正常人和胃食管反流病人的昼夜食管pH和动力变化

目的:为探讨正常人和胃食管反流病(gastroesophageal reflux disease,GERD)病人昼夜食管运动规律以及食管运动与酸反流的关系。方法:45例GERD病人和10名正常人均接受食管测压和动态食管pH及压力同步监测。结果:(1)下食管括约肌压、远端食管蠕动压及有效食管蠕动百分比在酸反流DeMeester高计分组明显低于低计分组(P<0.05),在反流性食管炎组也明显低于非反流性食管炎组(P<0.05)。(2)有GERD症状或食管炎的卧位有效蠕动百分比明显低于立位(P<0.05)。反流性食管炎组80％有夜间或伴有夜间反流,而不伴反流性食管炎的GERD无1例出现夜间反流。结论:昼夜食管pH和压力动态监测有利于进一步探讨GERD的运动病理,除LES功能外,食管清除功能在GERD发病中起重要作用。     

胃食管反流病食管测压与24小时pH监测的相关性研究

目的：对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测，运用统计学方法分析测压和ｐＨ结果，研究其相关性。方法：应用多导胃肠功能测定仪及便携式ｐＨ监测记录仪，对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测。结果：应用多元回归分析发现，ｐＨ的百分比和腹段下食管括约肌（ＬＥＳ）的长度、ＬＥＳ静息压及远端食管的蠕动压明显相关。依据测压及ｐＨ结果，使用ｔ检验方法，结果提示食管蠕动压不仅与ｐＨ＜４的百分化相关，也与酸反流大于５分钟的时间、最长反流时间有关（Ｐ＜００１）。结论：腹段ＬＥＳ的长度及食管下段的蠕动收缩是重要的抗反流屏障。食管酸暴露时间延长减弱食管体部酸清除能力     

Acid Gastroesophageal Reflux Reports in Infants: A Comparison of Esophageal pH Monitoring and Multichannel Intraluminal Impedance Measurements

Twenty-four-hour tracings generated from combined esophageal pH and multichannel intraluminal impedance measurements of 14 infants (nine males, median age 3.5 months) were examined retrospectively. For each tracing, two acid reflux assessment reports were generated using either pH monitoring alone or pH monitoring combined with impedance. Significantly fewer acid reflux episodes were detected using pH monitoring combined with impedance when compared to pH monitoring alone (25.1±4.0 versus 99.9±18.3 episodes/patient, p=.001). Estimates of esophageal acid exposure using pH monitoring alone were two-fold higher (137.4±23.7 versus 66.6±15.9 min/patient, p=.002) than estimates derived using both techniques. Of the total acid reflux episodes detected by pH monitoring alone, 71.8% could not be confirmed by combined pH and impedance. Detection of significant numbers of “pH-only” episodes raises concerns regarding possible over-estimations of acid exposure that may occur when estimates are based solely on esophageal pH monitoring.This study was funded in part by a grant from the National Institutes of Health (NIH 5R03DK62755-02) (HM) issued on July 1, 2002 (NIH, 900 Rockville Pike, Bethesda, MD).     

The Effect of Hiatal Hernia on Gastroesophageal Reflux Disease and Influence on Proximal and Distal Esophageal Reflux

Introduction Gastroesophageal reflux disease (GERD) is a very common disorder that substantially affects the patient's quality of life. Aim Our aim was to detect the frequency of GERD in patients with hiatal hernia (HH), to compare the acid reflux pattern in patients with and without HH, and to search the relationship between the erosive gastroesophageal reflux (GER) and HH. Methods Forty patients with HH diagnosed by at least two methods, and 121 patients with GERD as a control group were studied. The frequency of GERD in patients with HH, the acid reflux pattern, the relation of body mass index and erosive esophagitis with HH and control group was studied. Results Among patients with HH 67.5% of patients had GER. On comparison of acid reflux pattern, the isolated distal esophageal reflux was seen more in patients with HH than in the control group (P < 0.0001). Erosive GERD was seen more in patients with HH than in the control group (P = 0.017). There was no difference in body mass indices between patients with HH and erosive gastroesopahgeal reflux disease and patients with HH and nonerosive GERD. Conclusion Hiatal hernia is very closely associated with GERD, and isolated distal esophageal reflux is seen more in patients with HH than in patients without HH. There is no effect of body mass index on GER in patients with HH.     

