胆汁和胃泌素在小儿胃食管反流病中的作用

Roles of bile and gastrin in the pathogenesis of childhood gastroesophageal reflux disease

目的探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的发生情况以及胆汁和胃泌素在小儿GERD中的作用。方法根据内镜检查结果将GERD分为反流性食管炎(RE)组和非糜烂性反流病(NERD)组,共检测42例。同时应用便携式食管pH监测仪及胆汁监测仪对其进行24hpH监测及胆汁联合监测,对相应病例采用放射免疫测定法进行空腹血清胃泌素(GS)测定,同期检测13例无胃食管反流症状并排除了消化道及严重全身器质性疾病的儿童作为对照。结果42例患儿中24例为RE(内镜检查存在食管下段黏膜充血等病损),18例为NERD(内镜检查黏膜正常)。GERD患儿pH<4及胆红素吸收值≥0.14的总时间百分比、酸及胆汁反流的总次数和反流>5min的次数均明显高于正常对照组(P<0.05),RE组的食管酸暴露时间(pH<4)及胆红素吸收值≥0.14的时间百分比较NERD组明显增高(P<0.05)。NERD组6例(33.3%)、RE组16例(66.7%)出现酸和胆汁混合反流(P<0.01)。RE组和NERD组血清GS浓度均明显高于正常对照组(P<0.01,P<0.05),且RE组的血清GS浓度明显高于NERD组(P<0.05)。结论小儿GERD中以混合反流为主,胆汁反流在小儿GERD的发病中起一定作用,GS的分泌异常可能参与了小儿GERD的发病过程。在小儿GERD的发展过程中,GS和胆汁反流可能起正性协同作用。

Objective To explore the incidence of acid and bile reflux in children with gastroesophageal reflux disease （GERD） and to study the roles of bile and gastrin in the pathogenesis of childhood GERD. Methods Forty-two cases of GERD were divided into two groups according to endoscopic findings： reflux esophagitis （ RE ） and non-erosive reflux disease （NERD）. The patients underwent 24-hr ambulatory esophageal pH and bilirubin monitoring. The serum concentration of gastrin was detected by radioimmunoassay. Thirteen children without gastroesophageal reflux symptoms, digestive tract disease and severe systemic organic disease served as the Control group. Results Of the 42 cases of GERD, 24 cases were confirmed with RE, with esophageal mueosal lesions, and 18 were NERD without esophageal mueosal lesions by endoscopy. Both acid and bile reflux parameters, including the percentage of total time with pH 〈4 and bilirubin absorbanee ≥0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 minutes, were significantly higher in the GERD patients than those in the Control group （ P 〈 0. 05 ）. The time of esophageal acid exposure （pH 〈 4 ） and the percentage of total time with bilirubin absorbanee ≥0. 14 increased significantly in the RE group compared with in the NERD group （ P 〈 0. 05 ）. Sixteen RE patients had a mixed reflux of bile and acid （66.7%） but only 6 NERD patients （33.3%） had （P 〈0. O1 ）. The serum concentration of gastrin in the RE group （ 125.12 ±45.06 pg/mL） and the NERD group （ 98.22 ±27.92 pg/mL） was significantly higher than that of the Control group （74.22 ±20.34 pg/mL） （ P 〈 0.01, P 〈 0. 05 respectively）. A significant difference was noted in the serum concentration of gastrin between the RE and the NERD groups （ P 〈 O. 05 ）. Conclusions Mixed reflux of bile and acid are common in children with GERD. Bile reflux may play a role in the development of GERD. Gastrin paraseeretion may participate in the development of GERD. Gastrin and bile reflux may have synergistic effects on the development of childhood GERD.