惠州地区胃食管反流病与肠易激综合征重叠的特征

目的 探讨惠州地区胃食管反流病（GERD）重叠肠易激综合征（IBS）的症状特征.方法 采用整群、分层、随机抽样的方法,收集到61例GERD症状人群,其中12例（19.7％） GERD重叠IBS患者、49例单纯GERD患者,记录其人口统计学资料以及症状严重程度,对结果进行统计分析.结果 GERD重叠IBS组男女比例为1：1.4,其症状较单纯GERD组严重（P＜0.05）.结论 GERD与IBS的重叠现象多见,患者多为女性,且症状更严重.     

无效食管动力对伴呼吸道症状胃食管反流病发病机制及临床意义的研究

目的 观察伴有呼吸道症状的胃食管反流病(GERD)患者食管动力异常的类型及发生率,探讨无效食管动力(IEM)在其发病机制中的作用及临床意义.方法 应用多功能胃肠动力仪对首都医科大学附属北京朝阳医院2005年1月至2007年1月收治的34例伴有哮喘、慢性咳嗽和咽喉部不适等呼吸道症状的GERD患者进行食管压力测定及24h食管动态pH监测,测定下食管括约肌(LES)压力、食管体部蠕动波幅、蠕动时限及蠕动速度,计算pH＜4的时间百分比,卧位及立位pH＜4的时间百分比,平均食管酸清除时间(pH＜4的时间/酸反流次数),算出DeMeester评分.结果 伴有呼吸道症状GERD组LES压力及食管近端、远端蠕动波幅与典型反流症状GERD组及正常对照组比差异无统计学意义;伴有呼吸道症状CERD组的食管动力异常类型主要表现为IEM,IEM发生率为41.2%,明显高于典型反流症状GERD组(18.5%)及正常对照组(0);在伴有呼吸道症状GERD患者中,存在IEM组患者食管pH＜4的总时间百分比及立、卧位食管pH＜4的时间百分比均明显高于食管动力正常组;IEM组患者卧位食管酸清除时间(pH＜4的时间/酸反流次数)较食管动力正常组明显延长.结论 在伴有呼吸道症状GERD患者中,IEM是其最常见的动力异常类型;IEM与食管内酸暴露总时间及立、卧位时间,卧位食管酸清除时间均密切相关,因此,IEM在伴有呼吸道症状GERD患者的发病机制中起重要作用.     

呼吸系统症状为主的胃食管反流病48例临床分析

目的:观察以呼吸系统症状为主的胃食管反流病(GERD)患者酸反流事件和基础下食管括约肌压力(LESP)的关系。方法:对48例以呼吸系统症状为主的GERD患者的临床特点进行分析,测定食管内PH值和食管压力。结果:有呼吸系统症状的GERD患者,其食管下括约肌功能有所改变;质子泵抑酸剂和促胃肠道动力药物治疗前后24h食管反流变化和食管内pH值变化均有显著性差异;治疗后呼吸系统症状得到改善。结论:胃食管反流可以作为独立原因引起呼吸道病症状,抑酸抗反流治疗对胃食管反流相关的呼吸系统症状有较好的近期疗效。     

消化科就诊人群胃食管反流重叠功能性肠病的特征分析

目的 调查消化专科就诊人群症状谱的特点,以及胃食管反流病(GERD)合并功能性肠病(FBD)的比例.方法 2011年4-6月对就诊北京大学人民医院消化科门诊的患者进行问卷调查,记录患者一般信息及主诉；利用反流性疾病问卷(RDQ量表)对典型反流症状进行评分,以RDQ评分≥12分诊断GERD,并结合胃镜结果和对质子泵抑制剂治疗的反应来区分反流性食管炎(RE)和非糜烂性反流病(NERD).同时询问患者是否存在腹痛、腹胀、腹泻及便秘等症状,病程≥6个月考虑为慢性病程.按RomeⅢ标准判断是否患有FBD.结果 资料可利用的患者为1074例.具有胃食管反流症状者(RDQ评分＞0分)为351例(32.7％),诊断GERD107例(10.0％).具有慢性腹痛、腹胀、腹泻、便秘等任一种症状者404例(37.6％)；诊断肠易激综合征(IBS) 63例,功能性便秘(FC)40例,功能性腹泻28例,功能性腹胀75例,即FBD共计206例(19.2％).胃食管反流典型症状的RDQ评分越高,合并其他胃食管反流相关的食管表现及食管外表现的比例越高,合并慢性腹胀、慢性便秘及IBS、FC的比例也增高(P值均＜0.05).GERD患者合并慢性腹胀、慢性便秘的比例均高于非GERD者[25.2％ (27/107)比16.6％ (160/966),14.0％(15/107)比7.1％(69/966),P值均＜0.05]；26.2％ (28/107) GERD患者合并FBD,其中GERD合并IBS和FC的比例均高于非GERD者[10.3％ (11/107)比5.4％ (52/966),7.5％ (8/107)比3.3％ (32/966),P值均＜0.05].与RE相比,NERD合并多种FBD的比例较高,但差异无统计学意义(P＞0.05).结论 GERD患者常伴有慢性腹胀、慢性便秘等,易合并IBS及FC,且随着GERD症状加重,其重叠比例有增高的趋势.     

