睡前进食增加非糜烂性反流病患者的食管酸暴露

Late Evening Meal Increased The Esophageal Acid Exposure in Non-erosive Gastroesophageal Reflux Disease Patients

目的避免睡前进食被推荐为胃食管反流病的辅助治疗手段，但其对非糜烂性反流病（NERD）的影响如何尚不明确。本文探讨了睡前进食对NERD食管酸暴露和症状的影响。方法35例经反流诊断问卷及胃镜诊断的NERD患者分为睡前0．5h内进食组（21例）和睡前3h内不进食的对照组（14例）接受24h食管pH监测，分析DeMeester指数、夜间卧位酸反流、卧位前3h酸反流及全天酸反流时间及与症状的相关性。结果全部患者平均RDQ评分24．17±6．33，DeMeester指数中位值4．47（1．73，19．75），中位卧位酸反流时间1．68（0．22，7．13）min；中位卧位前3h酸反流时间0．12（0，1.62）min，中位全天酸反流时间10．18（3．4，47．58）min。相关性分析显示全部患者RDQ评分与DeMeester指数及BMI均无关（均P〈0．05）。两组在性别比例、辣食偏好、饮酒或吸烟习惯、RDQ评分、年龄及BMI等指标上无显著性差异（均P〈0．05），睡前进食组DeMeester指数、卧位酸反流时间、卧位前1．5h酸反流时间和全天酸反流时间均高于对照组（P〈0．05），卧位1．5-3h酸反流时间两组间无显著差异（P〉0．05），睡前进食组与对照组出现反流症状、酸相关反流症状以及夜间卧位酸相关反流症状者的比例均无显著性差异（P〉0．05）。结论尽管睡前进食的NERD患者并未出现更多反流症状，但睡前进食可显著增加卧位和全天食管酸暴露，避免在睡前2h内进食有助于降低NERD患者卧位酸暴露的程度。

[Abstract] Objective： Avoidance of late evening meals had been recommended as an adjunctive therapy for gastroesophageal reflux disease, however, the evidence supporting this lifestyle modification benefited to non-erosive gastroesophageal reflux disease （NERD） is still lacking. This study was designed to investigate the effect of late evening meal on the esophageal acid exposure and symptom of NERD patients. Methods： 35 cases of NERD patients were divided into late evening meal group （study group, 21 cases） and control group （14 cases）. All the patients were diagnosed by reflux diagnostic questionnaire and endoscopy. The patients in study group consumed a meal 0.5 h prior to the bed-time in the examination day. Esophageal pH probe was used for the 24h monitor of esophageal pH. Reflux symptom frequency and severity were recorded. Results： No significant difference was found between the two groups in gender, age, RDQ scores, BMI, spicy food consumption, alcohol consumption or smoking （P〈0.05）. DeMeester scores, supine reflux times（pH〈4.0）, reflux times in the first 1.5h of supine and total reflux times in study group were significantly higher than that in control group（P〈0.05）, while the reflux time in the second 1.5h of supine showed no significant difference between the two groups（P〉0.05）. No significant difference was found between the two groups in the percentage of patients with symptom, the reflux related symptom or the reflux related symptom during supine. Conclusion： Though not increasing the reflux related symptoms, consuming a late-evening meal caused significantly greater supine esophageal acid exposure in NERD patients, which supports the recommendation to NERD patients to avoid late-evening meal prior to the bedtime.