36例难治性胃食管反流病患者阻抗-pH监测结果分析

质子泵抑制剂（PPIs）广泛用于治疗胃食管反流病（GERD），但部分患者对抑酸治疗的疗效不佳，称为难治性GERD。目的：研究难治性GERD患者食管内反流的严重程度和反流物性质，以探讨难治性GERD症状形成的因素。方法：选取2009年1月-2010年12月华东医院确诊的难治性GERD患者36例，以PPls治疗后症状得到缓解的12例GERD患者作为对照。行24h阻抗-pH监测，根据反流物pH值和阻抗值，分析比较两组的反流情况。结果：难治性GERD组24h总反流和弱酸反流次数的中位数（第25百分位数，第75百分位数）分别为98（58，136）和62（40，86），均显著高于对照组（P〈0．001）；两组酸反流次数均控制在较低水平，且组问差异无统计学意义（P：0．423）。难治性GERD组的气体反流和液气混合反流次数分别为48（31，61）和41（22，58），均显著高于对照组（P〈0．001，P=0．002）；液体反流次数无明显差异（P=0．757）。结论：弱酸反流在难治性GERD患者症状形成中起一定的作用，气体反流可能加重反流症状的感知。

Analysis of 36 Cases of Refractory Gastroesophageal Reflux Disease with Impedance-pH Monitoring

Background:Proton pump inhibitors(PPIs) are widely used in the treatment of gastroesophageal reflux disease (GERD),but some GERD patients have poor response to PPIs,which are called refractory GERD.Aims:To study the severity and character of esophageal reflux in refractory GERD patients and in order to explore the factors of refractory GERD symptoms.Methods:Thirty-six refractory GERD patients at Huadong Hospital from Jan.2009 to Dec.2010 were enrolled,and 12 GERD patients whose symptoms had been alleviated after PPIs treatment were served as controls.24-hour impedance-pH monitoring was performed,and reflux were compared between the two groups according to pH and impedance of the reflux.Results:The median(25th percentile,75th percentile) of total reflux times and weak-acid reflux times in refractory GERD patients were 98(58,136) and 62(40,86),respectively,which were significantly higher than those in control group(P < 0.001 ).Acid-reflux were well controlled after PPIs treatment in both groups,and no significant difference was found between the two groups(P - 0.423).The median(25 th percentile,75 th percentile) of gas and liquid-gas reflux times in refractory GERD patients were 48(31,61) and 41(22,58),respectively,which were significantly higher than those in control group(P < 0.001,P =0.002).No significant difference of liquid reflux times was found between the two groups(P = 0.757).Conclusions:The symptoms of refractory GERD may be associated with weak-acid reflux.Gas reflux may aggravate the reflux symptom perception.