胃食管酸反流和胆汁反流在餐前和餐后分布的差异性

Differences in Distribution of Gastroesophageal Acid Reflux and Bile Reflux During Preprandial and Postprandial Period

背景:除酸反流外,胆汁反流对胃食管反流病(GERD)的黏膜损伤、Barrett化生也具有重要作用。胃食管胆汁反流是否与酸反流同步发生、是否具有相同的发生机制,目前相关研究尚少。目的:分析胃食管酸反流和胆汁反流在餐前、餐后不同时段分布的差异性。方法:回顾性收集具有典型胃食管反流症状、疑诊GERD而行食管24hpH-Bilitec2000监测者的相关信息,根据监测结果分为生理性酸反流组、病理性酸反流组和病理性胆汁反流组,分别比较各组餐前、餐后反流指标的差异。结果:无论是生理性还是病理性酸反流,胃食管酸反流均多分布于餐后。病理性酸反流组餐后每小时平均酸反流次数约为餐前的2倍(P<0.05),最长酸反流时间则显著短于餐前(P<0.05)。病理性胆汁反流组餐后每小时平均胆汁反流次数、最长反流时间和反流时间百分比均显著减少或短于餐前(P<0.05)。结论:胃食管酸反流倾向于在餐后发生,而胆汁反流多发生于餐前,两者可能具有不同的发生机制。

Background: Besides acid reflux, bile reflux also plays an important role in the mucosal injury and Barrett metaplasia in gastroesophageal reflux disease (GERD). Until now, there are rarely literatures reporting whether bile reflux and acid reflux occur simultaneously, and whether they have the same pathogenic mechanism. Aims: To analyze the differences in distribution of gastroesophageal acid reflux and bile reflux during preprandial and postprandial period. Methods: A retrospective analysis was performed on individuals with typical gastroesophageal reflux symptoms and suspicious of GERD. According to the results of esophageal 24-hour pH-Bilitec 2000 monitoring, the subjects were divided into physiological acid reflux group, pathological acid reflux group and pathological bile reflux group. The preprandial and postprandial profiles of acid and bile reflux were compared. Results: Both physiological and pathological acid reflux were much more frequent during postprandial than preprandial period. In patients with pathological acid reflux, the frequency of postprandial acid reflux was two-fold over the preprandial acid reflux ( P <0.05), and the postprandial longest acid reflux time was significantly shorter than preprandial ( P <0.05). In patients with pathological bile reflux, the frequency of preprandial bile reflux, the preprandial longest bile reflux time, and time percentage of bile reflux were significantly increased than those of postprandial ( P <0.05). Conclusions: Gastroesophageal acid reflux is prone to occur during postprandial period while bile reflux during preprandial period. There may be different mechanisms related with acid reflux and bile reflux.