24小时食管pH监测和食管测压在胃食管反流病中的应用

目的：对８０例患者同时进行食管测压和２４小时ｐＨ值监测,探讨压力和２４小时ｐＨ值与胃食管反流及反流性食管 炎间的关系。方法：８０例病人分为Ａ组无反流症状;Ｂ组有反流症状,但内镜或Ｘ线检查无食管炎;Ｃ组有反流症状,内 镜或Ｘ线检查有食管炎。使用多导胃肠功能测定仪测定食管上、下括约肌及食管体静息和吞咽时压力及运动功能; 同时使用便携式２４小时ｐＨ监测仪监测食管２４小时ｐＨ值。结果：Ｂ、Ｃ两组的下食管括约肌压力（ＬＥＳＰ）低于Ａ组（Ｐ＜ ０．０５）,且食管下段蠕动幅度低于Ａ组（Ｐ＜０．０１）;Ｃ组食管下段蠕动低于Ｂ组（Ｐ＜０．０５）;２４小时ｐＨ监测Ｂ、Ｃ两组各项 指标均明显高于Ａ组（Ｐ＜０．００１）。结论：胃食管反流与ＬＥＳＰ降低、食管下段蠕动减弱有关,ＬＥＳＰ低于１１ｍｍＨｇ食管 炎的危险性增加。其诊断以２４小时ｐＨ监测结果为准。     

Analysis of Esophageal Motility and Reflux Characteristics in Patients with Gastroesophageal Reflux Disease With or Without Extraesophageal Symptoms

Background: The pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease is complex, and esophageal motility and reflux may be involved in it. In this study, we aimed to compare esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with and without extraesophageal symptoms by high-resolution manometry and multichannel intraluminal impedance-pH monitoring.Methods: We retrospectively studied gastroesophageal reflux disease patients between January 2014 and December 2018. All patients had undergone high-resolution manometry and multichannel intraluminal impedance-pH monitoring. The results were compared and analyzed.Results: A total of 59 patients were included in this study. Patients were divided into 3 groups according to their main complaint: only typical symptoms (group A, n = 11), both typical and extraesophageal symptoms (group B, n = 33), and only extraesophageal symptoms (group C, n = 15). Compared with group A, the lower esophageal sphincter basal pressure, integrated residual pressure, and lower esophageal sphincter length were lower, and the proximal reflux percentages of a weak acid and non-acid reflux were higher in group B and group C (P < .017). The positive rate of esophageal motility disorders was lower in group A than in other groups (P < .05). The proportion of patients with multiple rapid swallows/single swallow—distal contractile integral ratio greater than 1—was higher in group A than in other groups (P < .05).Conclusions: Decreased lower esophageal sphincter pressure and lower esophageal sphincter length, increased proximal esophageal reflux of weak acid and non-acid reflux, esophageal motility disorders, and decreased peristaltic reserve are involved in the pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease.     

