低FODMAP饮食对老年胃食管反流患者的临床疗效分析

Clinical study of low FODMAP diet in elderly patients with gastroesophageal reflux disaese

目的探讨低量可发酵的低聚糖、双糖、单糖、多元醇(fermentable oligosaccharides,disaccharides,monosaccharides and polyols,FODMAP)饮食对老年胃食管反流患者的临床疗效。方法纳入首都医科大学附属北京朝阳医院2021年5月至2022年10月收治的老年胃食管反流病(gastroesophageal reflux disease,GERD)患者94例,应用随机数字法分为对照组和观察组,每组47例。对照组采用质子泵抑制剂治疗4周,期间进行常规饮食,观察组在对照组治疗的基础上采用低FODMAP饮食方案干预4周。观察两组患者治疗前后的食管动力指标及24h食管pH监测、胃食管反流病问卷(gastroesophageal reflux disease questionnaire,GredQ)评分、临床症状评分,比较两组的临床疗效。结果治疗4周后,两组食管下括约肌(low esophageal sphincter,LES)长度、食管下括约肌压力(lower esophageal sphincter pressure,LESP)、远端收缩积分(distal contractile integral,DCI)较治疗前均增加,且观察组高于对照组,差异均有显著性(P<0.05);两组酸反流时间百分比、GredQ评分、腹胀、反酸、嗳气及烧心症状评分均较治疗前降低,且观察组低于对照组,差异均有显著性(P<0.05)。观察组治疗总有效率为94.26%,明显高于对照组的74.47%(χ2=6.43,P<0.05)。结论低FODMAP饮食可有效改善老年GERD患者的食管动力指标及酸反流时间,降低腹胀、反酸、烧心、嗳气等临床症状评分及GredQ评分,其临床疗效优于单纯常规药物治疗,值得临床推荐。

Objective To investigate the clinical effect of low FODMAP diet on elderly patients with gastroesophageal reflux disease.Method 94 elderly GERD patients in Beijing Chao-Yang Hospital from May 2021 to October 2022 were selected,randomized number method was used to divide them into two groups,47 people in each group.The control group received conventional GERD diet plus proton pump inhibitor for 4 weeks.The observation group was treated with low FODMAP diet for 4 weeks on the basis of the control group.Esophageal dynamic index,esophageal pH monitoring,GredQ score,clinical symptom score and clinical efficacy were observed before and after treatment in the two groups.Result The length of LES,LESP and DCI in both groups increased after treatment,and the difference between the observation group and the control group was statistically significant(P<0.05).GerdQ scores and the scores of gastric distension,acid regurgitation,belching and heartburn of the two groups decreased,and the observation group decreased significantly compared with the control group(P<0.05).The total effective rate of the observation group was 94.26%,and that of the control group was 74.47%.The total effective rate of the observation group was higher than that of the control group,with a statistically significant difference(χ~2=6.43,P<0.05).Conclusion The low FODMAP diet can effectively improve the esophageal dynamic index and acid reflux of elderly patients with gastroesophageal reflux disease,improve the clinical symptoms such as gastric distension,acid regurgitation,heartburn,belching,and reduce GredQ score.The clinical effect is better than that of conventional drug treatment,which is worth recommending clinically.