Tailored therapy guided by multichannel intraluminal impedance pH monitoring for refractory non-erosive reflux disease.

作者: Nunzio Ranaldo , Giuseppe Losurdo , Andrea Iannone , Mariabeatrice Principi , Michele Barone

DOI: 10.1038/CDDIS.2017.436

关键词:

摘要: A relevant percentage of non-erosive reflux disease (NERD) is refractory to proton pump inhibitors (PPIs) treatment. Multichannel intraluminal impedance pH (MII-pH) monitoring should give useful pathophysiological information about refractoriness. Therefore, our aim was assess whether this technique could be guide a 'tailored' therapy in NERD. We retrospectively recruited NERD patients undergoing MII-pH for unsuccessful All had undergone upper endoscopy, and those with erosive esophagitis were excluded. No patient received PPI during monitoring. Subjects subgrouped into three categories: acid reflux, non-acid functional heartburn. MII-pH-guided performed 4 weeks as follows: at double dose, full dose plus alginate four times day heartburn levosulpiride 75 mg per day. visual analog scale (VAS) ranging from 0 100 mm administered before after such tailored evaluate overall symptoms. Responders defined by VAS improvement least 40%. Sixty-nine selected (female–male ratio 43 : 26, mean age 47.6±15.2 years). Overall effectiveness 84% without statistical difference among subgroups (88.5% 92% 66.6% heartburn; P=0.06). Univariate analysis showed that failure directly correlated diagnosis (OR=4.60) suggested trend toward negative correlation smoking positive one nausea. However, multivariate analysis, these parameters not significant. Functional experienced lower median percent reduction than (52.5% versus 66.6%, P<0.01) even if equal (66.6%). In conclusion, approach NERD, guided monitoring, demonstrated effective promising cure symptom persistence conventional failure. Nevertheless, standardized guidelines are advisable.

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