Hipersensitif Özofaguslu Hastalarda pH-İmpedans, Manometri ve Endoskopi Bulgularının Retrospektif Değerlendirilmesi ve Tedavi Sonuçları

Abstract

Hipersensitif özofagus (HE), pH-impedans izleminde normal asit maruziyeti süresine (AET) rağmen tipik reflü semptomlarıyla karakterize klinik bir tablodur. Patofizyolojisinin anlaşılması ve tedavi optimizasyonu halen zorluklar içermektedir. Bu retrospektif çalışmada, Lyon Konsensusu’na göre HE tanısı alan (AET <%4, semptom indeksi [SI] ve/veya semptom ilişki olasılığı [SAP] pozitif) 142 hastanın klinik özellikleri, endoskopik ve fonksiyonel bulguları, semptom-reflü ilişkisi ve tedavi sonuçları değerlendirildi. Los Angeles sınıflamasına göre endoskopik bulgular, Chicago sınıflaması v4.0’a göre yüksek çözünürlüklü manometri sonuçları analiz edildi. SI ve SAP değerleri hesaplandı. Kohortun %70,4’ü kadın olup, yaş ortalaması 42,2 ± 11,8 yıl idi. En sık görülen semptomlar yanma (%83,1) ve regürjitasyon (%76,1) idi. Endoskopik incelemede çoğunlukla normal bulgu saptanırken, %7,0 olguda hafif özofajit görüldü. Ortalama AET %1,56 ± 0,99 idi. Semptom grupları arasında reflü yükü, motilite veya bazal mukoza empedansında anlamlı farklılık bulunmadı. SI pozitifliği artmış reflü süresi ve düşük alt özofagus sfinkter basıncı ile ilişkilendirildi; SAP pozitifliği ise distal kontraktil integral azalması ile korelasyon gösterdi. Genel tedavi yanıtı %37,3 iken, özellikle seçici serotonin geri alım inhibitörleri (SSRI) ile uygulanan ikinci basamak tedaviler, ilk tedaviye yanıt vermeyen 89 hastada %98,9 oranında yüksek bir başarı sağlamıştır. HE, minimal asit yükü ve fonksiyonel değişikliklerle seyreden, geleneksel parametrelerle iyi yansıtılamayan özgün bir hastalık grubudur. Semptom-reflü ilişki indeksleri tanıda yardımcı olabilir ancak tedavi yönlendirmesinde tek başına yeterli değildir. Nöromodülatör tedaviler, özellikle SSRI’lar, asit baskılayıcı tedavilere kıyasla daha etkili görünmekte olup, bireyselleştirilmiş ve algıya yönelik tedavi stratejilerinin önemini vurgulamaktadır.

Keywords

• Hipersensitif özofagus
• pH-impedans izleme
• özofagus motilitesi
• yüksek çözünürlüklü özofagus manometrisi
• bazal mukoza empedansı
• semptom ilişki olasılığı

Supporting Institution

Bu çalışma, herhangi bir kurum veya kuruluş tarafından desteklenmemiştir

Ethical Statement

Etik onay, Kocaeli Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (Onay No: KU GOKAEK-2025/17/22, Proje No: 2025/431). Tüm katılımcılardan bilgilendirilmiş onam alınmış ve çalışma etik standartlara ve Helsinki Bildirgesi’ne uygun olarak yürütülmüştür.

Retrospective Evaluation of pH-Impedance, Manometry, and Endoscopy Patients with Hypersensitive Esophagus and Its Treatment Outcomes

Abstract

Hypersensitive esophagus (HE) is a clinical entity characterized by typical reflux symptoms despite normal acid exposure time (AET) on pH-impedance monitoring. Understanding its pathophysiology and optimizing management remain challenging. This retrospective study evaluated clinical characteristics, endoscopic and functional findings, symptom-reflux association, and treatment outcomes in 142 patients who met the Lyon Consensus 2.0 criteria for HE (AET <4%, symptom index [SI] and/or symptom association probability [SAP] positive). Endoscopic findings were classified according to the Los Angeles classification, and high-resolution manometry results were interpreted based on the Chicago Classification v4.0. SI and SAP. values were calculated. The cohort was predominantly female (70.4%) with a mean age of 42.2 ± 11.8 years. Heartburn (83.1%) and regurgitation (76.1%) were the most frequent. Endoscopy was normal in most, with only 7.0% showing mild esophagitis. Mean AET was 1.56% ± 0.99%. No significant differences were found in reflux burden, motility, or baseline impedance between symptom-based subgroups. SI positivity was linked to increased reflux time and diminished lower esophageal sphincter tone; SAP positivity correlated with reduced distal contractile integral. Overall treatment response was 37.3%, while second-line therapies—particularly selective serotonin reuptake inhibitors (SSRIs)—achieved a high success rate of 98.9% among the 89 patients who did not respond to initial treatment. HE is a distinct disorder with minimal acid burden and functional alterations, poorly captured by conventional metrics. Symptom association indices may aid diagnosis but cannot guide treatment alone. Neuromodulatory approaches, particularly SSRIs, appear more effective than acid suppression, highlighting the importance of individualized, perception-targeted strategies.

Keywords

• Hypersensitive esophagus
• pH-impedance monitoring
• esophageal motility
• high-resolution esophageal manometry
• baseline mucosal impedance
• symptom association probability

Supporting Institution

There is no supporting/funding institution.

Ethical Statement

Ethics approval was obtained from the Non-Interventional Clinical Research Ethics Committee of Kocaeli University (Approval No: KU GOKAEK-2025/17/22, Project No: 2025/431). Informed consent was obtained from all participants, and the study was conducted in accordance with ethical standards and the Declaration of Helsinki.

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