胃内胆汁反流与上消化道症状关系的研究

目的　探讨胃内胆汁反流与上消化道症状之间的关系。方法　使用Bilitec 2 0 0 0型便携式胆汁监测仪 ,分别对无症状对照组(2 2例 )及上消化道症状组 (4 4例 )进行胃内胆汁反流监测 ,观察胃内胆汁反流与上消化道症状之间的关系。结果　无症状对照组与上消化道症状组胃内胆汁反流 ,总时间百分比、总反流面积及反流次数 ,分别为 1 5 6 %± 1 4 0 %、2 0 6± 1 8 7、2 2 3± 1 3 6次 ,及 2 6 4 %±2 1 3%、4 8 7± 6 0 8、4 2 9±4 4 5次。结论　上消化道症状组胃内胆汁反流监测结果明显高于无症状对照组 ,提示胃内胆汁反流的程度对上消化道症状的发生有一定影响     

胃食管反流患者24h食管pH的监测分析

79例具有反酸、烧心、胸骨后疼痛症状的患者 ,内镜检查食管炎 40例 ,内镜阴性 39例 ,用Biostar 2 4hpH监测系统记录两组患者生理状态下 2 4h食管pH变化 ,以了解内镜阴性与内镜阳性反流症状患者之间反流状况的异同及与临床症状的关系。结果发现 ,DeMeester Johnson记分系统各项指标食管炎组明显高于内镜阴性组 ,其中总积分分别为 (85 85± 15 0 9)和 (2 6 2 0± 5 76 ) (P <0 0 0 1) ;症状次数分别为 (2 0 36± 5 2 5 )和 (2 2 33± 4 76 ) (P >0 0 5 ) ;反流次数分别为 (2 49 2 2± 2 9 5 9)和 (79 18± 15 37) (P <0 0 0 0 1)。症状特异性分别为 73 0 7%和 42 2 3% (P <0 0 0 3) ;症状敏感性分别为 8 0 2 %和 17 19% (P <0 0 0 1)。提示食管炎患者具有明显的胃食管反流 ,其反流症状的发生与酸反流密切相关 ;内镜阴性患者部分反流症状的发生不伴有酸反流的存在。     

胃食管反流病的食管运动与胃肠激素及雌激素的关系

为探讨胃食管反流病 (GERD)的食管运动功能及其与消化道激素、雌激素的关系 ,用SGY 3型消化道动力测定仪检测了 2 0例食管炎和 2 5例内镜阴性GERD患者的食管运动功能 ,并用RIA测定了各组患者血浆胃动素、胃泌素、胰高糖素及雌激素水平。结果发现 ,内镜阴性GERD患者下食管括约肌压力 (LESP) [( 2 12±1 0 0 )kPa]明显低于正常对照组 [( 3 2 3± 0 72 )kPa ,P <0 0 1] ,食管炎组LESP[( 1 2 8± 0 5 6 )kPa]又明显低于内镜阴性GERD组 (P <0 0 1) ;GERD患者食管中下段蠕动波压力较正常人也明显减低 (P <0 0 1) ,食管炎组的下段食管蠕动波压力又明显低于内镜阴性GERD组 (P <0 0 1) ;食管炎组与内镜阴性GERD患者血浆雌激素[( 4 70 42± 6 7 5 5 ) pmol/L ,( 396 5 9± 5 5 17) pmol/L]较正常人有明显增高 [( 91 2 3± 33 2 9)pmol/L ,P <0 0 1) ] ,并与LESP呈中等度负相关 (r =0 443,P <0 0 2 )。     

胃食管反流病的胃排空功能研究

目的　探讨胃食管反流病 (GERD)胃液体、固体排空情况及与pH值监测结果的相关性。方法　 15例GERD患者分别进行胃镜检查、2 4h食管pH值监测和放射性核素胃排空功能测定 ,与对照组液体和固体胃排空率、胃半排空时间进行比较 ,分析GERD患者液体、固体排空率与食管炎及 2 4hpH值监测指标之间的关系。结果　GERD组液体胃排空率在 15、30min明显低于对照组 (P<0 0 5 ) ,固体胃排空率在各时间点均低于对照组 (P <0 0 5 )。GERD患者液体半排空时间与pH值监测总积分无相关性 (r=0 0 6 1,P >0 0 5 ) ;固体半排空时间与pH值监测总积分呈直线相关 (r=0 6 43,P <0 0 5 )。结论　GERD患者存在胃液体、固体排空延迟。固体半排空时间与pH值总积分呈直线相关。胃排空延迟可能是GERD发病机制的重要因素。     