胃食管反流病与哮喘关系初探

目的探讨胃食管反流与哮喘的关系。方法对15例以哮喘为主要表现的GERD患者进行了食管24hpH值监测及胃镜检查,并分析食管pH值与症状的关系,并以22例无呼吸系统症状的GERD患者作为对照。结果以哮喘为主要表现的GERD患者食管24hpH监测的各项指标与无呼吸系统症状的GERD患者存在显著差异(P<0.001,0.05),胃镜结果无显著差异,提示症状与酸反流密切相关。结论以哮喘为主要表现的GERD患者酸反流比普通GERD患者重,并且哮喘为患者的唯一临床表现,而无食管症状,因此临床上极易误诊。     

胃食管反流病与特发性肺间质纤维化的关系

目的 明确特发性肺间质纤维化(IPIF)患者胃食管反流病(GERD)的患病率,探讨GERD与IPIF的关系.方法 对2006年12月至2008年1月在首都医科大学附属北京朝阳医院呼吸科住院确诊的24例IPIF患者进行24 h食管pH监测和食管测压,同期住院的23例非IPIF的弥漫性实质性肺疾病患者作为对照.比较两组患者GERD症状、病理性食管酸暴露及无效食管动力(IEM)的发生率.结果 (1)66.7%(16/24)的IPIF患者存在病理性食管酸暴露,明显高于对照组的26.10k(6/23),P<0.05;(2)在具有病理性酸暴露的IPIF(GERD-IPIF)患者中,87.5%(14/16)存在夜间酸暴露事件;(3)典型GERD症状在GERD-IPIF患者中的发生率只有37.5%(6/16);(4)IPIF组和非IPIF组患者IEM发生率相似,分别为42.9%(9/21)和39.1%(9/23),P>0.05.结论 在IPIF患者中GERD患病率较高,但多数患者没有典型GERD症状,IPIF患者应该进行24 h食管pH监测筛查GERD.     

非糜烂性胃食管反流病内脏高敏感机制研究

非糜烂性胃食管反流病(NERD)是指有典型胃食管反流症状而无内镜下食管黏膜损伤的疾病，又称“内镜阴性胃食管反流病”，约占胃食管反流病(GERD)的70％。其临床症状的严重程度与GERD相似，抑酸治疗效果不佳，往往对患者的生活质量产生严重的影响。其发病机制复杂，主要包括酸反流，内脏高敏感，非酸相关性刺激，中枢及外周水平调控失衡等机制。     

以慢性咳嗽为主要表现的胃食管反流病患者的食管功能及反流特点

目的 通过对以慢性咳嗽为主要表现的胃食管反流病(GERD)患者行高分辨食管内压力-阻抗联合测定(MII-HRM)及24h联合多通道腔内阻抗-pH( MII-pH)监测的结果分析,探讨此类患者食管运动功能及胃食管反流的特点.方法 选取2010年3-11月在首都医科大学附属北京朝阳医院就诊的19例GERD伴慢性咳嗽患者为研究对象.应用MII-HRM及24 h MII-pH监测系统测定上食管括约肌(UES)和下食管括约肌压力、食管体部蠕动功能、对液体和黏液性物质的传输功能、立位及卧位酸及非酸反流的次数、近端反流的次数、酸暴露时间、酸清除时间以及食团清除时间.以同期仅表现为典型胃食管反流症状的17例GERD患者作为对照,比较两组间食管运动功能以及胃食管反流参数的差异.结果 与仅表现为典型胃食管反流症状的GERD患者相比,以慢性咳嗽为主要表现的GERD患者的UES静息压力明显更低[(122.55 ±60.48)mm Hg比(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],食管体部异常蠕动的比例更高[(9.47±15.63)％比(22.16±17.45)％,P＜0.05],食管体部对液体物质传输能力减低[(88.82±12.23)％比(71.68±23.06)％,P＜0.05],卧位时酸及非酸反流次数及卧位近端非酸反流次数明显增多(P＜0.05),卧位食团清除时间延长(P＜0.05).结论 以慢性咳嗽为主要表现的GERD发病机制可能与单纯典型GERD不同,其与UES静息压力减低、卧位酸及非酸反流、近端反流的增多以及食管清除功能障碍密切相关.     

