消化科就诊人群胃食管反流重叠功能性肠病的特征分析

The characteristics of gastroesophageal reflux disease overlapping with functional bowel diseases in gastrointestinal clinic

目的 调查消化专科就诊人群症状谱的特点,以及胃食管反流病（GERD）合并功能性肠病（FBD）的比例.方法 2011年4-6月对就诊北京大学人民医院消化科门诊的患者进行问卷调查,记录患者一般信息及主诉；利用反流性疾病问卷（RDQ量表）对典型反流症状进行评分,以RDQ评分≥12分诊断GERD,并结合胃镜结果和对质子泵抑制剂治疗的反应来区分反流性食管炎（RE）和非糜烂性反流病（NERD）.同时询问患者是否存在腹痛、腹胀、腹泻及便秘等症状,病程≥6个月考虑为慢性病程.按RomeⅢ标准判断是否患有FBD.结果 资料可利用的患者为1074例.具有胃食管反流症状者（RDQ评分＞0分）为351例（32.7％）,诊断GERD107例（10.0％）.具有慢性腹痛、腹胀、腹泻、便秘等任一种症状者404例（37.6％）；诊断肠易激综合征（IBS） 63例,功能性便秘（FC）40例,功能性腹泻28例,功能性腹胀75例,即FBD共计206例（19.2％）.胃食管反流典型症状的RDQ评分越高,合并其他胃食管反流相关的食管表现及食管外表现的比例越高,合并慢性腹胀、慢性便秘及IBS、FC的比例也增高（P值均＜0.05）.GERD患者合并慢性腹胀、慢性便秘的比例均高于非GERD者[25.2％ （27/107）比16.6％ （160/966）,14.0％（15/107）比7.1％（69/966）,P值均＜0.05]；26.2％ （28/107） GERD患者合并FBD,其中GERD合并IBS和FC的比例均高于非GERD者[10.3％ （11/107）比5.4％ （52/966）,7.5％ （8/107）比3.3％ （32/966）,P值均＜0.05].与RE相比,NERD合并多种FBD的比例较高,但差异无统计学意义（P＞0.05）.结论 GERD患者常伴有慢性腹胀、慢性便秘等,易合并IBS及FC,且随着GERD症状加重,其重叠比例有增高的趋势.

Objective To analyze the common symptoms in our gastrointestinal （GI） clinic of a general hospital and the prevalence of gastroesophageal reflux disease （ GERD ） combined with functional bowel diseases （ FBD ） was also investigated. Methods Data of out-patients who visited GI clinic from April to June, 2011 were collected, including demographic information and chief complaints. A validated Chinese Reflux Disease Questionnaire （RDQ） was used to assess the frequency and severity of typical gastroesophageal reflux （GER） symptoms. Reflux esophagitis （RE） and non-erosive gastroesophageal reflux disease （NERD） were differentiated according to RDQ scores, endoscopic diagnosis, and response to proton pump inhibitors （PPIs）. FBD was diagnosed based on Rome III criteria. Results Totally 1074 patients （98.3%） had completed the questionnaires. A total of 107 patients（ 10% ） were diagnosed as GERD among 351 patients（32.7% ） who had GER symptoms. A total of 404 eases （37.6%）presented symptoms of chronic abdominal pain/bloating, chronic diarrhea/constipation. Totally 206 cases （ 19. 2% ） of FBD were diagnosed, including 63 irritable bowl disease （IBS）, 40 functional constipation and others. RDQ scores were positively correlated with the prevalence of other atypical GER symptoms, as well as chronic bloating, constipation, the incidence of IBS and functional constipation （FC） （ P 〈 0. 05 ）. Further, the incidences of chronic bloating[ 25.2% （27/107） ], chronic constipation[ 14.0% （15/107） ], IBS [ 10. 3% （ 11/107 ） ]and FC[ 7.5% （8/107）] in GERD patients were higher than those in non-GERD patients [ 16. 6% （160/966） ,7.1% （ 69/966）, 5.4% （ 52/966）, 3.3 % （32/966）, all P 〈 0. 05 ]. Higher rate of NERD than RE overlapping with FBD was found, but without statistic significance. Conclusions GERD frequently represents with chronic bloating and constipation, usually overlaps with IBS and FC. The severity of GERD symptoms is associated with higher rate of overlapping with FBDs.