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Abstract: Objective: To analyze reflux parameters by means of combined multichannel intraluminal impedance and pH (MII-pH) monitoring in patients with gastroesophageal reflux disease (GERD) symptoms off medication, and to find the reflux characteristics of Chinese GERD patients and the influences of gender, age, body posture, and body mass index (BMI) on gastroesophageal reflux (GER). Methods: Between Dec. 2008 and May 2014, 125 patients with typical GERD symptoms were subjected to 24-h MII-pH monitoring. Twelve patients with normal MII-pH profiles were not considered for analysis. The reflux parameters of 113 GERD patients with abnormal MII-pH results were analyzed. Results: (1) DeMeester scores were above the normal range in 46.90% (53/113) of GERD patients. Weakly acidic refluxes were prevalent in GERD patients, and the frequency of abnormal weakly acidic reflux was 75.22% (85/113). The frequencies of abnormal symptom index (SI) and symptom association probability (SAP) were 19.47% (22/113) and 14.16% (16/113), respectively. (2) The frequencies of DeMeester scores, the %time at pH<4, and the numbers of reflux episodes and of long reflux episodes >5 min were significantly higher in male patients than in female patients. (3) The %time at pH<4 was much higher during upright periods than during supine periods. During supine periods, 31.86% (36/113) of GERD patients had delayed bolus clearance time, compared with 19.47% (22/113) during upright periods. (4) The number of abnormal DeMeester scores, %time at pH<4, and the number of acid refluxes during upright periods were significantly higher in obese GERD patients than in GERD patients with a normal BMI. Overweight GERD patients also had many more acid refluxes during upright periods than GERD patients with a normal BMI. Conclusions: Weakly acidic refluxes were prevalent in Chinese GERD patients. The factors male, gender, upright position, obesity (BMI≥25), but not age, may increase the frequency and severity of GER.

24小时食管多通道腔内阻抗-pH监测阳性的113例胃食管反流病（GERD）患者的胃食管反流特点

[1]American Gastroenterological Association, 2011. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology, 140(3):1084-1091.

[2]Clayton, S.B., Rife, C.C., Singh, E.R., et al., 2012. Twice-daily proton pump inhibitor therapy dose not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing. Dis. Esophagus, 25(8):682-686.

[3]El-Serag, H., Hill, C., Jones, R., 2009. Systematic review: the epidemiology of gastroesophageal reflux disease in primary care, using the UK general practice database. Aliment. Pharm. Ther., 29(5):470-480.

[4]Farre, R., van Malenstein, H., de Vos, R., et al., 2008. Short exposure of oesophageal mucosa to bile acid, both in acidic and weakly acidic conditions, can impair mucosal integrity and provoke dilated intercellular spaces. Gut, 57(10):1366-1374.

[5]Fitzgerald, R.C., Pietro, M.D., Ragunath, K., et al., 2014. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut, 63(1):7-42.

[6]Frazzoni, M., Savarino, E., Manno, M., et al., 2009. Reflux patterns in patients with short-segment Barrett’s oesophagus: a study using impedance-pH monitoring off and on proton pump inhibitor therapy. Aliment. Pharmacol. Ther., 30(5):508-515.

[7]Grossi, L., di Tullio, A.M., Pagliaro, M., et al., 2013. Role of weakly acidic refluxes in the atypical symptoms of GERD. A pH-imedance study performed off-PPI therapy. Digest. Liver Dis., 45(2):S111.

[8]Gutschow, C., Bludau, M., Vallböhmer, D., et al., 2008. NERD, GERD, and Barrett’s esophagus: role of acid and non-acid reflux revisited with combined pH-impedance monitoring. Digest. Dis. Sci., 53(12):3076-3081.

[9]Hiroshi, Y., Kiyoshi, A., Takumi, F., et al., 2012. Combined pH-impedance monitoring and high-resolution manometry of Japanese patients treated with proton-pump inhibitors for persistent symptoms of non-erosive reflux disease. J. Smooth Muscle Res., 48(5):125-135.

[10]Katz, P.O., Gerson, L.B., Vela, M.F., 2013. American college of gastroenterology. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am. J. Gastroenterol., 108(3):308-328.

[11]Krishnan, K., Pandolfino, J.E., Kahrilas, P.J., et al., 2012. Increased risk for persistent intestinal metaplasia in patients with Barrett’s esophagus and uncontrolled reflux before radiofrequency ablation. Gastroenterology, 143(3):576-581.

[12]Schindlbeck, N.E., Heinrich, C., Konig, A., et al., 1987. Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology, 93(1):85-90.

[13]Vakil, N., 2010. Disease definition, clinical manifestations, epidemiology and natural history of GERD. Best Pract. Res. Clin. Gastroenterol., 24(6):759-764.

[14]Vela, M.F., 2014. Medical treatments of GERD: the old and new. Gastroenterol. Clin. North Am., 43(1):121-133.

[15]Wang, K., Duan, L.P., Ge, Y., et al., 2011. Diagnostic values of GerdQ, 24-h ambulatory oesophageal pH and impedance-pH monitoring in Barrett’s esophagus, reflux esophagitis and non-erosive reflux disease. Nat. Med. J. China, 91(18):1228-1232 (in Chinese).

[16]Xiao, Y.L., Lin, J.K., Cheung, T.K., et al., 2009. Reflux profile of Chinese gastroesophageal reflux disease patients with combined multichannel intraluminal impedance-pH monitoring. J. Gastroenterol. Hepatol., 24(6):1113-1118.

[17]Zerbib, F., Varannes, S.B., Roman, S., et al., 2005. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment. Pharmacol. Ther., 22(10):1011-1021.