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1.
胃食管反流病(GERD)是常见疾病,其中70%为非糜烂性反流病(NERD)。目前,治疗GERD的方法很多,其中药物治疗最易于被患者接受,抑酸治疗是主要的药物治疗手段,但是对NERD患者的治疗效果明显差于糜烂性GERD患者。埃索美拉唑(esomeprazole)是一种新型的质子泵抑制剂,本研究主要探讨其对NERD患者的疗效。  相似文献   

2.
目的 探讨心理干预和抗抑郁药物辅助治疗对非糜烂性胃食管反流病(NERD)患者生活质量的影响.方法 对95例NERD患者随机分为观察组48例,对照组47例,对照组应用雷贝拉唑;观察组在对照组用药的基础上给予心理干预和盐酸帕罗西汀.应用反流性疾病问卷(RDQ)和生活质量指数问卷(QL-Index)在入组时、治疗4周末、治疗8周末各调查评定1次.结果 在治疗4周末、治疗8周末2组间比较,观察组胃食管反流症状总分[(7.32±2.10)分]显著低于对照组[(11.64±2.54)分](P<0.01);生活质量量表评分,8周末观察组[(8.56±1.38)分]明显高于对照组[(7.98±1.42)分](P<0.05).结论 对NERD患者进行心理干预和应用抗抑郁药物辅助治疗能显著改善反流症状,明显提高患者的生活质量.  相似文献   

3.
目的 探讨心理治疗对非糜烂性胃食管反流病(NERD)患者抑郁情绪的干预效果及其对生活质量的影响.方法 将68例非糜烂性胃食管反流病患者随机分为治疗组和对照组,评定并比较2组抑郁自评量表(SDS)、健康状况问卷(SF-36)得分及其临床疗效.结果 治疗4周后,治疗组SDS评分[(41.58±6.85)分]显著低于对照组[(50.42±9.26)分](P<0.01);其临床疗效评定显著高于对照组(P<0.01);SF-36除生理机能[(86.9±11.7)分和(83.8±16.5)分]外,其他指标治疗组均优于对照组(P<0.05).结论 心理干预能显著降低NERD患者抑郁情绪,并可提高临床疗效、躯体功能及生活质量.  相似文献   

4.
目的:探讨根除幽门螺杆菌(HP)与胃食管反流病(GERD)疗效间的关系。方法选取GERD患者254例,分为非糜烂性反流病(NERD)组和糜烂性食管炎(EE)组,再进一步分为 HP阳性组、HP阴性组,HP阳性组随机分为不抗 HP治疗组和抗 HP治疗组,抗HP治疗组行HP根除三联疗法,不抗HP治疗组和HP阴性组仅服用雷贝拉唑(20 mg每天2次);10 d后所有患者仅服用雷贝拉唑(20 mg 每天2次)直至试验疗程2个月。试验结束时EE组行胃镜检查,所有患者均行食管酸反流测定和13 C呼气试验检测H P。结果179例患者完成了临床研究(N ERD组119例,其中抗 H P治疗组47例,不抗 H P治疗组32例,H P阴性组40例;EE组60例,其中抗HP治疗组24例,不抗HP治疗组15例,HP阴性组21例)。NERD组中抗HP治疗组36例患者HP转阴(76.6%),EE组中抗HP治疗组18例HP转阴(75.0%)。NERD组或EE组中HP根除成功患者组分别与 HP根除失败组、不抗HP治疗组、HP阴性组在治疗前后症状、食管炎症和食管酸反流方面比较差异无统计学意义(P>0.05)。结论根除HP治疗与GERD疗效间没有明显相关性。  相似文献   

5.
目的探讨雷贝拉唑、马来酸曲美布汀对胃食管反流病(GERD)患者十二指肠胃反流(DGR)的影响。方法采用彩色多普勒超声检测GERD患者DGR情况,比较用药前后GERD患者DGR变化情况。结果雷贝拉唑和雷贝拉唑联合马来酸曲美布汀对GERD患者DGR均有明显改善(P<0.05),雷贝拉唑与雷贝拉唑联合马来酸曲美布汀之间DGR变化不明显。结论雷贝拉唑对GERD患者DGR有改善作用,加用马来酸曲美布汀不能使作用加强。  相似文献   

