青年人原发性胆汁反流性胃炎的临床特征分析

Clinical features of primary bile reflux gastritis of young people

目的探讨青年人原发性胆汁反流性胃炎的临床特点。方法对胃镜检出的258例青年人胆汁反流性胃炎进行临床分析,其中76例进行了24h动态胃内pH和胆汁反流的监测(Bilitec2000),另选相匹配的18例非反流性胃炎进行pH及胆汁反流监测的对照。结果所有患者除有上腹痛外,多有上腹饱胀、烧心、呃逆、反酸、呕吐等胃肠动力障碍表现,其中伴消瘦者116例(44.9%),胃镜多为急性胃粘膜炎症表现,缺乏典型内镜特征,24h动态胃内pH和胆汁反流的监测(Bilitec2000)与对照组比较在反流时间百分比、最长反流时间差异有显著性(P<0.001),但这种反流的增加与胃内pH>4时间无相关性。结论青年人原发性胆汁反流可引起胃粘膜的急性炎症,其临床及内镜缺乏特征性表现,24h动态胃内胆汁反流的监测(Bilitec2000)是可靠的诊断方法之一。

【Objective】The aim of the study was to investigate the clinical characteristics of primary bile reflux gastritis of young people. 【Methods】 258 young patients of primary bile reflux gastritis diagnosed by endoscopy were evaluated and in 76 of which simultaneous 24-hour gastric pH and bile monitoring (Bilitec2000) were mea-sured according to a standardized protocol. 18 control patients were included in this study. 【Results】All the pa-tients had the symptoms of gastrointestinal motor disorders,such as heart burn,epigastric pain,nausea and vomiting,but only 116 (44.9%) patients had weight-loss. The commonest endoscopic alterations were hyperemia,edema,ero-sions of the gastric mucosa,which were the characteristics of acute inflammation. Comparing the periods of bilirubin exposure of the stomach,all the subjects were found to have bile reflux (gastric bilirubin absorbance >0.14),but there were significant differences in the percentages of total period of bile reflux,the length of reflux events (>5 min-utes) and the longest reflux duration between reflux gastritis and no reflux gastritis (P <0.001). However,there was no relation between the percentages of bile reflux time and the time of pH>4 in stomach. 【Conclusion】Primary bile reflux of young patients may cause acute inflammation of gastric mucosa. There is no special feature in symptoms and endoscopy. 24-hour intragastric bilimetry (Bilitec 2000) appears to be an useful investigation to confirm the di-agnosis.