反流性食管炎的临床特征分析

Clinical characteristics of reflux esophagitis in Chinese population

目的通过对14年间内镜诊断的反流性食管炎(RE)病例分析,探讨反流性食管炎的临床特征。方法收集1990年至2004年间经内镜诊断的反流性食管炎3851例,按LA分级系统分级,对其一般状况、临床症状、内镜表现以及部分患者进行的食管动力检测资料做回顾性分析。结果14年间RE占总胃镜检查人数的2.95%,而2000年至2004年间达4.25%。RE的男女性别比为3.4:1。近4年原发性RE发病年龄为(53.9±14.5)岁,其中A、B级者85.8%,C、D级者仅14.2%。RE患者行24 h食管pH、胆汁监测的pH<4时间百分比、光吸收值≥0.14时间百分比等均明显异常, 且在轻、重度患者间差异有统计学意义(P<0.05)。有反流症状者占67.23%。反流症状的发生率在轻、重度患者中无显著差异,但相对高龄、男性、合并消化性溃疡等在重度RE中的比例明显较高。结论反流性食管炎在近年来发病率有增高趋势,但仍以轻度RE为主,老年男性、合并消化性溃疡可能是发生重度RE的危险因素,酸反流、十二指肠胃食管反流在RE的发病中有重要作用。近年对反流症状识别率的提高有助于胃食管反流病的诊断。

Objective To investigate clinical characteristics of reflux esophagitis （RE） in Chinese population according to the retrospective analysis of RE in the past 14 years. Methods 3851 cases of RE were diagnosised in our department according to the Los Angeles grading system, and the general status, clinical symptoms, endoscopic findings and values of esophageal manometry ,24-hour esophageal pH and bilirubin monitoring were assessed. Results RE accounted for 2. 95% of the total endoscopy numbers, but the present of RE during 2000 - 2004 y was significantly elevated to 4. 25%. The gender ratio （ male： female） was 3.4： 1. In the recent 4 years mean age of the patients with original RE was （53.9±14. 5 ） years. Grade A and B RE comprised of 85.8% and grade C and D only 14. 2%. The index values such as percent of time with pH 〈4, percent of time with Abs 〉0. 14 and total reflux times were abnormal in RE group, and significant difference existed between the mild and severe RE（ P 〈0.05）. Reflux symptoms such as heartburn and regurgitation occurred in 67. 23% of patients. The occurrence of heartburn was no significantly different between the mild and severe RE, but the percentage of elder age, male gender and peptic ulcer were significantly higher in the severe RE group. Conclusion The incidence of RE tended higher in recent years and mild RE comprised most of the cases. The old male and complicated with peptic ulcer might be the risk factor for severe RE. Acid and duodenogastroesophageal reflux （DGER） had great role in the pathogenesis of RE. Recently more focus on the reflux symptom was helpful for the diagnosis of GERD.