6.
《陕西医学杂志》2014,(10):1427-1428
<正>胃食管反流病(GERD)的临床症状为:烧心、反酸、胸骨后灼痛、吞咽疼痛和吞咽困难等,胃食管反流病包括反流性食管炎(RE)和非糜烂性反流病(NERD)[1-2]。我院2008年9月至2013年8月对23例GERD患者在生活方式干预的同时,给予质子泵抑制剂泮托拉唑及胃动力药吗丁啉治疗,效果满意,现报道如下。资料与方法1一般资料选择门诊就诊的GERD患者46例,男28例,女18例,年龄2365岁,平均年龄52±2岁。入选标准:  相似文献   

7.
胃食管反流病(gsstro-esophageal reflux disease,GERD)系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.GERD包括非糜烂性反流病(non-erosive reflux disease,NERD)、糜烂性食管炎(erosive esophagitis,EE)即反流性食管炎(refluxesophagitis,RE)和Barrett食管(barrett esophageal,BE),它们也称为GERD相关性疾病.GERD反流形式:酸反流、非酸反流(胆汁反流最重要)和混合反流,其中胃酸反流至食管是GERD的主要病因.GERD发病日渐增多,其规范的诊断和治疗愈加重要.  相似文献   

8.
《新乡医学院学报》2015,(10):943-946
目的对比不同类型胃食管反流病(GERD)患者血浆血管活性肠肽(VIP)和血清一氧化氮(NO)水平的差异。方法 134例GERD患者分为非糜烂性反流病组(NERD组)46例、糜烂性食管炎组(EE组)43例、Barrett食管组(BE组)45例,应用放射性免疫分析法测定患者血浆VIP水平,应用硝酸还原酶法测定血清NO水平,并测定食管体部收缩情况。结果 EE组、BE组患者血浆VIP水平均显著高于NERD组(P<0.01,P<0.05);BE组患者血浆VIP水平显著低于EE组(P<0.05)。EE组患者血清NO水平显著高于NERD组(P<0.01);BE组患者的血清NO水平与NERD组比较差异无统计学意义(P>0.05);BE组患者血清NO水平显著低于EE组(P<0.05)。NERD组、BE组患者食管近段收缩波幅大于EE组(P<0.01);NERD组与BE组患者的食管近段收缩波幅比较差异无统计学意义(P>0.05)。NERD组患者食管远段收缩波幅大于EE组和BE组(P<0.01);EE组患者食管远段收缩波幅与BE组比较差异无统计学意义(P>0.05)。EE组、BE组患者的食管近段有效蠕动波均少于NERD组(P<0.05),EE组食管近段有效蠕动波与BE组比较差异无统计学意义(P>0.05);EE组患者食管远段有效蠕动波少于NERD组和BE组(P<0.05),NERD组患者食管远段有效蠕动波与BE组比较差异无统计学意义(P>0.05)。结论 VIP、NO对食管运动具有重要调节作用,血浆VIP、血清NO水平可作为GERD类型鉴别的重要参考指标,临床应根据GERD的类型及特点采取不同的治疗方案。  相似文献   

9.
《中国全科医学》2007,10(2):161-161
1定义胃食管反流病(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。2类型及定义GERD可分为3种类型:非糜烂性反流病(NERD)、糜烂性食管炎(EE)和Barrett食管(BE),以NERD最常见。(1)NERD是指存在反流相关的不适症状,但内镜下未见Barrett食管及食管黏膜破损;(2)  相似文献   

10.
目的探讨心理干预和抗抑郁药物辅助治疗对非糜烂性胃食管反流病(NERD)患者生活质量的影响。方法对95例NERD患者随机分为观察组48例,对照组47例,对照组应用雷贝拉唑;观察组在对照组用药的基础上给予心理干预和盐酸帕罗西汀。应用反流性疾病问卷(RDQ)和生活质量指数问卷(QL-Index)在入组时、治疗4周末、治疗8周末各调查评定1次。结果在治疗4周末、治疗8周末2组间比较,观察组胃食管反流症状总分[(7.32±2.10)分]显著低于对照组[(11.64±2.54)分](P<0.01);生活质量量表评分,8周末观察组[(8.56±1.38)分]明显高于对照组[(7.98±1.42)分](P<0.05)。结论对NERD患者进行心理干预和应用抗抑郁药物辅助治疗能显著改善反流症状,明显提高患者的生活质量。  相似文献   

11.
Background Gastroesophageal reflux disease (GERD) is a common disorder. Dilation of intercellular spaces of esophageal epithelium has been revealed at transmission electron microscopy both in the rabbit acid-perfused esophagus and in esophageal biopsies from GERD patients. This study aimed to observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in patients with GERD and the changes of intercellular spaces of patients with erosive esophagitis (EE) before and after omeprazole treatment.
Methods Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus (2 cm above Z-line) for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease (NERD) patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole (Losec, 20 mg bid) for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment.
Results Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were (0.37±0.07)μm, (1.31±0.08)μm, and (1.33±0.14)μm, respectively, with significant differences between the control group and the NERD group (P=0.000). In the 20 EE patients, the mean intercellular space before treatment was (1.14±0.15) μm After treatment the intercellular space was (0.51±0.18)μm, a significant difference compared with pre-treatment measurements (P=0.000). Conclusions Dilated intercellular spaces (DIS) were seen in both NERD and EE cases. The dilated intercellular spaces of esophaaeal epithelium in EE patients could be recove  相似文献   

12.
目的 观察柴胡疏肝散联合质子泵抑制剂(proton pump inhibitors, PPIs)治疗胃食管反流病的临床疗效。 方法 纳入212例胃食管反流病患者,分为糜烂性食管炎(erosive esophagitis, EE)和非糜烂性反流病(non-erosive reflux disease, NERD)两组,每组106例,所收集患者均符合中医肝胃郁热证诊断。EE组和NERD组再各自随机分为治疗组和对照组,每组53例。治疗组给予柴胡疏肝散加PPIs,对照组给予PPIs,疗程均为8周。治疗后通过反流诊断问卷(reflux diagnostic questionnaire, RDQ)了解患者症状及发作频率的改善情况,并在治疗结束4周后随访复发情况。 结果 共198例(占93.4%)患者按方案完成治疗。治疗8周末,4组患者RDQ评分均较治疗前降低(P<0.05)。停药4周末,4组患者RDQ评分均较治疗8周末上升,但均低于治疗前(P<0.05)。在EE患者和NERD患者中,治疗组患者治疗8周末和停药4周末的RDQ评分均低于对照组(P<0.05)。结论 柴胡疏肝散联合PPIs能显著改善肝胃郁热型胃食管反流病患者的症状,疗效明显优于单用PPIs,且能减少停药后的复发。  相似文献   

13.
背景 近年来,随着胃食管反流病(GERD)的流行病学和病理生理学研究的深入,发现该病存在较高的焦虑抑郁发生率,其典型症状(反酸、胃灼热)常与患者的情绪密切相关。食管外症状是GERD常见的一类症候群,在一定程度上加重了患者的焦虑抑郁情绪,降低了患者的生活质量,并影响治疗效果。目的 通过对伴或不伴食管外症状GERD患者的症状、情绪、生活质量的调查,探讨食管外症状对GERD患者的情绪及生活质量的影响;并通过对经质子泵抑制剂(PPI)治疗8周后GERD患者的随访,探讨影响GERD治疗效果的危险因素。方法 于2018年1-12月,收集在门诊及住院患者1 013例进行问卷调查。采用胃镜、24 h pH监测及GerdQ量表诊断GERD;采用SAS、SDS量表评价患者焦虑抑郁情况;采用SF-36量表对生活质量进行评价。采用Logistic回归分析影响GERD治疗效果的危险因素。结果 本次调查共发放问卷1 013份,回收有效问卷937份,有效回收率92.5%。伴食管外症状GERD患者的焦虑抑郁发生率高于不伴食管外症状GERD患者(42.6%比33.1%)。随访经PPI治疗8周后的GERD患者,伴食管外症状合并焦虑抑郁患者的症状、焦虑抑郁情绪好转率低于其他组,差异有统计学意义(P<0.05)。多因素分析结果显示:体质指数、GERD亚型、是否合并焦虑抑郁、伴/不伴食管外症状是GERD患者治疗效果的影响因素。结论 食管外症状加重患者焦虑抑郁情绪的发生,降低生活质量,并影响治疗效果。  相似文献   

14.
目的 比较GerdQ量表、24 h pH-DeMeester(pH-DeM)及阻抗-pH联合监测3种方法在Barrett食管(BE)、反流性食管炎(RE)和非糜烂性反流病(NERD)的阳性诊断率以及胃食管反流事件特点.方法 参考蒙特利尔共识意见纳入2009年6月1日至2010年9月30日于北京大学第三医院就诊的胃食管反流病(GERD)患者205例,胃镜检查将患者分为BE、RE和NERD 3组.患者均接受GerdQ量表调查、食管24 h pH及阻抗监测.结果 共纳入GERD患者205例.其中BE患者10例,RE 28例,NERD 167例.(1)24 h阻抗-pH法对GERD患者的阳性诊断率为74.1%,显著高于GerdQ(51.7%)和24 h pH-DeM法(29.2%)(P<0.05).(2)GerdQ及24 h pH-DeM法对BE及RE患者阳性诊断率高于NERD患者,而24 h阻抗-pH法在3种类型GERD的阳性诊断率均在较高水平(70.0%、82.1%及73.1%).(3)GerdQ量表得分值与pH-DeM积分及阻抗-pH酸反流分值呈正相关(r=0.242,P=0.000及r=o.182,P=0.009);pH-DeM积分与阻抗-pH酸反流分值呈显著正相关(r=0.632,P=0.000).(4)阻抗-pH监测对GerdQ问卷及pH-DeM积分法具有较强的补充诊断能力:GerdQ问卷阴性者,阻抗-pH的阳性诊断率为58.4%(59/101);pH.DeM积分法阴性者,阻抗-pH监测的阳性诊断率为74.5%(108/145).GerdQ问卷及pH-DeM积分法漏诊的患者均以弱酸反流为主.(5)RE患者酸反流事件检出率及积分均显著高于NERD[53.6%比23.4%,45.6(35.0~67.5)比23.1(9.3~35.0),均P
Abstract:
Objective To compare the diagnostic values of GerdQ questionnaire,24-h pH monitoring and 24-h impedance-pH monitoring for gastroesophageal reflux disease(GERD)and to analyze the reflux patterns of Barrett's esophagus(BE),reflux esophagitis(RE)and non-erosive disease(NERD).Methods From June 1,2009 to September 30,2010,205 GERD patients were included according to the Montreal consensus.All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pH monitoring The diagnostic sensitivities of GerdQ,24-h pH-DeM and 24-h IMP-pH were compared and the reflux pattern of BE,RE and NERD analyzed.Results A total of 205 GERD patients including 10 BE,28RE and 167 NERD were recruited.(1)The diagnostic rate of 24-h IMP-pH was 74.1%.It was significantly higher than that of GerdQ(51.7%)and 24-h pH-DeM(29.2%).(2)The diagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that for NERD.But there were no significant differences of 24-h IMP-pH for three types of GERD(70.O%,82.1%and 73.1%).(3)There were positive correlations among the scores of GerdQ,pH-DeM scores and acid scores in IMP-pH(r=0.242,P=0.000;r=0.182.,P=0.009 and r=0.632,P=0.000).(4)Added diagnostic values of IMP-pH were 58.5%and 74.5%respectively in patients who would have been missed by GeraQ and pH-DeM.(5)The detection rate and score of acid reflux in RE patients were higher than that of NERD [53.6%vs 23.4%,P<0.05;45.6(35.0-67.5)vs 23.1(9.3-35.0),P<0.05].But gas score and separate acid reflux were lower than that in NERD[17(0-194)vs 30(0-500),P<0.05;57.4%VS 28.6%,P<0.05].Conclusions Acid reflux plays an important role in RE.The value of GerdQ and 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE.Weak acid may be more important for BE and NERD patients than separate acid reflux.And 24-h IMP-pH monitoring has a distinct advantage in diagnosing these two types.  相似文献   

15.
Zheng J  Du ZM  Chen MH  Lin JK  Hu PJ 《中华医学杂志》2008,88(20):1390-1393
目的 评价内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测和质子泵抑制剂(PPI)试验等方法对胃食管反流病(GERD)相关非心源性胸痛(NCCP)的诊断价值.方法 因胸痛而接受冠状动脉造影的连续病例共255例中,符合本研究标准的NCCP患者27例纳入研究,对这些患者行问卷调查、内镜、24 h食管pH和胆汁监测后,予埃索美拉唑20 mg,2次/d,试验14 d.结果 27例NCCP中,若仅以存在糜烂性食管炎和(或)病理性酸反流诊断GERD相关NCCP有9例(33%);若以存在糜烂性食管炎和(或)病理性酸反流、症状指数阳性、病理性胆汁反流之其中1项诊断为GERD相关NCCP则有20例(74%).以后者为GERD相关NCCP的诊断标准,PPI试验的诊断敏感性75%、特异性86%,反流性疾病问卷(RDQ)敏感性35%、特异性86%.结论 结合内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测等检查可提高GERD相关NCCP的诊断,PPI试验是临床上诊断GERD相关NCCP的首选方法.  相似文献   

16.
Background The relationship between symptom elimination and normalization of esophageal acid level of gastroesophageal reflux disease (GERD) on proton-pump inhibitor (PPI) therapy has been questioned. This study aimed to evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese patients with GERD on esomeprazole therapy, and to assess the role of 24-hour esophageal pH-metry after therapy in GERD patients.Methods GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hour esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hour pH-metry after treatment. The pH- group achieved normalization of esophageal pH level whereas the pH+ group did not.Results Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 90% (52/58) of symptom-free patients and 67% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P=0.030). The mean post-therapy gastric nocturnal percent time of pH 〈4.0 was significantly higher in pH+group than that in pH- group (P 〈0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P〈0.001) and persistent reflux symptom (P=0.004) were two independent factors predicting the low post-therapy esophageal pH level.Conclusions Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse.Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.  相似文献   

17.
目的探讨SF-36量表在胃食管反流病(GERD)患者相关生存质量评价中的应用价值。方法121例门诊GERD患者为对象,以SF-36生活质量调查量表为工具,通过问卷调查的形式分析GERD患者的流行病学情况,分析治疗前后患者生活质量的改善情况。结果SF-36量表有良好的信度,各维度的重测信度良好,分半信度为0.93,内部一致性信度的Cronbach'sα系数均在0.700以上;治疗后SF-36生活质量量表的各个指标均有改善,以生理功能和躯体疼痛改善最为明显,其次为生理职能、总体健康、情感职能、心理健康和社会功能(P<0.05,P<0.01),但是活力因子差异无统计学意义(P>0.05)。结论用SF-36生活质量量表可以较准确地评估GERD患者的生活质量状况。  相似文献   

18.
Objective To evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese gastro-esophageal reflux disease (GERD) patients on esomeprazole therapy, and to assess the role of 24-hr esophageal pH-metry after therapy in GERD patients. Methods GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hr esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hr pH-metry after treatment; the pH- group achieved normalization of esophageal pH level whereas the pH+ group did not. Results Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 89.7% (52/58) of symptom-free patients and 66.7% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P=0.030). The mean post-therapy gastric nocturnal % time of pH< 4 was significantly higher in pH+ group than that in pH- group (P<0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P<0.001) and persistent reflux symptom (P=0.004) were 2 independent factors predicting the low post-therapy esophageal pH level. Conclusion Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse. Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.  相似文献   

19.
目的观察胃食管反流病(GERD)各亚型在埃索美拉唑治疗前后食管黏膜上皮细胞间隙增宽(DIS)的变化。方法19例以烧心为主诉、经内镜检查、24h食管pH监测和质子泵抑制剂治疗试验证实为GERD的患者,接受埃索美拉唑40mg/d治疗2个月。治疗前后内镜检查时在食管齿状线上3~5cm处外观正常黏膜取活检,分别进行组织学及透射电镜检查。15例正常人食管黏膜活检电镜检查作为正常参数。结果2个月治疗后,糜烂性食道炎(6例)、伴有病理性酸反流的NERD(7例)、不伴有病理性酸反流的NERO(6例)DIS恢复正常分别有5例(83.33%)、6例(85.71%)和5例(83.33%),均伴随烧心症状完全消失。DIS未恢复正常的3例患者中2例烧心症状仍然存在。结论GERD患者经埃索美拉唑治疗2个月后DIS恢复正常伴随症状消失,各组间在DIS恢复上差异无统计学意义。  相似文献   

20.
目的总结胃食管反流病临床症状的特点,评价影响症状问卷的相关因素。方法2004年3月-2010年12月就诊的行反流性疾病问卷的366例患者进行分析,其中男162例,女204例,平均年龄(53.0±14.0)岁,以“问卷总分≥12分”为阳性标准,总结所有及问卷阳性患者烧心、胸痛、反酸、反食症状的特点,分析相关影响因素。结果RDQ问卷阳性患者,烧心发生率为86.7%、胸痛64.5%、反酸82.8%、反食89.2%,每周2-3d、甚至每天有症状者居多,以中度症状为主;胸痛症状女性更易出现且程度较重,男性反食症状较易出现。吸烟是影响问卷结果的重要因素(B=0.789,P=0.018)。结论女性胸痛症状更易出现且程度较重,男性反食症状较易出现,吸烟是影响问卷结果的重要因素。  相似文献   

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