Predictive value of 24 h pH-impedance monitoring on therapeutic responsiveness of GERD patients
Objective To explore the predictive value of 24-hour pH-impedance monitoring in assessing the therapeutic response of patients with gastroesophageal reflux disease(GERD).Methods A total of 286 GERD patients with typical reflux symptoms who received treatment at the Third People's Hospital of Chengdu from December 2020 to November 2022 were selected for the study.All patients were treated with proton pump inhibitors(PPI).After two months,according to the treatment effect,the patients were divided into effective group and ineffective groups.A comparison was made between the two groups regarding their daily living habits,high-resolution manometry results,24-hour pH-impedance monitoring results,symptoms,and scale scores.Multivariate Logistic regression analysis was used to identify factors influencing treatment response,a prediction model was constructed,and the ROC curve was drawn to analyze the prediction value.Results After two months of treatment,184 cases were included in the effective group and 102 cases in the ineffective group.The length and the resting pressure of the LES in the effective group before treatment were lower than that in the ineffective group(P＜0.10).The distal latency(DL)and distal contractile integral(DCI)were higher in the effective group compared to the ineffective group(P＜0.10).The patients in the effective group had lower acid exposure time(AET)≥6%and total reflux episodes as well as DeMeester score before treatment than those in the ineffective group(P＜0.10).The proportion of the post-reflex swallowed-induced peristaltic wave(PSPW)index≥61%and the mean nocturnal baseline impedance(MNBI)value≥2 292 Ω in the effective group after reflux was higher than that in the ineffective group(P＜0.10).Multivariate Logistic regression analysis showed that the LES resting pressure(OR=0.738),DL(OR=3.643),DCI(OR=1.124)and comprehensive 24-hour pH-impedance monitoring prediction(OR=1.940)could affect the treatment response of GERD(P＜0.10).ROC curve analysis indicated that the comprehensive prediction based on 24-hour pH-impedance monitoring(AUC = 0.969,specificity = 90.2%,and sensitivity =91.3%)was higher than other contributing factors.Conclusions Relevant parameters associated with 24-hour pH-impedance monitoring can effectively predict the treatment response of typical GERD patients to PPI therapy.
NETL
NSTL
万方数据
维普
