Abstract：
A hierarchical approach for gastro-oesophageal reflux disease (GERD) diagnosis by impedance-pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics.
To establish the clinical value of Lyon Consensus criteria in the work-up of patients with proton pump inhibitory (PPI)-refractory heartburn.
Expert review of off-therapy impedance-pH tracings from unproven GERD patients with PPI-refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow-induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on-therapy preoperative impedance-pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases.
Off-therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p < 0.0002). At the on-therapy presurgical evaluation, abnormal/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (p < 0.00001); a relationship between on-therapy ongoing reflux and PPI-refractory heartburn was confirmed by the favorable surgical outcome at 3-year follow-up, 88% of cases being in persistent off-PPI heartburn remission.
Impedance-pH monitoring, off- and on-therapy, is of high clinical value in the work-up of patients with PPI-refractory heartburn.
To establish the clinical value of Lyon Consensus criteria in the work-up of patients with proton pump inhibitory (PPI)-refractory heartburn.
Expert review of off-therapy impedance-pH tracings from unproven GERD patients with PPI-refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow-induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on-therapy preoperative impedance-pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases.
Off-therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p < 0.0002). At the on-therapy presurgical evaluation, abnormal/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (p < 0.00001); a relationship between on-therapy ongoing reflux and PPI-refractory heartburn was confirmed by the favorable surgical outcome at 3-year follow-up, 88% of cases being in persistent off-PPI heartburn remission.
Impedance-pH monitoring, off- and on-therapy, is of high clinical value in the work-up of patients with PPI-refractory heartburn.
摘要：
里昂共识提出了一种通过阻抗-pH监测进行胃食管反流病（GERD）诊断的分层方法，基于酸暴露时间(AET)和支持阻抗指标。
建立里昂共识标准在质子泵抑制（PPI）难治性胃灼热患者检查中的临床价值。
在转诊中心前瞻性评估来自未经证实的PPI难治性胃灼热GERD患者的治疗外阻抗-pH示踪的专家回顾。阻抗指标，即总反流发作，吞吐后诱导的蠕动波指数，和平均夜间基线阻抗，被评估。来自手术治疗的糜烂性/非糜烂性GERD病例组的治疗前阻抗-pH值的专家审查。
非治疗,正常,不确定,59%的人发现AET异常，17%,317例的23%。在正常和不确定的AET组中，高达22％和62％的病例中，异常阻抗指标提供了GERD的支持性证据。分别。将AET指标不确定且阻抗指标异常的病例加入异常AET组,观察到GERD证据显着增加（从23％到37％的病例，p<0.0002)。在治疗前评估中，阻抗指标的异常/不确定的AET和超生理值显示96例中有21％和90％的患者正在进行反流，分别（p<0.00001）；3年随访时良好的手术结果证实了治疗中持续反流与PPI难治性胃灼热之间的关系，88％的病例持续发生PPI胃灼热缓解。
阻抗-pH监测，关闭和继续治疗，在PPI难治性胃灼热患者的检查中具有很高的临床价值。
建立里昂共识标准在质子泵抑制（PPI）难治性胃灼热患者检查中的临床价值。
在转诊中心前瞻性评估来自未经证实的PPI难治性胃灼热GERD患者的治疗外阻抗-pH示踪的专家回顾。阻抗指标，即总反流发作，吞吐后诱导的蠕动波指数，和平均夜间基线阻抗，被评估。来自手术治疗的糜烂性/非糜烂性GERD病例组的治疗前阻抗-pH值的专家审查。
非治疗,正常,不确定,59%的人发现AET异常，17%,317例的23%。在正常和不确定的AET组中，高达22％和62％的病例中，异常阻抗指标提供了GERD的支持性证据。分别。将AET指标不确定且阻抗指标异常的病例加入异常AET组,观察到GERD证据显着增加（从23％到37％的病例，p<0.0002)。在治疗前评估中，阻抗指标的异常/不确定的AET和超生理值显示96例中有21％和90％的患者正在进行反流，分别（p<0.00001）；3年随访时良好的手术结果证实了治疗中持续反流与PPI难治性胃灼热之间的关系，88％的病例持续发生PPI胃灼热缓解。
阻抗-pH监测，关闭和继续治疗，在PPI难治性胃灼热患者的检查中具有很高的临床价值。
