高清晰放大内镜诊断非糜烂性反流病的研究

The application of high-resolution endoscopy in non-erosive reflux disease

目的观察高清晰放大内镜下非糜烂性反流病的改变,结合24h胃食管pH监测及质子泵抑制剂试验,初步建立非糜烂性反流病高清晰放大内镜下的诊断标准。方法顺序收集具有胃食管反流症状超过3个月的病人及正常志愿者。应用高清晰放大内镜进行观察。根据症状及内镜检查结果将研究对象分为正常对照组、糜烂性食管炎组和无糜烂组。无糜烂组中24h食管pH监测阴性及pH监测阳性而内镜下无典型改变者给予PPI试验。结果正常对照组24例,糜烂性食管炎组19例,无糜烂组62例。齿状线形态分为锐利环型、宽齿型、锐齿型、破碎型、三角延伸型、舌样延伸型6型,无糜烂组分别占6.5%、6.5%、6.5%、11.2%、61.2%和8.1%。正常对照组仅有锐利环型、宽齿型、三角延伸型,分别占25.0%、58.3%和16.7%。无糜烂组锐齿型、破碎型、三角延伸型、舌样延伸型齿状线多于正常对照组,差异有统计学意义(P<0.05)。贲门黏膜粗糙程度分为平坦型、粗糙不平、凹凸不平及绒毛样不平4种。正常对照组中平坦型、粗糙不平、凹凸不平分别占16.6%、54.2%及29.2%,无糜烂组中分别占16.1%、9.7%及74.2%。贲门黏膜绒毛样不平在无糜烂组多于正常对照组,差异有统计学意义(P<0.05)。高清晰放大内镜诊断非糜烂性反流病的敏感度和特异度分别为77.8%和6/8。结论高清晰放大内镜检查可以提高非糜烂性反流病的诊断率;非糜烂性反流病可以分为非糜烂性反流性食管炎和症状性胃食管反流病。

Objectives To establish the diagnosis standards of the non-erosive reflux disease （NERD） using high-resolution endoscopy. The diagnostic standards are established by observing the evolution of main endoscopic appearance of NERD with high-resolntion endoscopy, in conjunction with 24 h monitoring of the pH and proton-pump inhibitor experiments. Methods Patients with gastroesophageal reflux disease symptoms and healthy volunteers were enrolled, All the individuals were assessed with highresolution endoscopy and 24 h ambulatory pH monitoring. Patients with negative 24 h ambulatory pH monitoring or with positive 24 h ambulatory pH monitoring but negative endoscopic appearance were undertaken proton-pump inhibitor test. Results The individuals were divided into 3 groups： 19 in erosive esophagitis, 62 in non-erosive group, and 24 were healthy volunteers. The shapes of Z-lines are divided into 6 types： sharply circle, sparsely serrafion, serration, tattered, triangular extension and lingulate extension. The percentage of each type in non-erosive group was 6. 5%, 6. 5%, 6. 5%, 11.2%, 61.2%, and 8.1% respectively. The percentage of sharply circle, sparsely serration and triangular extension Z-lines were 25.0%, 58. 3% and 16.7% respectively in the control group. There were more serration, fractured, triangular extension, and tongue-like extension Z-lines in the non-erosive group than in the control group. The difference was significant （P 〈 0. 05 ）. The appearance of the cardia membrane below the Z-line was categorized into four types： flatted, rough, concavo-convex and villiform. In the control group, the percentage of flatted, rough and concavo-convex types were 16.6%, 54. 2%, and 29. 2% respectively. In the non-erosive group, cardia membrane of rough, concavo-convex and villiform shapes were 16.1%, 9.7%, and 74. 2% respectively. There were more shapes of villiform types in the non-erosive group than in the control group. The difference was significant （ P 〈 0. 05 ）. The sensitivity and specificity of high resolution endoscopic test in diagnosing NERD was 77. 8% and 6/8 respectively. Conclusions High resolution endoscopic test will raise the diagnostic rate of NERD. NERD was divided into non-erosive esophagitis and symptomatic gastroesophageal reflux disease.