胃食管反流病维持治疗及有关影响因素的评估

Evaluation of Maintenance Therapy and its Influencing Factors in Patients with Gastroeso- phageal Reflux Disease

目的：评估胃食管反流病（ＧＥＲＤ）维持治疗的疗效及影响因素。方法：通过症状评分、内镜检查、食管压力测定和２４ｈ食管ｐＨ监测等方法，调查７３例ＧＥＲＤ患者对维持治疗的反应并分析其有关影响因素。结果：间断治疗有效组（间断组）患者４０例，维持治疗有效组（维持组）３０例，治疗无效组（无效组）３例。间断组患者病程较维持组短（Ｐ＜０．００１），下食管括约肌压力（ＬＥＳＰ）和上食管括约肌压力（ＵＥＳＰ）均比维持组高（Ｐ＜０．０５），食管体部蠕动收缩波幅高于维持组，但无显著差异；间断组患者内镜下反流性食管炎（ＲＥ）以０级和Ⅰ级为主，而维持组以Ⅲ级为主（Ｐ＜０．０１）；症状评分和２４ ｈ食管ｐＨ监测结果在间断组和维持组患者间无显著差异。结论：有些ＧＥＲＤ患者的远期治疗可采取间断维持的方式，ＲＥ的严重程度和ＬＥＳＰ减低是决定是否需长期维持治疗的重要预测因素。

Background/Aims: To evaluate the effectiveness of maintenance therapy and its influencing fac- tors in patients with gastroesophageal reflux disease (GERD). Methods: 73 patients with confirmed GERD were investigated in the response to maintenance therapy and its influencing factors using symp- toms scoring, endoscopy, esophageal manometry and 24-hour pH monitoring. Results: There were 40 patients in the intermittent maintenance therapy (IMT) group, 30 in continuous maintenance therapy (CMT) group and 3 in ineffective therapy (IT) group. The course of GERD in IMT group was signifi- cantly shorter than that in CMT group (P<0.001). Lower esophageal sphincter pressure (LESP) and upper esophageal sphincter pressure (UESP) in IMT group were higher than those in CMT group (P< 0.05). Endoscopy in IMT group displayed less severe renux esophagitis (RE) than that in CMT group (P<0.01). There was no significant difference in reflux symptoms and 24-hour pH esophageal moni- toring between IMT and CMT groups (P>0.05). Conclusions: Intermittent form may be used in pa- tients with long-term maintenance therapy. Seventy of RE and decreased LESP are important predic- tive factors of long-term maintenance therapy.