多通道阻抗联合24 h食管pH监测在胃食管反流病中的应用

目的探讨多通道阻抗联合24 h pH监测在胃食管反流病(gastroesophageal reflux disease,GERD),尤其在pH(-)GERD患者中的应用价值。方法 48例GERD患者应用多通道阻抗联合24 h pH监测,根据Demeester评分分为pH(-)与pH(+),其中pH(-)GERD 30例,pH(+)GERD 18例;另相同监测健康大学生志愿者20例做正常对照组。结果 GERD组酸反流次数、卧位食团暴露时间及总食团暴露时间均高于正常对照组,差别有统计学意义(P=0.01,P=0.002,P=0.03);GERD组非酸反流次数低于正常对照组,差别有统计学意义(P=0.002)。pH(-)GERD组卧位食团暴露时间高于正常对照组(P=0.015),pH(-)GERD酸反流次数及卧位食团暴露时间均低于pH(+)GERD,差别有统计学意义(P=0.02,P=0.04)。结论多通道阻抗联合24 h pH监测能发现更多的反流事件,在GERD尤其对pH(-)GERD患者的诊断有实用意义,需进一步研究。

Pathophysiology of functional heartburn based on Rome Ⅲ criteria in Japanese patients

AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese patients.METHODS:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedancep H(24MII-p H) testing.The patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease(QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease(FSSG), the gastrointestinal symptoms rating scale(GSRS), SF-36, and the Cornell Medical Index(CMI).The subjects were classified into FH and endoscopy-negative reflux disease(ENRD) groups based on the Rome Ⅲ criteria.RESULTS:Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time(p H-POS) and 34 with hypersensitive esophagus(HE) were included in the ENRD group.The FH group included 22 patients with no reflux involvement.Sex, age, and body mass index did not differ significantly between the groups.The mean SF-36 values were < 50(normal) for all scales in these groups, with no significant differences.The GSRS scores in these groups were not different and showed overlap with other gastrointestinal symptoms.The QUEST and the FSSG scores did not differ significantly between the groups.Neuroticism was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the p H-POS(n=4),HE(n=8),and FH(n=5)groups,with no significant differences.CONCLUSION:Clinical characteristics of the FH and PPI-refractory ENRD groups were similar.Therefore,esophageal function should be examined via manometry and 24MII-p H testing to differentiate between them.

围绝经期女性胃食管反流病的临床特征分析

目的分析围绝经期女性胃食管反流病(GERD)的临床特点,提高对该期女性GERD的认识。方法对该院2014年1月至2015年12月门诊及住院确诊GERD的246例患者的临床资料、胃镜检查及24h食管阻抗-pH监测结果进行回顾性分析;按性别将患者分为女性组和男性组,根据月经情况又将女性组分为围绝经期组和非围绝经组2个亚组,对比分析各组患者的临床特点。结果女性组NERD所占比例较男性组高,以非典型症状为主诉的发生率也高于男性组,差异均有统计学意义(P<0.05);女性组中围绝经期组、非围绝经组反酸发生率均低于男性组(P<0.05);围绝经期组弱酸反流次数与非围绝经组和男性组比较差异均有统计学意义(P<0.05)。结论围绝经期女性GERD多以非典型症状为主要表现,内镜、24h食管阻抗-pH联合监测是诊断围绝经期女性GERD的选择。