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DOI: 10.1055/s-2008-1027945
© Georg Thieme Verlag KG Stuttgart · New York
Katheterfreie pH-Metrie mittels Bravo-Kapsel versus Standard-pH-Metrie bei Patienten mit nicht erosiver Refluxkrankheit (NERD)
Catheter-Free pH-metry using the Bravo Capsule versus Standard pH-metry in Patients with Non-Erosive Reflux Disease (NERD)Publication History
Manuskript eingetroffen: 27.7.2008
Manuskript akzeptiert: 26.10.2008
Publication Date:
08 April 2009 (online)
![](https://www.thieme-connect.de/media/zfg/200904/lookinside/thumbnails/10.1055-s-2008-1027945-1.jpg)
Zusammenfassung
Einleitung: Die 24-h-pH-Metrie gilt als Goldstandard in der Diagnostik der nicht erosiven gastroösophagealen Refluxerkrankung (NERD). Experimentelle Studien konnten zeigen, dass bei bis zu einem Drittel der GERD-Patienten ein pathologischer Säurereflux jedoch erst nach einem Zeitraum von 24 h detektiert werden kann. Entsprechend müsste eine Säuremessung über den Zeitraum von 48 h bei mehr Patienten einen pathologischen Säurereflux erfassen können. Ziel: Das Ziel dieser Studie war es, zu evaluieren, ob eine pH-Messung über den Zeitraum von 48 h mittels Bravo-Kapsel die Diagnoserate der NERD gegenüber der standardmäßig verwendeten 24-h-pH-Metrie erhöhen kann. Patienten und Methoden: Prospektiv wurden 76 Patienten mit einer NERD eingeschlossen (47 Frauen, 29 Männer, mittleres Alter 49 Jahre). Die Patienten wurden in 2 Gruppen randomisiert: Standard-24-h-pH-Metrie (Gruppe A) und kabellose 48-h-pH-Metrie mittels Bravo-Kapsel (Gruppe B). Die Diagnose der Refluxkrankheit wurde basierend auf typischen Refluxbeschwerden wie Sodbrennen, saurem Aufstoßen und/oder Regurgitation sowie einem positiven Refluxfragebogen (RDQ) gestellt. Die Diagnose einer NERD basierte auf einem positiven RDQ und einer negativen Endoskopie. Ergebnisse: Insgesamt konnte bei 55 % der untersuchten NERD-Patienten ein saurer Reflux nachgewiesen werden. Verglichen mit der Bravo-Kapsel-pH-Metrie war der Nachweis eines pathologischen Säurerefluxes bei der Standard-24-h-pH-Metrie höher. Ebenso waren, mit Ausnahme der Anzahl saurer Refluxepisoden, alle verbliebenen pH-metrischen Kriterien bei der Standard-24-h-pH-Metrie höher. Gleichzeitig zeigte die 48-h-Bravo-pH-Metrie eine hohe Tag-zu-Tag-Variabilität. Schlussfolgerungen: Die pH-Messung über einen verlängerten Zeitraum von 48 h konnte bei Patienten mit NERD den Nachweis eines pathologischen Säurerefluxes nicht verbessern. Somit ist für die Bravo-Kapsel kein Vorteil gegenüber der konventionellen pH-Metrie als Standard in der täglichen klinischen Praxis gegeben.
Abstract
Background: pH-monitoring is considered the gold standard for the detection of acid reflux in patients with non-erosive reflux disease (NERD). Preliminary pH studies performed over periods longer than 24 hours have shown that in up to one-third of subjects abnormal pH exposure is detected only on the second day of monitoring. Therefore, pH-monitoring during 48 hours may yield more information about pathological acid reflux in patients being investigated for NERD. Aim: Thea im of this study was to compare conventional 24-hour pH-monitoring with the new wireless 48-hour Bravo pH-monitoring in patients with NERD. Patients and Methods: Patients with typical reflux symptoms, a positive reflux disease questionnaire and negative endoscopy (NERD) and without any form of acid suppressive therapy were included in this prospective study. The patients were divided into two groups: group A for conventional 24-hour pH-monitoring and group B for wireless 48-h Bravo pH-monitoring. Results: 76 patients with a diagnosis of NERD based on a positive RDQ questionnaire and negative endoscopy were included. (47 woman, 29 men, median age: 49 years). 54 underwent conventional pH-monitoring and 22 underwent 48-h pH-monitoring with the new wireless BRAVO system. The overall incidence of acid reflux was 55 % in patients with NERD. Acid reflux was detected less frequently when using Bravo as compared to conventional pH-monitoring. In addition, the Bravo pH-metry showed a large day-to-day variability. Conclusions: Prolonged pH-monitoring over a period longer than 24 hours did not improve the detection of acid reflux in patients with NERD. Thus, it appears that the Bravo pH-metry does not offer an advantage over standard pH-metry in the daily clinical practice.
Schlüsselwörter
Refluxösophagititis - GERD - NERD
Key words
reflux esophagititis - GERD - NERD
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PD Dr. Klaus Mönkemüller
Gastroenterologie, Hepatologie und Infektiologie, Uniklinikum Magdeburg
Leipzigerstr. 44
39120 Magdeburg
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Email: klaus.moenkemueller@medizin.uni-magdeburg.de