol Res, Hjorring, Denmark

[16] Univ Sains Malaysia, Sch Med Sci, Kota Baharu, Kelantan, Malaysia

[17] Univ New South Wales, St George & Sutherland Clin Sch, Sydney, NSW, Australia

[18] Cardiac Vasc Sentral Kuala Lumpur, Kuala Lumpur, Malaysia

[19] Walter Sisulu Univ, Div Med Physiol, Mthatha, South Africa

[20] Chulalongkorn Univ, Dept Med, Ctr Excellence Neurogastroenterol & Motil, Gastropenterol,Fac Med, Bangkok, Thailand

[21] Katholieke Univ Leuven, Translat Res Ctr Gastrointestinal Disorders, Leuven, Belgium

[22] Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Immunol Dept, Madrid, Spain

[23] Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Gastroenterol Dept, Madrid, Spain

[24] Hosp Alta Complejidad Cruce, Buenos Aires, DF, Argentina

[25] Univ Veracruz, Dept Gastroenterol, Xalapa, Veracruz, Mexico

[26] Sahlgrens Univ Hosp, Dept Internal Med, Gothenburg, Sweden

[27] Univ Leuven, Clin & Expt Med, Leuven, Belgium

[28] Bern Univ Hosp, Univ Clin Visceral Surg & Medcine, Bern, Switzerland

[29] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Expt Surg, Mexico City, DF, Mexico

[30] Sun Yat Sen Univ, Dept Gastroenterol, Affiliated Hosp 1, Guangzhou, Peoples R China

[31] Bordeaux Univ Hosp, Dept Gastroenterol, Bordeaux, France

[32] Washington Univ, Sch Med, Div Gastroenterol, St Louis, MO 63110 USA

来源：

GUT | 2021年 / 70卷 / 08期

关键词：

impedance-pH monitoring; acid exposure time; post reflux swallow-induced peristaltic wave; reflux episodes; BASE-LINE IMPEDANCE; MULTICHANNEL INTRALUMINAL IMPEDANCE; GASTROESOPHAGEAL-REFLUX; INTRAOBSERVER; INTEROBSERVER; DISEASE; REPRODUCIBILITY; VARIABILITY; AGREEMENT; CHILDREN;

D O I：

10.1136/gutjnl-2020-322627

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objective Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. Design Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). Results Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. Conclusion Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings.

引用

页码：1441 / 1449

页数：9

共 41 条

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