反流性食管炎和非糜烂性反流病患者酸暴露与食管压力监测结果分析

Clinical characteristics of esophageal acid exposure,esophageal pressure and Helicobacter pylori infection in reflux esophagitis and non-erosive reflux disease

目的通过对胃食管反流病（GERD）患者的酸暴露情况、食管下括约肌（LES）压力、食管体部压力、幽门螺杆菌（Hp）感染结果的比较，探讨反流性食管炎（RE）、非糜烂性反流病（NERD）的不同状况，为临床治疗提供科学依据。方法2001年10月至2005年7月，具有反流症状（烧心、反酸）的患者80例，胃镜检出RE31例，NERD45例，Barrett食管（BE）4例。行食管24hpH动态监测，并以De—Meester积分均值将GERD分为轻、中、重度，检测LES、食管体部即LES上方5cm、7cm、13cm（简记为L5、L7、L12）和食管上括约肌（UES）下方1cm、6cm、8cm（简记为U1、U6、U8）压力指标，并进行Hp感染的检查。结果RE、NERD两组患者食管24hpH酸暴露各指标的差异，无统计学意义（P〉0．05），De-Meester积分均值亦无统计学意义（P〉0．05）；轻、中、重度GERD患者食管24hpH监测指标具有统计学意义（P〈0．01）。RE、NERD两组患者LES压力、食管体部的L5、L7、L12、U6和u8压力监测指标无统计学意义（P〉0．05），只有RE组U1压力低于NERD组，差异有统计学意义（P〈0．05）；轻、中、重度GERD患者LES压力和食管体部的压力监测指标差异无统计学意义（P〉0．05）。RE和NERD组患者Hp感染率分别为16．1％和22．2％，其差异无统计学意义（P〉0．05），OR为1．309，95％C10．364～4．705。结论RE和NERD患者酸暴露、LES压力和食管体部压力等相应指标无明显差异；NERD在发病机制中，酸反流的强弱没有起到决定性作用。

Objective To explore the pathogenesis of reflux esophagitis （RE） and non-erosive reflux disease（ NERD）, and their scientific basis in clinical treatment by comparing the clinical characteristics of esophageal acid exposure,lower esophageal sphincter pressure （LESP） , esophageal pressure, and Helicobacter pylori infection in RE and NERD. Methods In this study, there were 80 cases with typical symptoms （heartburn and acid regurgitation）, of which 31 cases were diagnosed as RE ,45 cases as NERD and 4 cases as Barrett＇s esophagus by gastroscopy. In gastroesophageal reflux disease （GERD） the extents of esophageal acid exposure, based on the result of ambulatory 24h esophageal pH monitoring and the mean De-Meester points, were allocated into three levels, slight, medium and severe. Monitoring LESP, esophageal body contraction amplitude,namely LS,L7 and L13 at 5 cm, 7 cm and 13cm above LES, and U1 ,U6,U8 at 1 cm,6 cm and 8 cm below upper esophageal sphincter（UES）. Detection of Helicobacter pylori infection was conducted in all patients. Results There was no difference in 24h esophageal pH monitoring and De-Meester points between RE and NERD （P 〉 0. 05 ）. Among slight, midium, and severe GERD ： there were difference at 24h esophageal pH monitoring（P 〈0. 01 ）. There was no difference of esophageal acid exposure, LESP and esophageal body contraction amplitude （ LS, L7, L12, U6 and U8 ） between RE and NERD （ P 〉 0. 05 ）, RE patients have a lower pressure monitoring than NERD patients at U1 （P 〈0. 05）. Among slight, midium, and severe GERD patients,there were no difference in LESP, esophageal body contraction amplitude monitoring （ P 〉 0. 05 ）, The positive rate of Helicobacter pylori infection was 16. 1% and 22. 2% in RE and NERD respectively （P 〉 0. 05 ）. OR was 1. 309 （95% C1：0. 364-4, 705 ）. Conclusion There were no differences of esophageal acid exposure, LESP and esophageal body contraction amplitude between RE and NERD patients, and acid regurgitation can not be served as the determinator in NERD.