胃食管反流病的普通胃镜学特点:4086例临床分析

General gastroscopy of gastroesophageal reflux disease: Analysis of 4086 cases

目的分析胃食管反流病人群的普通胃镜学特点。方法回顾性分析2013年1月-2017年1月火箭军总医院收治的成年胃食管反流病患者首次胃镜检查发现食管炎、Barrett食管、食管裂孔疝等胃镜下胃食管反流病相关异常表现的检出率,以及各异常表现之间的关系。结果共纳入胃食管反流病患者4086例,男2004例,女2082例,年龄18~89(50.4±13.3)岁。非糜烂性胃食管反流病检出率为78.7%,食管炎检出率为21.3%;非Barrett食管检出率为87.7%,可疑Barrett食管检出率为8.3%,Barrett食管检出率为3.9%;大致正常贲门占61.4%,短段裂孔疝检出率为20.4%,长段裂孔疝检出率为18.2%。大致正常贲门、短段裂孔疝和长段裂孔疝三组食管炎的检出率两两比较差异均有统计学意义(P<0.001);长段裂孔疝组Barrett食管检出率明显高于大致正常贲门组和短段裂孔疝组(P<0.001,P=0.012),两组间比较差异无统计学意义(P>0.013)。18~39、40~59和≥60岁三个年龄组比较,结果显示:≥60岁组的食管裂孔疝检出率明显高于40~59岁组(P=0.007),而18~39组与40~59、≥60岁组比较差异无统计学意义(P>0.013);≥60岁组食管炎检出率明显高于18~39岁组和40~59岁组(P=0.004,P=0.008),18~39岁组与40~59岁组间比较差异无统计学意义(P>0.013)。结论胃镜可作为胃食管反流病评估的基本检查手段;短段裂孔疝可视为裂孔疝的早期形态,对于胃食管反流病的诊治具有重要参考价值;老年胃食管反流病患者裂孔疝和食管炎合并情况较为严重。

Objective To analyze the characteristics of gastroesophageal reflux disease（GERD） under general gastroscope. Methods The detection rates of GERD related abnormalities such as esophagitis, Barrett esophagus and hiatal hernia under the first gastroscopy of the adult GERD patients from January 2013 to January 2017 in our center and the statistical relationship between the abnormal findings were analyzed retrospectively. Results A total of 4086 GERD patients, 2004 males and 2082 females, were included in this study, and the age was 18-89（50.4±13.3） years old. The detection rate of non erosive GERD was 78.7%, esophagitis 21.3%; non Barrett esophagus 87.7%, suspected Barrett esophagus 8.3%, Barrett esophagus 3.9%; generally normal cardia 61.4%, short segment hiatus hernia 20.4%, and long segment hiatal hernia 18.2%. The detection rates of esophagitis showed statistically significant differences（P〈0.001） between the three groups of generally normal cardia, short segment hiatal hernia and long segment hiatal hernia; The detection rate of Barrett esophagus was significantly higher in long segment hiatal hernia group than in generally normal cardia group and short segment hiatal hernia group（P〈0.001, P=0.012）, but the difference between the later two groups was not statistically significant（P〈0.013）. Comparing the three age groups of 18-39, 40-59 and ≥60 years old, the detection rate of hiatal hernia was significantly higher in the group of ≥60 years old than in the 18-39 and 40-59 years old groups（P=0.007）, while there was no significant difference（P〉0.013） between the 18-39 and 40-59 years old groups. The detection rate of esophagitis was significantly higher in ≥60 years old group than in 18-39 and 40-59 years old groups（P=0.004, P=0.008）, while no significant statistically difference（P〉0.013） was found between the later two groups. Conclusions Gastroscopy can be used as a basic examination means for GERD; short segment hiatal hernia can be regarded as an early form of hiatal hernia, and is of important reference value for the diagnosis and treatment of GERD; more serious hiatal hernia and esophagitis could be found in elderly GERD patients.