食管内酸、胆盐监测及内镜检查对胃食管反流病的诊治意义

Intraesophageal double monitoring and endoscopy for the diagnosis and treatment of gastroesophageal reflux diseases

目的 探索胃食管反流病 (GERD)的合理治疗方案。方法 应用 2 4h食管内胆红素与pH监测 ,对 110例有GERD症状的患者检测 2 4h食管内胆汁反流情况及 pH动态变化 ,结合内镜检查来综合分析。结果 根据 2 4h食管内酸和胆红素监测的结果 ,以内镜检查有无黏膜病变而分成两组。内镜检查阳性组 2 5例 ( 2 2 .7% )均有酸 (碱 )病理性反流 ;内镜检查阴性组 85例 ( 77.3 % ) ,其中 73例有酸 (碱 )病理性反流 ,另 12例 ( 10 .9% )反流在生理范围内。内镜检查阳性组与阴性组有反流者相比 ,差异无显著性 (P >0 .0 5 ) ,但内镜检查阳性组和阴性组有反流者与内镜阴性且反流在生理范围者相比均差异有显著性 (P <0 .0 5 )。结论 根据 2 4h食管内监测及内镜检查结果 ,显示 89%GERD均有酸 (碱 )病理性反流 ,酸 (碱 )反流是导致临床症状和食管黏膜损伤的主要攻击因子 ,削弱或消除反流是GERD治疗的关键。GERD易复发 ,需长期维持治疗 ,应特别注意药效、不良反应和经济学问题。

ObjectiveTo investigate a project of rationalization treatment for gastroesophageal reflux disease (GERD). MethodsUsing 24-hour double (bilirubin and pH) monitory technique, 24-hour intra- esophageal bile reflux and pH changes were assessed for 110 patients with GERD. The results of 24-hour intraesophageal bile reflux and pH changes were analyzed in combination with the results of endoscopy. ResultsThe patients were divided into two groups according to mucosal lesion or not. Twenty-five patients (22.7%) with endoscopy-positive had pathological reflux with acid or alkali. In the patients with endoscopy-negative, 73 patients (66.4%) had pathological reflux with acid or alkali and 12 persons (10.9%) had physiological reflux. There was no significant difference between the patients with endoscopy-positive and endoscopy-negative (pathological reflux) (P>0.05). Significant difference existed between the patients and endoscopy-negative (pathological reflux) and endoscopy-negative (physiological reflux) (P<0.05). ConclusionsAccording to results of 24-hour intraesophageal double monitory and endoscopy, 89% of persons with GERD symptoms have pathological reflux with acid and alkali. Acid or alkali reflux is major attack factor causing clinical symptoms and mucosal injury of esophagus. Elimination of reflux is key to the therapy of GERD. GERD is easy to recur and the treatment must be maintained for a long time. We must pay attention to the effect of medicine, side action and economical problems.