老年例胃食管反流病98例5年随访报告

目的　研究胃食管反流病 (GERD)相关症状的长期变化趋势及其与药物治疗之间的关系 ,为防治胃食管反流病提供依据。方法　对 98例 6 0岁以上老年GERD患者以问卷调查形式进行 5年的随访。分析前后两次调查结果 ,比较其胃食管反流相关症状的变化 ,研究用药情况对症状的影响。结果　在 98例随访结果中 ,71例 (72 4 % )反流症状好转(其中 10例症状消失 ) ,18例症状无变化 ,9例加重。用药组的症状好转率显著高于不用药组(P <0 0 1)。用药规律性、用药种类与症状变化无明显关系 (P>0 0 5 )。在 98例中改善生活方式、饮食习惯者共 6 2例 ,其中 5 3例 (85 5 % )症状缓解 ,9例(14 5 % )无效。 98例中胃镜检查发现有食管炎者 (RE) 4 4例 ,其余 5 4例胃镜检查未发现异常但具有典型的烧心、反酸症状 ,这部分病例被认为是内镜阴性的胃食管反流病患者 (NERD)。经统计发现NERD组症状好转率显著高于RE组(P <0 0 1)。结论　药物治疗仍是缓解老年例胃食管反流症状的必要手段 ,但只能使少数患者症状完全消失 ;RE对GERD症状的缓解具有一定影响。     

胃底贲门癌消化道重建术后胃排空的研究

目前胃底贲门癌消化道重建术式较多 ,但尚无首选术式。笔者于 1 997年 1月～ 2 0 0 0年 1 2月对近端胃次全切除治疗胃底贲门癌患者术后行核素胃排空显像 ,以比较不同消化道重建术后对胃排空的影响及手术效果 ,现报道如下。一、资料与方法1 .研究对象。对照组 5例 (Ｎ组 ) ,男 3例 ,女 2例 ,平均年龄 ( 4 3.4± 4 .2 )岁 ,为健康志愿者 ,5年内无任何胃肠道、肝胆胰、食管反流等消化系统症状。胃底贲门癌手术组 ,患者均做标准胃癌根治术。抽取单纯胃次全切除 ,术后无吻合口狭窄患者 5例 (Ａ组 ) ,男 3例 ,女 2例 ,平均年龄 ( 4 8.7± 5.1 )岁…     

单纯反流性食管炎及合并滑动型食管裂孔疝的食管动力学研究

探讨滑动型食管裂孔疝合并反流性食管炎 (SHH组 )和单纯性反流性食管炎 (RE组 )患者的食管动力学特点。对经X线钡餐检查造影或胃镜证实的 5 0例SHH组和 5 0例RE组患者进行了食管动力和 2 4h食管pH监测。SHH组和RE组下食管括约肌长度 (LESL)为 (1 31± 0 33)cm和 (2 10± 0 86 )cm、下食管括约肌压力 (LESP)为 (1 17± 0 5 3)kPa和 (2 16± 0 6 5 )kPa ,SHH组均明显低于RE组 (P <0 0 5 )。两组反流参数均明显高于对照组 (P <0 0 1) ,SHH组除 pH <4时的反流次数其余指标均高于RE组 (P <0 0 5 )。提示SHH的食管抗反流功能比单纯RE患者明显低下 ,反流更严重 ;临床应对RE患者 ,特别是对可疑SHH患者应定期进行食管动力和 2 4h食管 pH监测。     

