Barrett’s食管、糜烂性食管炎及非糜烂性反流病发生机制的比较

Comparison of clinical characteristics among Barrett’s esophagus, erosive esophagitis and non-erosive reflux disease

目的:比较糜烂性食管炎(EE)、非糜烂性反流病(NERD)及Barrett’s食管(BE)患者反流发生特点,探讨不同类型GERD的可能发病机制.方法:105例GERD患者根据胃镜及病理情况分为:EE组(35例)、BE组(34例)及NERD组(36例),对照组30例为健康志愿者.比较4组受检者食管测压与24h食管pH及胆汁反流同步监测结果的差异.结果:与对照组相比,GERD各组LES静息压均有不同程度减低,以EE组最明显(P<0.05).EE与BE组患者远段食管收缩波幅及有效蠕动百分比明显低于NERD组与对照组(均P<0.05).DeMeester评分等酸反流指标在EE组最高.BE组Abs>0.14时间百分比等长时间胆汁反流指标最高.NERD患者中仅52.8%存在病理性反流.各组中混合反流类型占各组病理性反流总人数的比例分别为68.57%(EE组)、84.38%(BE组)及63.15%(NERD组).结论:胃酸与胆汁的混合反流是GERD患者中最常见病理性反流类型,且对食管黏膜的损害较单纯酸或胆汁反流为重,胆汁反流在BE的发病机制中占有重要地位.

AIM： To explore etiological differences among erosive esophagitis （EE）, non-erosive reflux disease （NERD） and Barrett’s esophagus （BE） by comparing their reflux characteristics. METHODS： A total of 105 gastroesophageal reflux disease （GERD） patients, including 35 EE patients, 34 BE patients and 36 NERD patients, and 30 healthy controls were enrolled in the study. All subjects underwent esophageal manometery, 24-hour ambulatory esophageal pH monitoring using the Synectics Digitrapper MkIII and bilirubin measurement using the Bilitec 2000. RESULTS： The lower esophageal sphincter pressure （LESP） in all GERD patients, especially EE patients, was lower than that of healthy controls （P 〈 0.05）. No statistical significance wasobserved in the LESP among different groups of GERD patients. The amplitude of distal esophageal body contraction and the percentage of effective esophageal movements were both lower in EE and BE patients than in NERD patients and healthy controls （all P 〈 0.05）. The acid reflux index （e.g., DeMeester score） was highest in EE patients. The bile reflux index （e.g., the percentage of total time of bilirubin absorbance level 〉 0.14） was highest in BE patients. Only 52.8% of NERD patients had abnormal re？ ux. The percentages of double reflux （acid and bile） in EE, BE and NERD patients were 68.57%, 84.38% and 63.15%, respectively. CONCLUSION： The majority of GERD patients have abnormal esophageal exposure to both acid and bile （double reflux）, which tend to contribute to more severe mucosa injuries. Bile reflux may play an important role in the pathogenesis of Barrett’s esophagus.