24h食管pH监测和食管测压及奥美拉唑治疗试验在食管原性胸痛中的应用

Utility of Ambulatory 24-hour Esophageal pH,Esophageal Manometry and Omeprazole Therapeutic Test in Esophageal Chest Pain

目的 :探讨 2 4 h食管 p H监测和食管测压及奥美拉唑治疗试验在食管原性胸痛中的诊断价值。方法 :对食管原性胸痛 6 8例行内镜、食管测压、2 4 h食管 p H监测及 7d的奥美拉唑 (2 0 mg,2次 / d)治疗试验 ,治疗后症状评分比治疗前降低超过 75 %者则为治疗试验阳性。结果 :食管原性胸痛 6 8例中 5 5例 (81% )符合胃食管反流病 (GERD) ,胡桃夹食管 2例 ,早期贲门失驰缓症 3例 ,弥漫性食管痉挛 3例 ,无效食管运动 (IEM) 5例。GERD5 2例测压分析 ,35例(6 7% )符合 IEM诊断标准。奥美拉唑治疗试验对诊断 GERD的敏感性为 93% ,特异性为 85 %。结论 :GERD是食管原性胸痛的主要原因。 2 4 h食管 p H监测和食管测压是诊断食管原性胸痛的主要检查手段 ,奥美拉唑治疗试验是临床诊断GERD简便而实用的方法。

Objective:To assess the diagnostic value of ambulatory 24-hour esophageal pH, esophageal manometry and omeprazole therapeutic test in esophageal chest pain.Methods:Endoscopy,esophageal manometry and 24-hour esophageal pH monitoring were performed in 68 consecutive patients with esophageal chest pain. All subjects underwent a diagnostic test by receiving omeprazole 20mg twice daily for 7 days.A symptom reduction of over 75% after treatment was considered positive.Results:Of the 68 patients with esophageal chest pain, 55(81%) patients were diagnosed as gastroesophageal reflux disease (GERD),2 nutcracker esophagus, 3 Achalasia, 3 diffuse esophageal spasm, and 5 ineffective esophageal motility (IEM). 35 of the 52 (67%) patients with GERD met the diagnostic criteria for IEM. The sensitivity and specificity of omeprazole therapeutic test was 93% and 85% respectively.Conclusion:GERD is the primary finding in esophageal chest pain. Esophageal manometry and 24-hour esophageal pH monitoring are primary tools in the diagnosis of esophageal chest pain, and omeprazole therapeutic test is a simple and practical method in the diagnosis of GERD.