海勤人员胃食管反流发生与发病探讨

目的 探讨海勤人员胃食管反流(gastroesophageal reflux,GER)发生与胃食管反流病(gastreesophageal reflux disease,GERD)发病情况.方法 (1)航行前任意2 h、航行开始2 h后,对63名在舰艇工作的健康志愿者,连续2 h实时监测食管下端pH值;同时计算烧心感、胸骨后疼痛、反酸、反食等4种症状的程度和频度积分(symptomatic core,Sc).(2)对某部177名海勤人员和139名陆勤人员进行反流症状问卷调查(reflux diagnostic questionnaire,RDQ),按烧心感、胸骨后疼痛、反酸、反食等4种症状统计、计算RDQ积分.RDQ≥20分者为GERD组,≤15分者为非GERD组,剔除16～19分者(海勤人员39例,陆勤人员31例).(3)对2004年1月至2007年12月我科门诊患者作胃镜检查,Sc积分≥8分者入选为研究对象,胃镜检查排除食管狭窄、消化性溃疡、胃食管肿瘤等疾病后,最终入选的海勤人员187人,陆勤人员251人.结果 (1)航行前Sc积分、pH<4的总时间百分数、反流持续>5 min次数及pH<4的反流次数均显著高于航行2 h时段,症状程度及频度亦同步增加.(2)同卷调查显示:海勤人员组反流症状发生率显著高于陆勤人员组;舰龄>3年者,反流发生率明显增加;(3)Sc症状积分≥8分者,海勤人员反流性食管炎(reflux esophagitis,RE)发病率显著高于陆勤人员组;舰龄>1年者,RE发生率明显增加.结论 (1)航行时较非航行时胃食管酸反流明显增加,症状也明显加重;(2)经常航海的海勤人员反流症状发生率显著高于陆勤人员;(3)海勤人员RE发生率显著高于陆勤人员.     

食管反流大鼠肿瘤诱发过程中p53基因突变的研究

通过动物实验研究不同反流状态下食管肿瘤诱发过程中 p5 3基因的突变情况。选用SD大鼠进行不同手术 ,制作单纯胃食管反流 (G组 )、单纯十二指肠食管反流 (D组 )、胃十二指肠混合液食管反流 (DG组 )及无反流对照 (C组 )模型 ,于术后 4周开始注射食管致癌剂甲基戊基亚硝胺 (MANA) ,共 15周 ,于术后 2 0、2 6、40周分批取得食管组织 ,进行基因组DNA抽提 ,合成 p5 3基因的第 5、6、7、8外显子的 4对引物 ,进行PCR扩增。扩增产物变性后进行非变性聚丙烯酰胺凝胶电泳 (PCR SSCP) ,电泳后凝胶以硝酸银染色。结果显示PCR扩增未见 p5 3基因缺失。 2 0周时D组及DG组各有 1只 (10 % )标本检测出p5 3突变。此后随时间延长各组突变增加 ,40周时D组 (31 6 % )、DG组 (33 3 % )的突变率显著高于C组 (15 4% )和G组 (11 7% ) ,P均 <0 0 5 ,后两者差异无显著性意义 (P >0 0 5 )。提示十二指肠内容物食管反流可导致食管粘膜上皮p5 3基因的突变率增加 ,这可能是它促进食管肿瘤发生的机制之一。而单纯胃液反流不增加食管的 p5 3基因突变     

食管植入式胃食管吻合法临床应用55例

为防止食管、贲门癌切除后胃食管吻合口瘘、狭窄和反流性食管炎，我院设计了“食管植入”式冒食管吻合法，自1987年5月至1988年8月无选择地对贲门癌和贫门癌侵犯食管下段者采用此法吻合，共施术55例，效果满意，报告如下。一、临床资料本组男49例，女6例，年龄38～71岁。均为中晚期货门癌。食管受侵3cm者9例。全部采用本术式，未附加其他方法。无手术死亡，无吻合口疼和其他并发症。55例治愈出院时均可吃半流饮食，无胃排空障碍的病例。钡餐透视：同食管吻合口管腔内径1．2cm以上者12例，1～1．2cm者35例，0．8～1cm者8例。出院后3个月来院…     

Relationship between gastric emptying and gastroesophageal reflux in infants and children

PURPOSE: The aim of our study was to evaluate the relationship between gastric emptying and gastroesophageal reflux (GER) in infants and children. METHODS AND MATERIALS: One hundred eight patients (pts) between 3 months and 5 years of age (77 boys, 31 girls) with clinical suspicion of GER disease were included in the study. Patients were divided into 2 groups according to the age range: group A, 0-2 years (57 pts), and group B, 2-5 (51 pts) years. Each group was divided into 2 subgroups according to the scintigraphic study as GER-positive and -negative. Cow's milk with Tc-99m sulfur colloid as radiotracer was used. Gastric emptying was expressed as the half emptying time (T1/2). The detection of activity in the esophagus at any time during scintigraphy was considered an indicator of GER episodes. Reflux episodes were graded as grade 1 if activity was detected on one or 2 frames and grade 2 if activity was detected on more than 2 frames. RESULTS: Forty of the 108 patients (37%) had GER findings on scintigraphy. The comparison of gastric emptying time between positive GER scintigraphy and negative GER scintigraphy groups was not statistically significant in any age group. No association was found between age and rate of gastric emptying time. Although the comparison of T1/2 between grade 1 patients and the GER-negative group was not statistically significant, grade 2 patients showed significant differences and had prolonged gastric emptying times. Mild statistical correlation between the number of reflux episodes and gastric emptying half time was found. CONCLUSIONS: As a conclusion, the relation between gastroesophageal reflux and delayed gastric emptying cannot be ignored. Our results support delayed gastric emptying to be a pathogenetic factor in gastroesophageal reflux in infants and children.     