Effect of Cholecystectomy on Gastric and Esophageal Bile Reflux in Patients with Upper Gastrointestinal Symptoms

Epidemiologic data have shown that cholecystectomy is associated with a moderately increased risk of esophageal adenocarcinoma. The study objective was to evaluate the role of refluxed bile. A total of 696 patients with upper gastrointestinal symptoms were included in the study, of whom 55 had a history of cholecystectomy (CHE). Bilirubin exposure was measured in percent time above absorbance 0.25 in the stomach and above 0.14 in the esophagus. Total gastric and esophageal bilirubin exposure was similar in both groups. Supine gastric bile reflux was slightly increased after cholecystectomy (30.6 ± 30.2 vs. CHE: 37.1 ± 29.5, P < 0.05). In patients with erosive esophagitis or Barrett’s esophagus, there were differences in total gastric exposure (24.3 ± 22.6 vs. CHE: 36.7 ± 26.8, P < 0.05) but not in esophageal exposure. Cholecystectomy slightly augments bile reflux into the stomach without detectable differences in the esophagus. Therefore, increased esophageal bile reflux following cholecystectomy as a potential cause for the associated cancer risk could not be substantiated.     

Gastroesophageal Reflux Disease: Review of Presenting Symptoms, Evaluation, Management, and Outcome in Infants

We conducted a retrospective review of 342 infants presenting with symptoms suggestive of gastroesophageal reflux disease (GERD) to assess their evaluation, management, and outcome. All infants underwent extended pH monitoring (EPM) for one or more of the following symptoms: regurgitation, choking, irritability, failure to thrive, apparent life-threatening event, or wheezing. EPM was considered abnormal if distal reflux index was 5% and/or if the Euler and Byrne score was 50 and these patients were labeled as having GERD. Those with normal EPM parameters were controls. All infants were <1 year of age (198 boys, 144 girls). Most received conservative treatment with formula changes and/or thickening and positional management before EPM. Of 342 infants studied, EPM was normal in 169 patients, ie, controls, and GERD was present in 173 children. GERD was more prevalent in Caucasians compared to African Americans (P < 1 0.045). Although a prokinetic or acid suppression medication or both were given more commonly in infants with GERD, almost half of infants in the control group also needed pharmacotherapy because of persistent symptoms. Mean time to resolution of symptoms in the control group infants with normal EPM was 3.5 months, and in infants with GERD it was 5.4 months (P < 0.001). In conclusion, the Majority of infants with symptoms suggestive of GERD resolve their symptoms within 3–6 months of initiating treatment. Day-to-day variability of the spectrum of GERD may contribute towards normal results of EPM in some infants who need pharmacotherapy.     

The Value of Ambulatory 24 hr Esophageal pH Monitoring in Clinical Practice in Patients Who Were Referred with Persistent Gastroesophageal Reflux Disease (GERD)-Related Symptoms While on Standard Dose Anti-Reflux Medications

To determine the value of pH testing in clinical practice in gastroesophageal reflux disease patients who failed anti-reflux treatment. Patients resistant to standard dose proton pump inhibitor or an H₂-blocker underwent pH testing. Randomly selected patients from the proton pump inhibitor failure group underwent the modified acid perfusion test as compared to patients with non-erosive reflux disease. In the proton pump inhibitor failure group (n = 70), 63.8% had a normal pH test as compared to 29% in the H₂-blocker group (n = 31) (P = 0.007). Sensory intensity rating and acid perfusion sensitivity score were significantly higher in the non-erosive reflux disease control group than the proton pump inhibitor failure group (P < 0.05). Most patients who continued to be symptomatic on proton pump inhibitor once daily demonstrated a normal pH test and overall lack of increased chemoreceptor sensitivity to acid.     

Acid and Non-Acid Reflux Patterns in Patients with Erosive Esophagitis and Non-Erosive Reflux Disease (NERD): A Study Using Intraluminal Impedance Monitoring

