Characteristics of clinical manifestation and reflux monitor in patients with low mean nocturnal baseline impedance of proximal esophagus
10.3760/cma.j.cn311367-20250513-00200
- VernacularTitle:近端食管平均夜间基线阻抗下降患者的临床和反流监测特点
- Author:
Ge BAI
1
;
Lihong WU
1
;
Jinying LUO
1
;
Yuling TIAN
1
Author Information
1. 北京大学第一医院消化内科，北京 100034
- Publication Type:Journal Article
- Keywords:
Proximal esophageal impedance;
Gastroesophageal reflux disease;
24 hour multichannel intraluminal impedance and pH monitoring;
Mean nocturnal baseline im
- From:
Chinese Journal of Digestion
2025;45(8):513-519
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the characteristics of clinical manifestations and parameters of 24 hour multichannel intraluminal impedance and pH monitoring (24 h MII-pH) in patients with low mean nocturnal baseline impedance (MNBI) of proximal esophagus.Methods:From November 4, 2014 to February 18, 2024, 308 patients who underwent 24 h MII-pH at Peking University First Hospital due to typical gastroesophageal reflux disease symptoms and(or) extra-esophageal symptoms were retrospectively enrolled. MNBI at 17 or 15 cm above the lower esophageal sphincter (LES) < 2 292 Ω was defined as low proximal esophageal impedance (LPEI), both MNBI at 17 and 15 cm above the LES ≥ 2 292 Ω was defined as normal proximal esophageal impedance (NPEI). The 24 h MII-pH parameters were compared between patients with LPEI and patients with NPEI, as well as the incidence of extra-esophageal symptoms. And the 24 h MII-pH parameters were compared between patients with and without extra-esophageal symptoms. Independent sample t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among the 308 patients, 71 patients with LPEI, 236 patients with NPEI, and 1 patient was excluded due to missing the 24 h MII-pH data; and there were 215 patients with extra-esophageal symptoms and 93 without extra-esophageal symptoms. The proportion of extra-esophageal symptoms in the LPEI patients was higher than that in the NPEI patients(81.7% (58/71) vs. 66.1% (156/236)), the times of postprandial total reflux, postprandial acid reflux detected by impedance, proximal total reflux, and proximal acid reflux in the LPEI patients were more than those in the NPEI patients (22.5 (22.8) vs. 17.0 (19.0), 10.5 (13.3) vs. 7.0 (13.0), 9.0 (12.0) vs. 5.0 (11.0), 5.0 (10.0) vs. 3.0 (7.0)), and the differences were statistically significant( χ2=6.28, Z=-1.99, -2.06, -2.26 and -2.44; all P<0.05). The times of weak acidic reflux at supine position, proximal total reflux, proximal acid reflux, and proximal non-acid reflux of the patients with extra-esophageal symptoms were more than those in patients without extra-esophageal symptoms (2.0(5.0) vs. 1.0(4.0), 6.0(13.0) vs. 4.0(10.0), 4.0(10.0) vs. 3.0(7.0), 2.0(4.0) vs. 1.0(3.0)), the MNBI at 15 cm above the LES in patients with extra-esophageal symptoms was lower than that in patients without extra-esophageal symptoms ((3 222.4±1 018.7) Ω vs. (3 512.3±1 032.1) Ω), and the differences were statistically significant ( Z=-2.32, -2.25, -2.00 and -2.13, t=-2.28; all P<0.05). Conclusions:LPEI patients have higher proportion of extra-esophageal symptoms, more times of proximal and postprandial acidic reflux. The proximal esophageal impedance and proximal reflux parameters should be emphasized in the diagnosis and treatment of patients with extra-esophageal symptoms.