Value of gastroesophageal scintigraphy for the detection of gastroesophageal reflux in infants

50 children with a strong clinical suspicion of gastroesophageal reflux and 10 control patients were evaluated with gastroesophageal scintiscans. 500 muCi à 1 mCi of Tc sulfur colloid mixed the patients' routine milk or formula feeding was administered and serial images of the abdomen and thorax were obtained. A positive scintiscan was found in 35 patients (sensitivity 70%) and none of the controls (specificity 100%). A comparison of findings in 34 patients referred for both radiographic and radionuclide studies showed that barium studies were positive in 38% and radionuclide in 64.7%. We found this examination to be more sensitive that the standard barium radiography particularly in patients with respiratory symptoms. We concluded that the GE scintiscan is complementary to barium studies in the diagnosis of GE reflux. Pulmonary aspiration of gastric contents was detected in only a case of the 35 patients with documented GE reflux. A T 1/2 emptying gastric longer than 90 minutes (linear calculation) or 105 minutes (exponential calculation) is an indirect GE reflux test. This procedure is simple, safe more physiologic than other available examinations.     

The relationship of gastroesophageal reflux and gastric emptying in infants and children: concise communication

One hundred twenty-six pediatric patients (0-16 yr of age) with clinically suspected gastroesophageal reflux (GER) were evaluated using radionuclide scintigraphy. Although 46 of the patients (38.3%) had abnormal studies exhibiting evidence of GER, there were no significant differences in gastric emptying between patients with and without GER. At 60 min after ingestion, the 76 patients less than 2 yr old had a mean residual of 54%, whereas those over 2 yr of age had a value of 29% (P less than 0.0001). Gastric emptying values may be age-related.     

99mTc-sulfur colloid gastroesophageal scintigraphy with late lung imaging to evaluate patients with posterior laryngitis.

The aim of this study was to use gastroesophageal and pulmonary scintigraphy to evaluate the prevalence of gastroesophageal reflux and airway involvement among patients with posterior laryngitis. METHODS: The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoarseness. A control population of 20 healthy volunteers (13 females, 7 males; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12-h fast, all subjects underwent gastroesophageal scintigraphy through administration of 300 mL orange juice labeled with 185 MBq 99mTc-sulfur colloid. After 18 h, planar anteroposterior thoracic images were acquired with the subjects supine. RESULTS: Sixty-seven percent of patients (134/201) had scans positive for gastroesophageal reflux; of these, 30 (22%) had distal reflux and 104 (78%) had proximal reflux. In addition, the scans of 31 patients were positive for proximal reflux-associated pulmonary uptake. The frequency, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.001). The 67 patients in whom reflux was not detected had diseases or reflux-associated cofactors that could account for laryngeal symptoms. No statistically significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal reflux had significantly prolonged gastric emptying times compared with healthy volunteers. CONCLUSION: Most patients with posterior laryngitis had detectable proximal gastroesophageal reflux. Exposure of the proximal part of the esophagus to acid, by setting the stage for microaspiration of gastric material into the larynx, remains a major cause of damage to the laryngeal mucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symptoms such as a dry cough, painful swallowing, or hoarseness may not be reliable predictors of the presence of gastroesophageal reflux or of associated airway involvement.     

Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux

OBJECTIVE: Our aim was to provide exact sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux (GER) and to investigate its diagnostic value. GER severity and hiatal hernia presence were also evaluated and correlated with esophageal length. MATERIALS AND METHODS: This retrospective case-control study comprised 258 neonates and infants (150 without reflux and 108 with reflux). There were 50 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 42 were less than 1 month old; 34, 1-6 months; and 32, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. The number of refluxes during a 10-min period were recorded; GER was categorized as mild, one to three refluxes; moderate, three to six refluxes; and severe, more than six refluxes. Presence of hiatal hernia was recorded. RESULTS: Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.8 mm; 1-6 months, 4.5 mm; 6-12 months, 3.4 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. In contrast, children with reflux associated with hiatal hernia had a significantly shorter esophagus compared with children with mild reflux in all three age groups. Sonographic sensitivity was 94%. CONCLUSION: Sonographic measurement of the abdominal esophagus length is highly diagnostic for GER in neonates and infants. In neonates, it can also indicate GER severity. Hiatal hernia is associated with a significantly shorter abdominal esophagus.     

