胃食管反流病临床诊断路径探讨

Route of Clinical Diagnosis of Gastroesophageal Reflux Disease

背景:关于胃食管反流病(GERD)的临床诊断路径,目前尚未达成共识。目的:探讨简便易行、可靠的GERD临床诊断路径。方法:对初诊时有反酸、烧心等症状者行反流性疾病问卷(RDQ)调查,分值≥8者行"C-尿素呼气试验和胃镜检查,并予递减法抑酸治疗或在根除幽门螺杆菌(H.pylori)感染的基础上行递减法治疗。16周后复行RDQ调查,并随访6个月以上。结果:共118例患者符合纳入标准。RDQ分值≥12、可诊断为GERD者86例(72.9%),RDQ均值为19.08分,烧心症状的频率和程度均高于其他症状。RDQ分值≥12者内镜诊断为反流性食管炎(RE)且H.pylori阳性的概率为57.0%(49/86),RDQ分值<12者内镜下无RE表现且H.pylori阴性的可能性为37.5%(12/32)。RDQ分值≥12者16周递减法抑酸治疗的有效率为95.3%(82/86),随访过程中31.4%(27/86)的患者仍需间断服用H_2受体拮抗剂。结论:以RDQ量表初诊GERD有一定可行性,如与内镜检查和H.pylori检测联合应用,对GERD的处理更具指导意义。

Background： Up to date, no consensus has yet been arrived for the route of clinical diagnosis of gastroesophageal reflux disease （GERD）. Aims： To appraise a convenient and reliable route of clinical diagnosis of GERD. Methods： First visit patients with symptoms such as acid regurgitation and heartburn were surveyed with reflux disease questionnaire （RDQ）. 13C-urea breath test and gastroscopy were performed and ＇step down＇ inhibition of acid secretion therapy was applied in patients with RDQ score ≥ 8. When patients was positive for Helicobacter pylori （H. pylori） infection, eradication regimen was used prior to ＇step down＇ antiacid therapy. RDQ score was then re-assessed after 16-week treatment. The patients were followed for at least 6 months. Results： One hundred and eighteen patients fulfilling the inclusion criteria were enrolled. Of them 72.9% （n=86） were diagnosed as having GERD because of RDQ score ≥12 （mean 19.08）, and the heartburn was more frequent and more severe than other symptoms. Of the 86 patients with RDQ score .≥ 12, 57.0% （n= 49） had endoscopic reflux esophagitis （RE） and positive for H. pylori; while in 32 patients with RDQ score 〈12, 37.5% （n=12） were negative for RE and H. pylori. The efficacy of 16-week ＇step down＇ antiacid therapy in patients with RDQ score ≥12 was 95.3% （82/86）. 31.4% （n=27） of the patients needed H2 receptor antagonist intermittently during follow-up. Conclusions： It is feasible to make a preliminary diagnosis for GERD by using RDQ scale. Combination of RDQ scale with endoscopy and H. pylari examination will be more helpful for the management of GERD.