反流性食管炎pH值监测正常的原因探讨

To investigate why patient with reflux esophagitis could be with normal pH-monitoring

目的探讨反流性食管炎（RE）患者食管pH值监测正常的原因。方法经内镜确诊为RE的46例患者，根据食管监测结果分为pH正常组12例和pH异常组34例。比较2组患者食管裂孔疝罹患率、幽门螺杆菌（Hp）感染以及患者食管动力学的改变。结果2组患者食管裂孔疝的构成比无统计学意义，Hp感染率一致。2组下食管括约肌静息压力（LESP）及食管体部中下点及肛侧收缩幅度的比较有统计学意义（P=0．016和P=0．043，P=0．007），均为pH正常组高于pH异常组。剔除食管裂孔疝患者后，食管体部肛侧的收缩幅度（P=0．011）和LESP（P=0．036）仍有明显差异。结论Hp感染对RE患者pH监测并无影响，较强的屏障功能以及清除功能可能是部分RE患者pH监测正常的原因。

Objective To discuss why patients with endoscope -positive gastroesophageal reflux disease （GERD） could show normal pH - monitoring. Methods From February 2005 to March 2007, Patient with reflux esophagitis underwent upper endoscope, H. pylori test, esophageal manometry and ambulatory pH monitoring at Beijing People＇s Hospital. Among them, 46 patients were diagnosed as reflux esophagitis （RE） and were divided into normal pH - monitoring group and abnormal pH monitoring group, according to DeMeester Score. Of the 46 patients, 34 were in abnormal pH - monitoring group[ male 24, female 10, mean age（57 ± 15 ）years], and 12 were in normal pH - monitoring group [male 8, female 4, mean age（51 ± 11 ）years]. Results There were no significant differences between the two groups in age, gender, hiatus hernia and H. pylori infection. The mean lower esoph - ageal sphincter （ LESP）, mean peristalsis amplitude of middle - down esophagus and anal lateral esophagus in normal group were higher than abnormal group （ P 〈 0.05 ）. When patients with hiatus hernia were excluded, the mean LESP and peristalsis amplitude of anal lateral esophagus were higher in normal group than abnormal group （P 〈 0.05 ）. Condusion The mean LESP and the mean peristalsis amplitude of middle - down esophagus and anal lateral esophagus in the normal pH - monitoring group were higher than the abnormal group. Helicobacter pylori had no effect on pH monitoring.