The mode of action alginic acid compound in the reduction of gastroesophageal reflux.

This study was designed to evaluate quantitatively the mode of action of alginic acid compound (AAC) in the treatment of patients with symptomatic gastroesophageal reflux. Gastroesophageal scintigraphy using an orall administered Tc-99m sulfur colloid solution was used to demonstrate that AAC decreased significantly the gastroesophageal reflux index from (9.9 +/- 1.3) % to (6.5 +/- 0.8) % (p less than 0.05). No alteration of lower esophageal sphincter pressure was observed. After ACC was suitably labeled with Sr-87m, a dual-nuclide scintigraphic technique was used to show that most (greater than 75%) of the AAC was located in the upper half of the stomach in both normal subjects and patients with gastroesophageal reflux. In those subjects in whom reflux did occur after treatment with AAC, the Sr-87m-AAC refluxed into the esophagus preferentially compared with the liquid containing Tc-99m sulfur colloid. These findings suggest that AAC dimishes gastroesophageal reflux by means of its foaming, floating, and viscous properties.     

Gastric scintigraphy with a liquid-solid radiolabelled meal: performances of solid and liquid parameters

AIM: To assess the clinical performance of parameters of liquid-solid gastric emptying (GE) scintigraphy. METHODS: Fifty-three controls and 476 patients underwent GE scintigraphy using a liquid-solid test meal (non-ulcer dyspepsia, n=180; gastro-oesophageal reflux disease, n=123; dyspepsia after anti-reflux surgery, n=29; diabetes mellitus, n=96; cystic fibrosis prior to heart-lung transplantation, n=48). Time-activity curves were fitted by a power exponential function and half-emptying times (T1/2) were computed. The lag phase (Tlag) and constant emptying (TRE) times of solid emptying were also calculated using a mathematical method (maximum slope tangent method). RESULTS: TRE and T1/2 of solids were higher in each subgroup of patients vs. controls (P=0.0001) and in cystic fibrosis patients vs. gastro-oesophageal reflux patients (P=0.0001). Tlag was significantly higher only in non-ulcer dyspepsia patients vs. controls (P=0.001). There was no significant difference for liquid parameters. Using the mean+/-1.96 SD of the solid and liquid T1/2 values obtained in controls, GE was normal (n=251; 53%), delayed (n=183; 38%), accelerated (n=33; 7%) or mixed (n=9; 2%). Delayed solid T1/2 was the most prominent alteration (n=189), and alterations of liquid GE alone were present in only 24 (5%) patients. A good correlation was found between solid T1/2 and TRE (r=0.88), but no correlation between Tlag and TRE, suggesting that these estimates represent independent phases of GE. In 26 patients, all GE parameters of solids and liquids were normal except Tlag (n=8) or TRE (n=18). The lack of significant differences between the different patient subgroups did not allow emptying profiles to be drawn according to patient pathology. CONCLUSION: Liquid GE scintigraphy provided poor and unreliable information in terms of patient discrimination and the drawing of pathophysiological profiles of abnormal GE. Tlag and TRE may confirm GE alteration, especially when solid T1/2 values are at the superior limit of normality, and may improve the performance of GE scintigraphy, rather than using liquid parameters.     

Gastroesophageal reflux in children. A combined radiologic and scintigraphic study

Thirty-one children examined for gastroesophageal (GE) reflux were studied with both barium meal X-ray and gastroesophageal scintigraphy. The study was performed with a double-blind method. The children with negative findings at both tests were submitted to intraluminal esophageal pH probe test. Barium X-ray detected GE reflux in 17/27 patients, whereas radionuclide scintigraphy was positive in 24/27 (positivity: 63% versus 89%; p less than 0.05). Their combined use provided positive findings in 26/27 cases. Scintigraphy appeared to be a safe and reliable screening test to detect GE reflux. Moreover, scintigraphy was superior to barium X-ray study for it had higher diagnostic accuracy, it could be easily performed on young patients, and delivered smaller radiation doses.     

Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease

OBJECTIVES: The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD). METHODS: The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy. RESULTS: GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (LA grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy. CONCLUSION: GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients.