胃胆汁反流与胃食管反流病关系的探讨

[目的]探讨胃镜下胃胆汁反流与胃食管反流病的相关性,指导临床治疗。[方法]临床诊断为胃食管反流病(GERD)的患者列入研究组(173例),将同期行健康检查、胃镜未发现明显器质性病变者作为对照组(92例)。统计分析研究组与对照组胃胆汁反流阳性率、GERD中各型胃胆汁反流阳性率及反流性食管炎(RE)中不同分级的胃胆汁反流阳性率,比较其差异性。[结果]研究组胃胆汁反流阳性率29.5%(51/173)、对照组16.3%(15/92);GERD中RE型胃胆汁反流45.7%(21/46)、Barrett食管(BE)型26.4%(14/53)、非糜烂性反流病(NERD)型21.6%(16/74);RE中A级胃胆汁反流31%(9/29)、B级64.3%(9/14)、C级100%(3/3),未见D级。胃胆汁反流阳性率比较:研究组与对照组、GERD中RE与BE型、RE与NERD型之间差异均有统计学意义;RE中A级与B级之间比较差异也有统计学意义。[结论]胃镜下胃胆汁反流与GERD具有相关性。GERD患者如胃镜下发现胃胆汁反流,治疗时应将胆汁反流作为重要的致病因素考虑。     

非糜烂性胃食管反流病的研究及中西医治疗进展

非糜烂性胃食管反流病（non—erosive reflux disease,NERD）是胃食管反流病（gastroesophageal reflux disease,GERD）的一种类型,又称内镜下阴性GERD。GERD还包括反流性食管炎（reflux esophagitis,RE）和Barrett食管（Barrett esopha-gus,BE）两种类型。其中RE可见食管远端黏膜破损,BE是指食管远端鳞状上皮被柱状上皮所取代,它们共称为胃食管反流相关性疾病[1]。     

Barrett食管、糜烂性食管炎和非糜烂性反流病食管酸暴露及食管动力学分析

目的分析胃食管反流病(GERD)三种亚型Barrett食管(BE)、糜烂性食管炎(EE)和非糜烂性反流病(NERD)患者食管24 h pH监测与高分辨率食管测压结果,探讨不同亚型胃食管反流病食管酸暴露及动力学变化特点。 方法收集2015年12月至2017年12月,新疆维吾尔自治区人民医院接受住院治疗的90例GERD患者的临床资料,其中BE组28例、EE组35例、NERD组27例,通过食管24 h pH监测结果评价患食管酸暴露及反流特点,高分辨率食管测压检查评价食管动力学特点。 结果3组患者年龄及身体质量指数(BMI)等一般资料比较,差异无统计学意义(P>0.05);EE组患者24 h食管pH监测中pH≤4(酸反流)、40.05);3组Demeester评分比较,差异无统计学意义(P>0.05);LES长度3组无明显差异,BE组LES静息压及残余压较EE组和NERD组稍高,但差异无统计学意义(P均>0.05);3组在食管远端收缩积分比较,差异无统计学意义(P>0.05)。 结论食管测酸检查在GERD临床亚型的鉴别方面并无显著差别;Barrett食管、糜烂性食管炎、非糜烂性反流病均存在抗反流屏障功能减退,但不同程度的食管粘膜损伤对食管动力学的影响并无差异。     

唾液胃蛋白酶含量与老年胃食管反流病的关系

目的探讨唾液中胃蛋白酶与胃食管反流病(GERD)的关系。方法 60例GERD患者依照病情不同分为反流性食管炎(RE)组、非糜烂性食管反流病(NERD)组及Barrett食管(BE)组,采用中国消化内镜学会标准(1998烟台)分级内镜下表现积分对患者临床症状进行评价,应用乳胶增强免疫比浊法分析患者唾液中胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及总胃蛋白酶原水平。结果 RE组胃蛋白酶原Ⅰ水平显著高于NERD组和BE组,总胃蛋白酶原水平显著高于BE组(均P<0.05);3组症状评分差异无统计学意义(P>0.05);3组均有较佳的阴性预测值和敏感性;RE、NERD、BE组临床症状评分与唾液内胃蛋白酶原Ⅰ浓度均呈正相关(r=0.573,0.463,0.452;P<0.05)。结论老年GERD患者唾液中胃蛋白酶水平与症状评分呈正相关,临床中可考虑通过检测患者唾液中胃蛋白酶水平分析老年GERD患者病情。     

反流性食管炎、Barrett食管和食管腺癌的研究

背景:胃食管反流病(GERD)是一种常见疾病,包括非糜烂性反流病(NERD)、反流性食管炎(RE)和Barrett食管(BE),近年其发病率逐渐增高。目的:探讨RE、BE与各种因素的关系。方法:应用反流性疾病问卷筛选具有胃食管反流症状的患者,行胃镜检查检测RE、BE和食管腺癌的检出率,分析吸烟、饮酒、饮食、年龄、性别和民族与RE、BE的关系。结果:共纳入1834例具有胃食管反流症状的患者,其中RE患者234例(12.8%);BE患者213例(11.6%),包括特殊肠化生型BE 47例;食管腺癌5例(0.3%)。蒙古族RE、BE的检出率显著高于汉族和其他民族。饮酒者中RE和BE的比例明显升高。BE患者中-重度异型增生和食管腺癌的检出率升高。结论:蒙古族人群RE和BE的检出率较高,饮酒与食管反流致损伤的关系密切,BE为食管腺癌的癌前病变。     

Barrett食管、反流性食管炎和非糜烂性胃食管反流病的反流物特点

目的应用食管24 h pH-阻抗(MII-pH)等检查方法,分析具有胃食管反流病(GERD)典型症状、并且食管MII-pH检查结果异常的GERD患者,比较分析其各亚型,即Barrett食管(BE)、反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者的胃食管反流特点。 方法入选具有典型胃食管反流症状(烧心/反流),并且食管24 h MII-pH检查结果异常的GERD患者,根据内镜检查结果分为BE、RE、NERD三组,收集患者24 h的食管pH-阻抗信息,应用SPSS16.0统计软件进行组间Mann Whitney检验、多因素方差分析,P< 0.05认为具有统计学差异。 结果共入组103例具有典型反流症状且MII-pH监测阳性的GERD患者,其中有15例BE患者、32例RE患者、56例NERD患者。三组患者的平均年龄、性别构成、以及BMI无显著差异性。将三组患者的各项胃食管反流指标数值进行Mann-Whitney检验,显示RE、BE患者的DeMeester评分、pH<4反流时间百分比、长反流周期数显著高于NERD患者,具有显著性差异。BE患者的反流周期数显著多于RE和NERD患者,具有显著性差异。阻抗相关指标在三组患者之间均没有统计学差异。 结论与NERD相比,酸反流对于RE和BE具有更重要的致病意义。     

不同类型胃食管反流病发病机制的差异

目的:比较不同类型胃食管反流病(GERD),即反流性食管炎(RE)、非糜烂性反流病(NERD)和Barrett食管(BE)发病机制的差异.方法:113例GERD患者,根据内镜下表现及病理情况分为RE、NERD、BE三组,比较三组患者内镜下表现、食管测压和24 h pH监测指标、合并食管裂孔疝(HH)情况的差异.结果:RE组较NERD组与BE组下食管括约肌压力减低,但无统计学差异.食管体部各段的收缩波幅比较,RE组减低最明显,NERD组减低最少,两组比较P<0.05;无效食管运功比较,RE组较另两组明显增多( P<0.05).RE、NERD、BE组24 h食管pH监测的DeMeester计分分别为90.2、55.2、48.8;RE组以重度酸暴露多见(43%),反流总时间阳性率较高;NERD组以轻度酸暴露多见(45.8%),反流频率阳性率较高;BE组以长反流时间阳性率较高.HH在RE、NERD、BE组中的检出率分别为50%、14.6%、25.7%( P = 0.003).结论:下食管括约肌及食管体部运动功能受损程度、酸反流情况的差异可能是造成三种不同类型GERD食管黏膜损伤表现不同的主要原因.     

胃食管反流病患者脾胃虚弱评分与GerdQ的相关性研究

[目的]研究胃食管反流病患者脾胃虚弱与GerdQ评分的相关性。[方法]以量表形式获得胃食管反流病患者GerdQ评分及脾胃虚弱评分,分析GerdQ评分与GERD疾病分型、中医证型及脾胃虚弱之间的相关性。[结果]GerdQ评分与胃镜下食管黏膜损伤的程度相反,GerdQ评分最高的为NERD,其次为RE,最后为BE。各中医证型间GerdQ评分比较无明显差异。胃食管反流病患者脾胃虚弱评分与GerdQ评分呈正相关,且为显著性相关。[结论]胃食管反流病患者GerdQ评分与脾胃虚弱评分明显相关,且脾胃虚弱程度越高,GerdQ评分越高,胃食管反流病临床症状越明显。     

胃食管反流病的诊断进展

胃食管反流病(GERD)是指胃内容物反流入食管,引起不适症状和(或)并发症的一种疾病,临床可分为非糜烂性反流病(NERD),反流性食管炎(RE)和Barrett食管(BE)三种类型。GERD是消化科门诊最常见疾病之一,在欧美的发病率达到10%～20%,年发病率约为0.38%～0.45%[1],在我国的发病率也呈逐年上升的趋势[2]。GERD严重影响患者的生活质量,同时对政府卫生保健系统     

北京地区反流性食管炎患者谷胱甘肽转硫酶P1基因基因多态性分析

目的探讨GSTP1基因型多态性表达与反流性食管炎的关系。方法选择反流性食管炎患者119例和正常对照者121例,通过PCR-RFLP方法检测GSTP1基因型。结果GSTP1突变型基因表达反流性食管炎组(32·77%)显著高于对照组(20·66%),P<0·05。结论GSTP1基因型多态性与反流性食管炎发病风险相关。     

Genetic polymorphisms in glutathione S-transferases T1, M1 and P1 and susceptibility to reflux esophagitis

Recent studies indicate that the prevalence of reflux esophagitis (RE) in China is increasing. RE is one of the most common esophageal complications associated with gastroesophageal reflux disease (GERD) and RE-Barrett's esophagus-esophageal adenocarcinoma (EAC) sequence has been considered as an histogenesis model for EAC in Western countries. RE is only present in a subset of patients with GERD, suggesting an altered susceptibility to RE may exist in these GERD individuals. However, the genetic changes related with high susceptibility to RE is largely unknown. The polymorphisms in glutathione S-transferases (GSTs) T1, M1 and P1 have been reported with high susceptibity to esophageal cancer in Chinese people. The present case-control study was thus undertaken to characterize the genetic polymorphisms of GSTs and their correlation with susceptibility to RE. One hundred and nine patients with RE, 97 patients with nonerosive reflux disease (NERD) and 97 normal controls were recruited in this study. All the subjects were from Beijing, China, and received endoscopic examination and questionnaires for RE. Genomic DNA was extracted from the lymphocytes of peripheral blood for each subject. Genotypes of the GSTM1 and GSTT1 genes were analyzed by a multiplex PCR method. A-->G polymorphism of codon 104 of the GSTP1 gene was detected using PCR-based restriction fragment length polymorphisms (RFLP). The variant GSTP1 genotypes (*A/*Bomicron*B/*B) was found with a high frequency in the case with RE (40%), and followed by NERD (25%) and normal control (22%). The differences were statistically significant (P < 0.05). The risk for RE increased 2.42-fold [odds ratio (OR); 95% confidence interval (95% CI), 2.42 (1.22-4.80)] in the subjects with variant GSTP1 genotype. The subjects with positive variant GSTP1 genotypes and negative H. pylori infection showed increasing tendency for risk of RE [OR (95% CI), 2.67 (1.06-6.70)]. However, the subjects with GSTT1 and GSTM1 polymorphisms did not show any correlation with high risk for RE or NERD. No significant interactions were identified between the variant GSTs and cigarette smoking, or alcohol drinking and subtype of RE. The present result suggests that GSTP1 genetic polymorphism may be one of the high susceptibility factors involved in the mechanisms of RE. H. pylori infection may play a protective role against RE.     

The role and frequency of glutathione s‐transferase P1 polymorphism in Iranian patients affected with reflux esophagitis

Reflux esophagitis is a common complication of the gastroesophageal reflux disease. Glutathione s‐transferases (GSTs) have important role in the protection of cells from the products of oxidative stress. GSTP1*B allele has a correlation with susceptibility to several diseases. In this case‐control study, the role and frequency of GSTP1 polymorphism was evaluated in Iranian patients with erosive reflux esophagitis. Seventy patients with erosive reflux esophagitis and 75 normal individuals were enrolled in this study. The grade of esophagitis was determined via endoscopy. DNA was extracted from venous blood of each subject using the salting out method. GSTP1 genetic polymorphisms were detected using the polymerase chain reaction restriction fragment length polymorphism method. There was a significant difference in GSTP1 genotype frequency between patients and normal groups (P= 0.006). Also, in the patient group, the grade B of esophagitis was significantly associated with variant GSTP1 genotype (P= 0.028). The rate of throat pain symptom was higher in the no‐variant group (P < 0.036). The GSTP1*B allele frequency in Iranian normal groups is similar to Orientals. Reflux esophagitis are more commonly found in variant (*B/*B and *A/*B) GSTP1 genotypes. In addition, GSTP1 polymorphism is correlated with a higher grade of esophagitis.     

不同亚型胃食管反流病食管黏膜下层炎症因子变化特点研究

目的分析3种亚型胃食管反流病患者与对照组食管黏膜的组织变化和局部IL-4、IL- 6表达,探讨Th2型炎症因子在胃食管反流病发生发展中的作用。 方法选取2016年12月至2017年12月新疆维吾尔自治区人民医院69例患者临床资料,根据Gerd Q评分和内镜结果将所有入选研究者分为Barrett食管（BE）、糜烂性食管炎（EE）、非糜烂性反流病（NERD）和对照4组,利用食管24 h pH监测法评价胃食管反流病（GERD）患者食管酸暴露及反流特点;通过食管组织HE染色进行组织病理学评分,使用免疫组化法和酶联免疫吸附剂测定法检测食管局部及血清中IL-4、IL-6表达情况。 结果食管24 h pH监测结果中,3亚组间DeMeester指数、弱酸反流次数、反流总事件数比较,差异均无统计学意义（P均>0.05）,NERD组酸反流次数较其余2组低,差异有统计学意义（P均<0.05）;4组样本食管黏膜组织病理学评分中发现,BE组、EE组与其余2组相比均明显升高,差异有统计学意义（P均<0.05）,BE组与EE组评分之间亦有显著差异（P<0.05）,NERD组与对照组间差异不明显;IL-4在4组食管标本中均有不同程度表达,但4组间IL-4阳性率的比较并无显著差异（P均>0.05）;IL-6在NERD组和对照组表达量较低甚至不表达,EE组IL-6阳性率明显高于对照组（P<0.05 ）,但与NERD组间无显著差异,BE组阳性率与对照组和NERD组之间均有明显差异（P均<0.05 ）。 结论GERD食管黏膜上皮组织学炎症等级随食管炎的恶化而升高,其中NERD的食管组织学已出现炎性化趋势,但尚不足以与正常食管区别;IL-4在不同亚型GERD食管黏膜组织中的表达差异不及IL-6显著。     

The epidemiology of gastroesophageal reflux disease

Symptoms of gastroesophageal reflux disease (GERD) are among the most common encountered in primary practice. Reported symptoms certainly under-represent the true prevalence of this disease in the population, because many patients do not seek care for symptoms of GERD and many physicians do not specifically ask about such symptoms when performing the review of systems. We describe the epidemiology of GERD. We begin by considering the prevalence of GERD as a function of the disease definition used. We then discuss the epidemiology of nonerosive reflux disease. After that, we consider the population risk factors for GERD. Next, we briefly touch on the epidemiology of GERD complications, including erosive esophagitis, strictures, and Barrett esophagus. We will end with a brief discussion of population screening of those with GERD for Barrett esophagus.     

放大内镜下胃食管反流性疾病的临床研究

目的应用放大胃镜观察胃食管反流病内镜下表现，探讨其特征性微细结构表现。方法66例胃食管反流性疾病者（非糜烂性食管炎NERD44例、糜烂性食管炎EE12例、Barrett食管10例）和9名健康志愿者行24小时食管pH检测和放大胃镜检查，于病变部取活检行H．pylori检测。结果内镜下，NERD组77．2％患者齿状线呈锯齿状、三角形及舌形与正常对照组比较差异有显著性（P＜0．01）；EE组83．3％患者食管下段粘膜血管呈螺旋型、不规则型炎症性表现与NERD组比较差异有显著性（P＜0．05）；Barreu组100％患者齿状线下黏膜小凹形态呈分枝状、斑片状或绒毛状，与EE组相比差异有显著性（确切概率法P=0．0396）。结论放大内镜下胃食管返流病特征性表现对于胃食管反流病的诊断有重要意义。     

Is Barrett's esophagus characterized by more pronounced acid reflux than severe esophagitis?

Objective: Barrett's esophagus is related to gastroesophageal reflux disease (GERD). However, only a small fraction of patients with GERD develop Barrett's esophagus. We evaluated whether gastroesophageal acid reflux is more pronounced in Barrett's patients than in patients with moderate or severe endoscopic esophagitis.
Methods: Retrospective evaluation of results of esophageal manometry and 24 hour ambulatory pH monitoring performed between 1990 and 1996 at the Leiden University Medical Center in those patients who also underwent endoscopy ≤3 months before pH-metry. Included were 51 patients with Barrett's esophagus, 30 patients with severe esophagitis, 45 patients with moderate esophagitis, and 24 healthy control subjects.
Results: Patients with Barrett's esophagus had significantly increased acid reflux time (   p < 0.01  –0.05) compared to patients with moderate, but not compared to patients with severe esophagitis. Distal esophageal body motility and LES pressure were significantly (   p < 0.01  –0.05) reduced in patients with Barrett's esophagus compared to patients with moderate esophagitis but not compared to those with severe esophagitis.
Conclusion: Although acid reflux is increased in patients with Barrett's esophagus and esophageal motility is impaired, other factors apart from acid exposure and motility contribute to the development of Barrett's esophagus.     

加强对胃食管反流病几个热点问题的研究

胃食管反流病（GERD）是一种常见胃肠道疾病。近年研究进展，尤其是内镜下食管炎的洛杉矾分类、蒙特利尔GERD全球定义和分类以及Barrett食管的布拉格C＆M分类标准，使我们对该病的认识逐步深入，但仍有诸多问题有待进一步研究。内镜下“微小病变”食管炎的诊断、非糜烂性反流病（NERD）的特点及其与功能性烧心的鉴别、非酸性反流的检测及其意义以及Barrett食管的诊断和治疗均为今后研究的热点。     

胃食管阀瓣在胃食管反流病中的分布及其与症状的相关性

背景：近年我国胃食管反流病（GERD）的发生率不断升高,胃食管阎瓣（GEFV）分级对评估GERD有重要作用。目的：探讨GEFV在GERD中的分布特征及其与患者症状的关系。方法：选取2010年1～12月聊城市人民医院行胃镜检查发现的343例糜烂性食管炎（EE）、483例非糜烂性反流病（NERD）和99例Barrett食管（BE）患者,记录GEFV的Hill分级,采用GERD症状评定量表（GSAS）记录症状频率、严重度评分。比较GERD各型中GEFV的分布及其与症状频率、严重度评分的关系。结果：异常GEV多见于男性、高龄、超重和食管裂孔疝患者。随着EE的Los Angeles分级增加,异常GEV的发生率增加（P=0.002）;GEFV分级在EE、NERD和BE组间的分布无明显差异（P=0.612）：与正常GEFV组相比,异常GEFV组GERD的症状频率评分明显增高（P〈0.05）,而症状严重度评分无明显差异（P〉0.05）。多重线性回归分析显示症状频率评分与年龄、GEFV分级和GERD类型相关（P〈0.05）,症状严重度评分与年龄、GERD类型相关（P〈0.05）。结论：GEFV分级在GERD各亚型中的分布无明显差异,而与GERD症状频率相关。