反流性食管炎1827例临床分析

Clinical analysis of 1 827 patients with reflux esophagitis

目的 通过研究 10年间内镜所诊断的反流性食管炎 (RE)病例 ,探讨中国人RE的内镜和临床特点。方法 1990至 1999年胃镜诊断的 182 7例RE患者 ,按洛杉矶标准及中国试行标准进行分级 ,部分患者还进行食管运动功能检查。分析患者年龄、性别、症状、伴发疾病及与各项检查的关系。结果 RE占总胃镜检查人数的 2 .0 2 % ,男女之比为 3.9∶1。平均年龄 (5 2 .0 2± 14.38)岁 ,5 8.6 2 %的原发性RE超过 5 0岁。仅 36 .2 9%有典型的反流症状。RE以中、轻度者 (洛杉矶标准的A、B级或烟台标准Ⅰ级 )多见 ,近 80 % ,重度少见。RE患者的平均pH <4总时间百分比及平均胆红素吸收值>0 .14总时间百分比均显著高于正常 (P <0 .0 1) ,重度RE显著高于轻度 (P <0 .0 5 ) ,而平均下食管括约肌压与正常相比差异无显著性 (P >0 .0 5 )。结论 中国人RE患病率较西方国家低 ,以男性老年人多见 ,程度多较轻 ,与胃及十二指肠内容物反流均有密切关系。仅依据反流症状来诊断RE的敏感性较低 。

Objective To investigate clinical and endoscopic characteristics of reflux esophagitis (RE) in Chinese. Methods 1 827 patients with RE ,diagnosed by endoscopy in the past 10 years, were divided into different grades according to Los Angeles System and Chinese Standard. A part of them underwent esophageal manometry, 24 hour pH monitoring, and 24 hour bilirubin monitoring. The relationship between age, sex, symptom, accompanied diseases and each examinations were analyzed. Results RE was 2.02% of the total endoscopy number, and male vs female was 3.9:1,mean age was (52.02±14.38) years old. Only 36.29%of RE patients have typical reflux symptom. Patients with light mordent (Los Angeles System A,B and Chinese Standard Ⅰ)RE were more than those with severe RE. Both of the time of esophageal acid exposure and total percent time bilirubin absorbance ≥0.14 for RE was significantly more than normal( P <0.01). Conclusion The incidence of RE in Chinese is lower than that in Western and the severity is less. Most of RE are male and aged. There is a close association between RE and both of gastroesophageal reflux and duodenogastroesophageal reflux. Endoscopy is very important for diagnosis of RE.