酸和胆汁反流与胃食管反流症状的关系

The relationship between acid and bile reflux and symptoms in gastroesophageal reflux

目的 分析酸反流及胆汁反流在引起胃食管反流症状中的作用。方法 对 5 6例有典型反流症状的患者进行 2 4小时食管内 pH值及Bilitec胆汁同步监测。患者通过症状按键标记典型反流症状 ,对每一症状事件按症状发生前 2分钟内食管最低 pH值和最高胆红素光吸收值 ,分别计算症状与酸反流或胆汁反流事件的相关性 ,得出每一例患者的酸反流相关症状指数 (SIa)及胆汁反流相关症状指数 (SIb)。结果 5 6例患者中共发生典型症状事件 3 5 7次。其中大部分症状 ( 3 7.2 5 %)与酸反流有关 ,仅 7.5 6%的症状与单纯胆汁反流有关。反流性食管炎组 (RE)亚组的 2 43次症状事件中 ,10 5次 ( 4 3 .2 1%)事件与酸反流相关 ,而 2 1次 ( 8.64 %)与胆汁反流有关。两种症状相关指数均值比较差异有显著性。结论 胃食管反流症状事件与酸反流的相关性明显高于胆汁反流 。

Objective To investigate the contribution of acid and bile reflux to symptoms in patients with presumed GERD.Methods A total of 56 patients with typical reflux symptoms underwent 24 hour ambulatory pH and Bilitec monitoring.Patients pressed a marker button when experiencing typical symptoms.For each symptom episode,minimal pH and maximal bilirubin optical density in a 2 min interval were calculated.For each patient,the symptom indexes(SI) including acid reflux(SIa) and bile reflux (SIb) were calculated.Results A total of 357 symptom episodes were identified.Most symptom events(37.25%) were associated with acid reflux and only 7.56% of symptom events were with bile reflux alone.In the patients with esophageal reflux,243 symptom events were registered,of which 105(43.21%) were associated with acid reflux while 21(8.64%) with bile reflux.There was a significant difference in the SI mean value between SIa and SIb.Conclusion Symptom episodes in patients with presumed GERD are more related to acid reflux than bile reflux.Bile reflux does not seem to play a major role in producing typical esophageal symptoms.