西安地区老年胃食管反流病发病情况调查

目的了解西安地区老年人胃食管反流病(GERD)的发病情况,同时评价GerdQ量表对GERD的诊断价值。方法随机选取消化内科门诊老年患者894例,非老年患者1 010例,应用标准方法诊断GERD,比较老年与非老年GERD的症状、发生率及食管酸暴程度;所有GERD患者均进行GerdQ评分。结果 (1)老年患者GERD检出率高于非老年患者(P<0.025);(2)老年糜烂性食管炎(EE)中男性检出率高于女性及非老年男性(P<0.05),老年非糜烂性反流病(NERD)中女性检出率高于男性及非老年女性(P<0.025);老年患者DeMeester评分高于非老年患者(P<0.001);(3)应用GerdQ量表与标准方法比较,GERD检出率差异无显著性,老年GERD患者的GerdQ评分低于非老年患者(P<0.001)。结论 GERD发生率随年龄增长而增高;老年GERD患者的非典型症状及食管外症状较突出、食管黏膜损害较非老年患者加重;GerdQ量表对GERD的初步诊断具有临床应用价值。     

老年胃食管反流病临床特征的研究

目的分析老年胃食管反流病（GERD）患者的临床症状和治疗反应的特点,为提高老年GERD诊治水平提供依据。方法选取2011年2月22日至2012年9月23日期间在仁济医院门诊确诊并进行药物治疗的老年GERD患者（≥60岁）55例,随机抽取同期诊治的非老年GERD患者（〈55岁）55例作为对照。比较分析2组GERD患者的临床症状、内镜下表现、食管运动、酸反流特征以及药物治疗反应等方面的差异。结果老年组GERD患者烧心症状少于非老年患者（P〈0．001）;老年组食管体部运动缺乏、下食管括约肌压力（LESP）较低,但两组酸反流DeMeester评分相当（P=0．112）。两组质子泵抑制剂（PPI）治疗反应均较好（P=0．85）。但PPI初治疗效不理想的老年GERD对加用莫沙必利有治疗反应的患者少于非老年组。结论老年GERD与非老年GERD存在诸多不同特点,了解这些特点对改善老年GERD治疗效果有益。     

Gastroesophageal Reflux Disease and Tooth Erosion: A Cross-Sectional Observational Study

Background/Aims

Gastroesophageal reflux disease (GERD) is common in children. Recurrent exposure to gastric acid in GERD may contribute to tooth erosion.

Methods

In this prospective study, 54 GERD patients qualified according to endoscopy, pH-metry, and the GERD questionnaire and 58 healthy controls qualified by the GERD questionnaire were assessed. Two groups underwent dental evaluations for the presence, severity, and patterns of erosion and for the stage of dentition using a Tooth Wear Index. The health care providers who performed the dental exams did not know which children had been diagnosed with GERD.

Results

A total of 112 children, 3 to 12 years old were enrolled in the study, and 53 of 54 (98.1%) GERD patients and 11 of 58 (19.0%) controls had dental erosions (p<0.0001). In GERD patients, the posterior occlusal surfaces of milk teeth were more affected (p<0.0001). There was no correlation between GERD and the affected surfaces in permanent teeth, nor in the patterns or erosion grades (localized or general). In both groups, milk teeth had more erosions than permanent teeth, but the difference was not statistically significant.

Conclusions

According to this study, there is a positive correlation between GERD and dental erosion. Posterior occlusal surface erosions in milk teeth could indicate GERD.     

Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function

Background  

This preliminary clinical study aimed to evaluate the effects of salivary flow volume and swallowing function on oral symptoms including dental erosion in gastroesophageal reflux disease (GERD).     

The clinical characteristics of gastroesophageal reflux disease in patients with laryngeal symptoms who are referred to gastroenterology

The prevalence of gastroesophageal reflux disease (GERD) has increased recently in Asia‐Pacific countries. However, little is known about its prevalence and clinical characteristics in GERD patients with atypical symptoms in Asia. The aim of this study was to investigate the clinical characteristics of GERD in patients who had laryngeal symptoms in Korea. Data were gathered retrospectively from patients who presented with atypical symptoms, such as throat discomfort, globus pharyngeus, hoarseness, and chronic cough. They underwent a 24‐hour ambulatory intraesophageal pH monitoring and filled in a validated reflux questionnaire. Overall, 128 patients (36 men and 92 women) with laryngeal symptoms were included. Of these 128, 43 patients (34%) had erosive esophagitis or pathological reflux from 24‐hour ambulatory pH monitoring, and 24 (19%) had a positive Bernstein test or positive symptom index from 24‐hour pH monitoring. Sixty‐one patients (48%) had no evidence of reflux esophagitis on upper endoscopy and pathological acid reflux on 24‐hour pH monitoring. Fifty‐six patients (44%) had weekly heartburn or regurgitation. Typical symptoms and dyspepsia were significantly more common in patients with GERD who had laryngeal symptoms than non‐GERD. Fifty‐two percent of patients had laryngeal symptoms that were associated with GERD. The presence of typical reflux symptoms and dyspepsia are risk factors for GERD in patients who present with laryngeal symptoms.     

Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastroesophageal reflux disease in general practice

AIMS: To establish the prevalence of functional gastrointestinal (GI) disorders in adult patients with symptoms of gastroesophageal reflux disease (GERD) and to assess the impact of GERD treatment on functional GI disorders in medical practice in France. METHODS: 3318 patients with GERD symptoms (mean age 53 yr; 1726 women and 1592 men) were involved in the survey. A questionnaire on demographic data, GERD features, presence of functional GI disorders and their features, and impact of GERD treatment on functional GI disorders was performed by the physician. The size of the different groups was compared using either a chi2 test or a Mantel-Haenszel analysis, on a case by case basis. RESULTS: Seventy-two percent of patients with GERD had associated functional GI disorders, with a mean of 4.1 +/- 1.9 functional digestive symptoms per patient. Gas, flatulence, transit disorders and abdominal distension were the most commonly reported symptoms. Among patients with functional GI symptoms, 27% had symptoms suggestive of irritable bowel syndrome (IBS), 16% were suggestive of dyspepsia while 57% had both upper and lower functional digestive symptoms. According to the patients, GERD treatment had a positive impact (significant to complete improvement) on their functional GI disorders in about one-third of patients particularly in those with dyspeptic-type symptoms. CONCLUSIONS: Functional GI disorders are particularly common in adult patients suffering from GERD, with a three times higher prevalence than in the general population.     

Gastroesophageal reflux disease in intellectually disabled individuals: how often, how serious, how manageable?

Gastroesophageal reflux disease (GERD) is an important and frequently occurring problem among intellectually disabled individuals (IDI). Early suspicion and recognition of the presence of GERD in IDI is the cornerstone of adequate management of these patients. The prevalence of GERD among institutionalized IDI with an IQ < 50 is about 50%, with 70% of these reflux patients having endoscopically established reflux esophagitis. In case of symptoms as hematemesis, rumination, or dental erosions, there is an increased risk for GERD. GERD has also been shown to be associated with cerebral palsy, an IQ < 35, scoliosis, and the use of anticonvulsant drugs or benzodiazepines. To establish the diagnosis, 24-h pH measurement or endoscopy should be used in all those intellectually disabled individuals in whom GERD clinically is suspected. The efficacy of proton-pump inhibitors (PPIs) in IDI with GERD is indisputable. In IDI, adults as well as children, PPIs are highly effective, independent of the severity of esophagitis. Marked improvement of symptoms and quality of life can be noticed after medical treatment, thereby decreasing the need for surgery in this complicated group of patients.     

Gastroesophageal reflux disease: extraesophageal manifestations and therapy

Gastroesophageal reflux disease (GERD) can present with both typical symptoms such as heartburn and regurgitation as well as atypical symptoms. These symptoms may include chest pain, asthma, chronic cough, hoarseness, otitis media, atypical loss of dental enamel, idiopathic pulmonary fibrosis, recurrent pneumonia, chronic bronchitis and even sudden infant death. The diagnosis of GERD in these patients can often present a challenge and usually requires a combination of selected testing and therapeutic trials. Acid suppression by using proton pump inhibitors remains the treatment of choice in GERD, but some patients will also respond well to antireflux surgery. This article addresses the presentations, diagnostic challenges, and therapeutic opportunities in GERD patients with atypical presentations.     

胃食管反流病的食管外表现及其临床进展

胃食管反流病(GERD)的食管外表现是指除反酸、烧心等典型症状外,同时伴有呼吸系统、耳鼻喉、口腔等部位的症状,如支气管哮喘、慢性咳嗽、阻塞型睡眠呼吸暂停综合征、特发性肺纤维化、咽炎、喉炎、牙侵蚀症等.因其表现特殊、临床容易误诊,本文特对其发病机制及临床表现作一综述.     

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms.
METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance.
RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）.
CONCLUSION： The prevalence     

Esophageal epithelial surface in patients with gastroesophageal reflux disease： An electron microscopic study

A/M： To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease （GERD）.
METHODS： Eighteen patients with erosive esophagitis, 10 patients with non-erosive reflux disease （NERD）, and 18 normal asymptomatic volunteers were enrolled. Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion. Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment.
RESULTS： The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals.
CONCLUSION： Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.