為什么用阻抗技術(shù)檢測(cè)胃食管反流

為什么用阻抗技術(shù)檢測(cè)胃食管反流目前一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)阻抗-pH檢測(cè)VS單純pH檢測(cè)單純pH阻抗-pH酸反流YesYes非酸反流NoYes餐后反流50%100%酸性癥狀YesYes非酸性癥狀NoYes單純pH檢測(cè)是以病人主訴為基礎(chǔ)的檢查方法。有主觀性。聯(lián)合阻抗-pH檢測(cè)的意義是可以客觀確診各種反流。目前二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)單純pH檢測(cè)不能辨別酸性食物造成的假象。單純pH檢測(cè)不能發(fā)現(xiàn)非酸性反流。單純pH檢測(cè)不能發(fā)現(xiàn)不是反流。單純pH檢測(cè)不能評(píng)判胃底折疊術(shù)效果。Agrawaletal:DigDisSci2005;50:1916食物最低pH值Cola1.9Lemonade2.0Strawberry2.3WhiteWine2.6RedWine2.8Ketchup2.9AppleJuice3.1OrangeJuice3.4Coffee3.8Tea3.9阻抗可以通過食團(tuán)運(yùn)動(dòng)反向辨別酸性食物造成的假象。阻抗可以發(fā)現(xiàn)非酸反流。阻抗可以發(fā)現(xiàn)不是反流的病人。阻抗可以評(píng)判胃底折疊術(shù)效果。目前三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)阻抗-pH檢測(cè)VS單純pH檢測(cè)聯(lián)合阻抗-pH檢測(cè)單純pH檢測(cè)聯(lián)合阻抗-pH檢測(cè)可以客觀和準(zhǔn)確提供更多信息。目前四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx阻抗的作用：全面監(jiān)測(cè)反流抗反流治療尋找其它原因抑酸治療58%35%7%目前五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedanceat17cmImpedanceat15cmImpedanceat9cmImpedanceat7cmImpedanceat5cmImpedanceat3cmpHat5cm阻抗-pH導(dǎo)管監(jiān)測(cè)原理利用阻抗檢測(cè)反流利用pH區(qū)分酸堿度目前六頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)24小時(shí)pH-阻抗檢測(cè)系統(tǒng)重要意義利用阻抗檢測(cè)反流利用pH區(qū)分酸堿度判定是否發(fā)生返流鑒別返流性質(zhì)（酸性或非酸性返流）返流高度檢測(cè)食團(tuán)和化學(xué)物質(zhì)的排空情況檢測(cè)內(nèi)容返流時(shí)間、返流次數(shù)最長(zhǎng)返流持續(xù)時(shí)間酸清除時(shí)間（pH<4的時(shí)間）酸返流時(shí)間、返流時(shí)間百分比返流性質(zhì)（氣體返流/液體返流/混合性返流）返流高度綜合評(píng)分目前七頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)為什么要聯(lián)合使用pH-阻抗？AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:139841%48%11%99例持續(xù)典型癥狀的病人在99例有典型胃食管反流癥狀的病人中，經(jīng)檢測(cè)發(fā)現(xiàn)48%沒有反流，41%為非酸性反流，只用11%為酸性反流。服藥期間做聯(lián)合阻抗-pH檢測(cè)目前八頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)InderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004

服藥期間做聯(lián)合阻抗-pH檢測(cè)148例在服藥期間有持續(xù)癥狀的病人研究期間有121例病人有癥狀48%42%10%NoRefluxAssociationNonacidAssociationAcidAssociation非酸反流19%沒有反流77%沒有反流48%非酸反流42%酸性反流10%

有典型癥狀的病人N=69

有不典型癥狀的病人N=52典型癥狀:

燒心

反胃

胸痛不典型癥狀:

咳嗽

聲嘶

打嗝,吞咽困難,globus&acidtaste4%酸性反流目前九頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:1398172例在服藥期間有持續(xù)癥狀的病人48%42%10%NoRefluxAssociationNonacidAssociationAcidAssociation非酸性反流19%沒有反流78%沒有反流41%非酸性反流48%酸性反流11%

有典型癥狀的病人N=99

有非典型癥狀的病人N=73典型癥狀:

燒心

反胃

胸痛非典型癥狀:咳嗽

聲嘶

打嗝,吞咽困難a,globus&acidtaste3%酸性反流服藥期間做聯(lián)合阻抗-pH檢測(cè)目前十頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)有典型癥狀的病人N=5845%45%10%NoRefluxAssociationNonacidAssociationAcidAssociationInderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004典型癥狀:燒心、打嗝、胸痛目前十一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)99例持續(xù)非典型癥狀的病人78%19%3%服藥期間做聯(lián)合阻抗-pH檢測(cè)AcidandNonacidRefluxinPatientswithPersistentSymptomsDespiteAcidSuppressiveTherapy.AMulticentreStudyUsingCombinedAmbulatoryImpedance-pHMonitoring;Maineetal;Gut2006;55:1398非典型癥狀:

咳嗽

聲嘶

打嗝,吞咽困難,globus&acidtaste目前十二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)非典型癥狀的病人N=432%23%75%AcidAssociationNonacidAssociationNoRefluxAssociationInderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004非典型癥狀:Cough咳嗽

聲嘶

打嗝,吞咽困難,globus,腹部癥狀&acidtaste目前十三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)聯(lián)合阻抗-pH檢測(cè)期間有癥狀的病人N=200AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx35%3.5%3.5%58%這些病人單純pH檢測(cè)為陰性目前十四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)在服抗酸藥期間做聯(lián)合阻抗-pH檢測(cè)AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx42%58%癥狀指數(shù)陽(yáng)性癥狀指數(shù)陰性42%58%200例病人在檢測(cè)期間有癥狀癥狀指數(shù)>50%目前十五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)218名PPI治療后癥狀持續(xù)的患者AnAnalysisofPersistentSymptomsinAcid-SuppressedPatientsUndergoingImpedance-pHMonitoring;Sharma,Agrawal,Freeman,Vela&Castell;ClinicalGastroenterologyandHepatology2008;6:xxx24%17%16%13%10%9%7%4%癥狀發(fā)作目前十六頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)成人病人

服藥期間做聯(lián)合阻抗-pH檢測(cè)125例在服藥期間有持續(xù)癥狀的病人非酸性反流36%(36patients)沒有反流57%(58patients)101例病人在研究期間有癥狀酸性反流7%(7patients)InderMainie,

R.Tutuian&D.O.Castell;MedicalCollegeofSC;SymptomsonPPITherapyAssociatedwithNonacid,AcidorNoReflux;ACGPresentation;October2004目前十七頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)pH-阻抗聯(lián)合測(cè)試的意義可以鑒別反酸性和非反酸性胃食管返流性疾病，排除有反流癥狀的非反流病人?？梢詼y(cè)量返流性質(zhì)和返流高度?？梢詸z測(cè)咽喉反流?？梢詼y(cè)量食團(tuán)和化學(xué)物排空，可以測(cè)量食團(tuán)上下運(yùn)動(dòng)。可以檢查反流物的性質(zhì)：液體、氣體、混合等。結(jié)合阻抗和壓力波以動(dòng)畫技術(shù)動(dòng)態(tài)顯示食團(tuán)傳送和食管蠕動(dòng)。目前十八頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)最佳GERD治療方案

可能有GERD癥狀癥狀緩解抗酸治療AcidReductionTherapy服藥期間做聯(lián)合阻抗-pH檢測(cè)癥狀持續(xù)尋找最佳抗酸治療嚴(yán)重酸反流抗反流治療非酸性反流找其它原因不是反流DonaldO.Castell,MD;MedicalUniversityofSouthCarolina目前十九頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)聯(lián)合阻抗-pH指導(dǎo)治療ClinicalTrial:PersistentGastro-OesophagealRefluxSymptomsDespiteStandardTherapywithProtonPumpInhibitors–AFollow-upStudyofIntraluminal-ImpedanceGuidedTherapy;Beckeretal;AlimentaryPharmacology&Therapeutics26,1355–1360服用PPI期間持續(xù)有燒心反胃的病人N=143PPI治療期間用聯(lián)合阻抗-pH檢測(cè)聯(lián)合阻抗-pH檢測(cè)39%的病人有病理性變化調(diào)整PPI用量或做胃底折疊術(shù)91%的病人癥狀消失目前二十頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)阻抗-pH檢測(cè)系統(tǒng)構(gòu)成3-20-09?2009性能齊全的記錄器功能強(qiáng)大的軟件種類豐富的固態(tài)導(dǎo)管目前二十一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)獨(dú)特的食管括約肌定位器確保導(dǎo)管放置位置，保證檢查結(jié)果的準(zhǔn)確性、一致性、可重復(fù)性。食管括約肌定位器對(duì)研究結(jié)果至關(guān)重要目前二十二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)兒童阻抗–pH導(dǎo)管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES11cmaboveLES13cmaboveLES6ImpedanceSensors1pHSensor目前二十三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)成人阻抗–pH導(dǎo)管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensors1pHSensor目前二十四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)成人阻抗–pH+胃pH導(dǎo)管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensorsEsophagealpHSensorGastricpHSensor目前二十五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)成人咽喉反流-胃食管反流導(dǎo)管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensors1pHSensor1cmaboveUES1pHSensor目前二十六頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)單支咽喉返流監(jiān)測(cè)導(dǎo)管5cmaboveLES3cmaboveLES7cmaboveLES9cmaboveLES15cmaboveLES17cmaboveLES6ImpedanceSensorsEsophagealpHSensorNonaAcidAcid1cmaboveUESPharyngealpHSensorAcidLPRMonitoringProbe目前二十七頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)-1123456-13-12-11-10-9-8-7-6-5-41718190-2-3-2-1016-3-7雙分支咽喉返流監(jiān)測(cè)導(dǎo)管左側(cè)分支檢測(cè)咽喉反流右側(cè)分支檢測(cè)胃食管反流優(yōu)點(diǎn)：可以分別精確定位上、下食管括約肌可以同時(shí)監(jiān)測(cè)咽喉反流和胃食管反流可以準(zhǔn)確放置導(dǎo)管目前二十八頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)阻抗-pH客觀評(píng)價(jià)反流目前二十九頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)30AcidGEREpisode30酸性非酸性pH4.0是閾值酸性和非酸性反流目前三十頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)AcidRefluxNonacidReflux快速鑒別酸性和非酸性反流

3cm

5cm

7cm

9cm

15cm

17cm4pHEsophagealGastric4目前三十一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)ClearanceSwallows阻抗隨食團(tuán)變化pH下降典型酸性胃食管反流目前三十二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)33AcidGEREpisode食團(tuán)從下向上反向運(yùn)動(dòng)食團(tuán)進(jìn)入后pH低于4酸性胃食管反流pH4.0為閾值Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm33目前三十三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)酸性胃食管反流顯示方式目前三十四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm酸性反流物清除食團(tuán)清除10秒目前三十五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cmAcidGERClearancePhasesAcidClearance38secondsImpedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm目前三十六頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)AcidGERClearanceSwallowClearanceSwallow目前三十七頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)DistalEsophagealGERProximalEsophagealGERLPR酸性胃食管反流和咽喉反流目前三十八頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)39RetrogradeBolusMovementpHRemainsAbove4.0NonacidGEREpisodepH4.0threshold39Impedance17cmImpedance15cmImpedance3cmImpedance5cmImpedance7cmImpedance9cmpH5cm目前三十九頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)非酸性胃食管反流顯示方式目前四十頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)智能建立分析模型PPI模板Joshson-DeMeesterpH評(píng)分模板Joshson-DeMeester阻抗-pH評(píng)分模板Joshson-DeMeester/PPI阻抗-pH評(píng)分模板Biox-Ochoa阻抗-pH評(píng)分模板Biox-OchoapH評(píng)分模板Vandenplas評(píng)分模板目前四十一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)結(jié)論大量臨床研究證明，只有聯(lián)合pH—阻抗技術(shù)才能真正快速鑒別胃食管反流患者。進(jìn)行監(jiān)測(cè)的目的是否有效抑酸？癥狀與反流的關(guān)系：酸、弱酸、非酸、弱堿、堿反流頻率反流高度目前四十二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)每小時(shí)總反流次數(shù)

未用PPI在用PPI非酸

酸(ZapataCetal:MUSC,Charleston,SC)目前四十三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)據(jù)MII-pH監(jiān)測(cè)指導(dǎo)治療ClinicalTrial:PersistentGastro-OesophagealRefluxSymptomsDespiteStandardTherapywithProtonPumpInhibitors–AFollow-upStudyofIntraluminal-ImpedanceGuidedTherapy;Beckeretal;AlimentaryPharmacology&Therapeutics26,1355–1360PPI治療中燒心/反流癥狀持續(xù)的患者N=143行治療過程中的MII-pH監(jiān)測(cè)39%患者在MII-pH監(jiān)測(cè)中存在病理性反流治療升級(jí)PPI劑量調(diào)整或胃底折疊術(shù)91%患者癥狀緩解目前四十四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)胃底折疊術(shù)結(jié)果

非酸反流(14)酸反流(4)與反流無關(guān)(1)19名癥狀指數(shù)陽(yáng)性的患者(>50%)CombinedMultiChannelIntraluminalImpedance-pHMonitoringtoSelectPatientswithPersistentGastro-oesophagealRefluxforLaparoscopicNissenFundoplication;Mainieetal;BritishJournalofSurgery;10.1002/bjs.5493;2006燒心-2反流-3咳嗽-7清喉-1聲嘶-1燒心-1燒心-3惡心-1Hoarseness

?目前四十五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)需要考慮的問題

病人有無GERD?癥狀的原因是什么?

適當(dāng)?shù)目顾嶂委熍c癥狀相關(guān)因素酸性反流非酸性反流反流頻率目前四十六頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)阻抗-pH檢測(cè)報(bào)告pH反酸時(shí)間酸反流成分評(píng)分阻抗反流性質(zhì)：酸反流、非酸反流反流次數(shù)目前四十七頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)選擇合適的報(bào)告格式打印報(bào)告自動(dòng)分析自動(dòng)出報(bào)告目前四十八頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance-pHMonitoringDataSummaryAcidExposure(pH) Upright Recumbent AcidExposure

Upright

Normal

Recumbent

Normal

TotalTime 2.1min 0.0min 2.1minPercentTime 0.4% (<6.3%) 0.0% (<1.2%) 0.2%AcidRefluxCompositeScoreAnalysis(DeMeester)(pH)

PatientValue

PatientScore

NormalThresholdUprightTimeInReflux 0.4% 0.2 <8.4RecumbentTimeInReflux 0.0% 0.4 <3.5TotalTimeInReflux 0.2% 0.1 <4.5EpisodesOver5min. 0.0 0.3 <3.5LongestEpisode 1.1min 0.3 <19.8TotalEpisodes 6.8 0.0 <46.9CompositeScore 1.2 <14.7NOTE:CompositeScoreNormalizedfor24Hours.目前四十九頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance-pHMonitoringDataSummary(page2)RefluxEpisodeActivity

Upright

Recumbent

Total

TotalNormalAcid 5 0 5Nonacid 42 1 43AllReflux 47 1 48 (<73)SymptomCorrelationtoReflux Acid Nonacid AllRefluxSymptom

Occurrences

Related

Related

Related

UnrelatedHeartburn 3 2 1 3 0Regurgitate 17 0 16 16 1RefluxSymptomIndexSymptom

Acid

Nonacid

AllRefluxHeartburn 66.67% 33.33% 100.00%Regurgitate 0.00% 94.12% 94.12%RefluxSymptomAssociationProbabilitySymptom

Acid

Nonacid

AllRefluxHeartburn 99.93% 66.51% 99.72%Regurgitate 0.00% 99.75% 99.46%目前五十頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance-pHMonitoringDataSummaryAcidExposure(pH) Upright Recumbent TotalAcidExposure

Upright

Normal

Recumbent

Normal

Total

NormalTime 1.0min (onPPI)

0.0min (onPPI)

1.0min(onPPI)PercentTime 0.2% (<1.5%) 0.0% (<0.5%) 0.1%(<1.3%)MeanAcidClearanceTime20sec 0sec 20sec

AcidRefluxCompositeScoreAnalysis(DeMeester)(pH)

PatientValue

PatientScore

NormalThresholdUprightTimeInReflux 0.2% 0.1 <8.4RecumbentTimeInReflux0.0% 0.4 <3.5TotalTimeInReflux 0.1% 0.0 <4.5EpisodesOver5min. 0.0 0.3 <3.5LongestEpisode 0.6min 0.2 <19.8TotalEpisodes 5.1 0.0 <46.9CompositeScore 1.0 <14.7NOTE:CompositeScoreNormalizedfor24Hours.

Acid(chemical)ExposureDataFrompHSensorAdultorPediatricCompositeScoreFrompHSensor目前五十一頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)Impedance-pHMonitoringDataSummaryRefluxEpisodeAcidity(Impedance)

Upright

Recumbent

Total

TotalNormalAcid 3 0 3(onPPI)Nonacid 45 40 85AllReflux 48 40 88(<48)SymptomAssociationData Acid Nonacid AllRefluxSymptom

Occurrences

Related

Related

Related

UnrelatedHeartburn 3 2 1 3 0Regurgitate17 0 16 16 1RefluxSymptomIndexSymptom

Acid

Nonacid

AllRefluxHeartburn 67% 33% 100Regurgitate 0% 94% 94%RefluxSymptomAssociationProbabilitySymptom

Acid

Nonacid

AllRefluxHeartburn 99% 66% 99%Regurgitate 0% 99% 99%NumberofAcid&NonacidRefluxEpisodesSymptomAssociationtoReflux目前五十二頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesExampleOne目前五十三頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesAbnormalAcidExposureExampleOne目前五十四頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)___________________________________________________________________________SuggestedEditingRequirementsAbnormalacidexposure: NoEditingAbnormalacidsymptomindex: NoEditingAllRefluxsymptomindex<50%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex>75%: NoEditingrelatedtothatspecificsymptomAllRefluxsymptomindex50-75%forasymptom: Editasfollows 1.Reviewimpedancerefluxepisodesprecedingsymptoms(5min.priortosymptomevent) 2.Deleteanyimpedancemeasurementareasprecedingsymptomswhicharenottrue retrogradebolusmovement(i.e.notimpedancereflux) 3.DeleteanypHmeasurementareascorrespondingtothedeletedimpedancemeasurement areasAdultEditingGuideline;DonaldCastell,MD;MedicalUniversityofSouthCarolinaDataandpageformattingareexamplesAbnormalHeartburnSymptomIndexExampleOne目前五十五頁(yè)\總數(shù)六十頁(yè)\編于十點(diǎn)PreliminaryDataPatientName: AcidGERDPatientNumber: 123456

NormalAcidExposurePercentTimeUpright 39.3% (6.3%)AcidExposurePercentTimeRecumbent 5.6% (1.2%)RefluxSymptomIndexSymptom

Acid

Nonacid

AllReflux

NormalHeartburn 93% 15% 98% (<50.00%)Regurgitate 17% 68%

85% (<50.00%)________________________________________________________________________