酸反流与胆汁反流在胃食管反流病中的作用

Role of Acid and Bile Reflux in Gastroesophageal Reflux Disease

目的：探讨酸反流与胆汁反流在胃食管反流病（ＧＥＲＤ）中的作用及相互关系。方法：４６例ＧＥＲＤ患者（反流性食管炎组３０例，胃镜阴性组１６例）及２６例健康对照者在完成食管测压后，应用便携式食管ｐＨ监测仪及Ｂｉｌｉｔｅｃ２０００胆汁反流监测仪，同时进行２４ｈ食管内酸及胆汁反流的动态连续监测。结果：ＧＥＲＤ患者酸反流及胆汁反流各指标均明显高于健康对照者，且与食管炎严重程度一致。ｐＨ＜４总时间百分比与胆红素光吸收值（Ａｂｓ）＞０．１４总时间百分比存在线性相关关系（ｒ＝０．３４，Ｐ＜０．０１）。酸反流和胆汁反流共存的双重反流在ＧＥＲＤ患者中最为常见，且较单纯反流更易引起严重食管炎。结论：ＧＥＲＤ患者中较为常见的双重反流对食管粘膜的损伤作用强于单纯酸或胆汁的不完全反流，酸反流与胆汁反流间可能有正性协同作用；联合应用胃镜检查及食管内酸和胆汁反流监测将为ＧＥＲＤ的诊治提供可靠的客观依据。

Background/Aims: To explore the role of acid and bile reflux in causation of esophageal mu- cosal injury in patients with gastroesophageal reflux disease (GERD). Methods: 46 patients with GERD (30 patients had reflux esophagitis and 16 were endoscopically negative) and 26 healthy controls were enrolled. After esophageal manometry, all subjects obtained 24-hour ambulatory acid and bilirubin measurements using antimony pH electrode and Bilitec 2000 with fiberopotic sensor. Results: Both acid and bile reflux parameters were much higher in GERD patients than those in healthy controls, and were consistent with the degree of esophagitis. Linear regression analysis showed a significant correlation (r=0.34, P<0.01) between percentage total time of pH<4 and percentage total time of bil- irubin absorbance (Abs) level > 0.14. The majority of the patients with GERD had abnormal degrees of esophageal exposure to both acid and bile (double reflux) during the study period, which tended to con- tribute to more severe esophagitis. Conclusions: Double reflux is the most prevalent reflux-type and may contribute to more severe mucosal injury than either acid reflux or bile reflux alone, which sug- gests a synergistic role of gastric and duodenal juice in the development of esophageal mucosal injury. Combined detection of endoscopy and ambulatory acid and bilirubin measurements may act as objec- tive evidences for diagnosis and treatment of GERD.