食管微小病变对胃食管反流病的诊断意义及其临床特点

Diagnostic significance and clinical characteristics of esophageal minimal change in gastroesophageal reflux disease

目的 评估食管微小病变对于GERD的诊断意义,并探讨其临床特点.方法 在2013年5月至9月行胃镜检查的患者中,纳入食管黏膜改变符合微小病变（食管黏膜粗糙或有白色分泌物附着、红斑、水肿、脆性增加,齿状线模糊或呈锯齿状、栅栏状血管模糊）或洛杉矶分级（LA）者.对受试者采用胃食管反流病问卷（GerdQ）进行调查及采集相关病史,以GerdQ总评分≥8分为诊断GERD的标准.统计学分析采用行×列卡方检验.结果 共完成有效问卷41 7份,其中微小病变组202例,LA-A级组176例,LA-B级组36例.微小病变组的GERD诊断率为20.3％（41/202）,低于LA-A组的74.4％（131/176）和LA-B组的83.3％（30/36）,差异有统计学意义（x2=129.144,P＜0.01）.微小病变组、LA-A组和LA-B组的胃灼热发生率分别为25.7％（52/202）、62.5％（110/176）和86.1％（31/36）,反流发生率分别为29.7％（60/202）、67.6％（119/176）和75.0％（27/36）,非心源性胸痛发生率分别为5.4％（11/202）、22.2％ （39/176）和22.2％（8/36）.微小病变组的胃灼热、反流、非心源性胸痛发生率均低于LA A级组和LA-B级组,差异均有统计学意义（x2=75.775,64.120,24.016;P均＜0.01）.微小病变组行胃镜检查的首要原因是腹部症状,占49.0％（99/202）;LA-A级和LA-B级组行胃镜检查的首要原因是食管症状,分别占52.8％（93/176）和61.1％（22/36）.结论 食管微小病变患者的GERD诊断率低,临床症状不典型,不足以将其作为GERD的诊断依据,其临床意义有待进一步研究.

Objective To evaluate the diagnostic significance of esophageal minimal change in gastroesophageal reflux disease （GERD） and explore its clinical characteristics.Methods From May to September in 2013,patients with minimal esophageal mucosa changes including esophageal mucosa rough,white secretin adhesion,erythema,edema,increased brittleness,blurring of the Z line or zigzag looking and blurring of paliform blood vessel,or patients with Los Angeles classification （LA） which were identified by endoscopy were enrolled.The subjects received gastroesophageal reflux disease questionnaire （GcrdQ） investigation and the related history were collected.The total score of GerdQ over eight was set as the criteria for GERD diagnosis.The R × C chi-square test was performed for statistical analysis.Results A total of 417 valid questionnaires were completed.Of which,202 cases were in minimal change group,176 were in LA A group and 36 were in LA-B group.The diagnostic rate of GERD in minimal change group was 20.3％ （41/202）,which was lower than that of LA-A group （74.4％,131/176） and LA-B group （83.3 ％,30/36）,and the differences were statistically significant （x2 =129.144,P＜0.01）.The incidences of heartburn in minimal change group,LA A group and LA-B group were 25.7％ （52/202）,62.5％ （110/176） and 86.1％ （31/36）,respectively.The incidences of reflux were 29.7％ （60/202）,67.6％ （119/176） and 75.0％ （27/36）,respectively.The incidences of non cardiac chest pain were 5.4％ （11/202）,22.2％ （39/176） and 22.2％（8/36）,respectively.The incidences of heartburn,reflux and non cardiac chcst pain of minimal change group were all lower than those of LA A group and LA-B group,and the differences were statistically significant （x2 =75.775,64.120,24.016;all P＜0.01）.The leading cause of endoscopy examination in minimal change group was abdominal discomfort,which accounted for 49.0％（99/202）.The leading causes of endoscopy examination in LA A group and LA-B group were esophageal symptoms,which accounted for 52.8％ （93/176） and 61.1％ （22/36）.Conclusions The diagnostic rate of GERD in patients of minimal change group is low and the clinical symptoms are not typical,which is insufficient for diagnosis of GERD and needed further investigation.