难治性非糜烂性胃食管反流病患者食管动力学特点分析

Analysis of motility characteristics of refractory non-erosive gastro-esophageal reflux disease patients

目的分析探讨难治性非糜烂性胃食管反流病(NERD)患者的食管动力学特点。方法选取2017年9月至2018年9月就诊于河南科技大学第一附属医院新区医院消化内科,有反酸、胃灼热等症状的74例患者,将其分为NERD组36例、难治性NERD组28例和难治性反流性食管炎组(难治性RE组)10例。所有患者均行高分辨食管测压及24 h pH-阻抗联合监测。结果难治性NERD组食管下括约肌平均静息压高于难治性RE组,低于NERD组,差异均有统计学意义(P<0.05);难治性NERD组远端收缩积分高于难治性RE组,收缩前沿速度高于NERD组,差异均有统计学意义(P<0.05)。难治性NERD组酸暴露次数、暴露时长百分比及Demeester评分低于难治性RE组,差异均有统计学意义(P<0.05);难治性NERD组气-液混合反流次数高于难治性RE组、NERD组,差异均有统计学意义(P<0.05);难治性NERD组弱酸反流次数高于难治性RE组、NERD组,差异均有统计学意义(P<0.05)。结论难治性NERD患者存在与难治性RE和NERD不同的食管动力学障碍,并且多存在弱酸反流和气-液反流,这些可能是导致其产生质子泵抑制剂抵抗成为难治性的原因之一。

Objective To analyze the characteristics of esophageal dynamics in patients with refractory non-erosive gastroesophageal reflux(NERD).Methods A total of 74 patients with symptoms of acid regurgitation,heartburn were selected from the department of gastroenterology in the new district hospital of the First Affiliated Hospital to Henan University of Science and Technology from September 2017 to September 2018,who were divided into NERD group(n=36),refractory reflux esophagitis(refractory RE group)(n=10)and refractory NERD group(n=28).All patients received high resolution esophageal manometry and 24 h pH-impedance combined monitoring.Results The mean resting pressure of lower esophageal sphincter in refractory NERD group was higher than that in refractory RE group,and lower than that in NERD group,the differences were statistically significant(P<0.05).Distal contraction integral of distal contraction in refractory NERD group was higher than that of the refractory RE group,the contractile front velocity higher than that of the NERD group,the differences were statistically significant(P<0.05).The number of exposure,times and Demeester score of the refractory RE group were lower than those of the refractory RE group,the differences were statistically significant(P<0.05).The gas-liquid mixed reflux times of refractory NERD group were higher than those of refractory RE group and NERD group.The number of weak acid reflux in the refractory NERD group were higher than that in the refractory RE group and NERD group,the differences were statistically significant(P<0.05).Conclusion Refractory NERD patients have different esophageal dynamic disorders from refractory RE and NERD,and most of them have weak acid reflux and gas-liquid reflux,which may be one of the reasons leading to the generation of proton pump inhibitor resistance and becoming refractory.