Background Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most common phenotypic presentations of gastroesophageal reflux disease (GERD). Aim To assess acid and non-acid reflux patterns in patients with EE and NERD using combined esophageal pH-impedance monitoring. Methods A total of 26 GERD patients off acid-suppressive medication and ten healthy volunteers (HV) underwent upper endoscopy and 24-h pH-impedance monitoring. Analysis of the pH-impedance signals included total reflux time, number of reflux episodes according to gas–liquid composition, and pH (acid, non-acid). Results EE was identified in 13 patients and NERD in 13 patients. Pathologic acid reflux was found in 92.3 and 69.2% of patients with EE and NERD, respectively (P = 0.15). When compared to HV, EE patients and NERD patients showed a higher incidence of acid (P = 0.002 and P < 0.001, EE vs. HV and NERD vs. HV, respectively) and non-acid reflux episodes (P = 0.03 and P = 0.001, EE vs. HV and NERD vs. HV, respectively). Mean reflux times, as assessed by both pH-metry and impedance monitoring, and incidence of acid and non-acid reflux episodes were similar in EE and NERD patients. In the supine position, however, EE patients showed a higher incidence of acid (P = 0.048) and liquid reflux episodes (P = 0.07). Conclusion Whereas EE patients have more acid reflux episodes in the supine position than NERD patients, patients with EE and NERD have similar non-acid reflux patterns. This observation lends support to the notion that non-acid reflux is less damaging to the esophageal mucosa than acid reflux.     

胃食管反流病夜间酸突破与食管酸暴露的关系探讨

目的探讨胃食管反流病(GERD)患者夜间酸突破(NAB)与食管酸暴露的关系。方法将45例GERD患者随机分为两组,对照组(21例)给予雷贝拉唑钠10 mg早晚各1次口服,试验组(24例)治疗同对照组外晚间睡前另加服雷尼替丁150 mg,疗程共7 d。两组治疗前后行24 h食管、胃pH监测,及反流诊断问卷评分(RDQ),并进行比较。结果加服雷尼替丁组夜间酸突破的发生率为20.83%,单用雷贝拉唑钠组为57.14%,两组比较差异有统计学意义(P0.05)。结论食管酸暴露和食管反流症状的控制不依赖于夜间酸突破的缓解,更大程度上取决于食管动力异常的改善。     

Gastric Acid Normosecretion Is Not Essential in the Pathogenesis of Mild Erosive Gastroesophageal Reflux Disease in Relation to Helicobacter pylori Status

In the pathogenesis of gastroesophageal reflux disease (GERD), gastric acid is considered to be one of the most important factors, but little is known about the degree of gastric acid secretion in GERD patients. In this study, we evaluated it in GERD patients and control subjects by 24-h intragastric pH, and serological and histological investigations, in relation to Helicobacter pylori (H. pylori) status. In H. pylori-negative GERD patients gastric acid secretion was similar to that in H. pylori-negative control subjects. In H. pylori-positive GERD patients, in particular, mild GERD patients, it decreased significantly compared to that in H. pylori-negative control subjects, but the degree of decrease was smaller than in H. pylori-positive control subjects. Results of serological and histological evaluation were supportive. In conclusion, in some GERD patients, gastric acid secretion was significantly decreased. Increased or maintained gastric acid secretion was not essential in the pathogenesis of mild GERD.     

联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病202例疗效观察

目的 探讨联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病(rGERD)的临床疗效.方法 将202例rGERD患者随机分为A(n=72)、B(n=68)和C组(n=62),分别采用雷贝拉唑+铝碳酸镁+莫沙比利、雷贝拉唑+莫沙比利及铝碳酸镁+莫沙比利治疗.4及8周后评价临床症状,8周后评价内镜下有效率.结果 治疗4周后,A、B和C组患者临床症状总改善率分别为88.9%、79.4%和61.3%,A组与B、C组相比差异显著(X2=7.3531,P<0.05).治疗8周后,A、B和C组患者临床症状总改善率分别为97.2%、88.2%和71.0%,内镜下有效率分别为94.4%、85.3%和67.7%,A组临床症状总改善率和内镜下有效率与B、C组相比存在显著性差异(X2=9.6079,P<0.01;X2=8.6496,P<0.05).结论 雷贝拉唑联合铝碳酸镁和莫沙比利治疗rGERD有良好的临床疗效.     

Value of the Gastroesophageal Reflux Disease Questionnaire (GerdQ) in predicting the proton pump inhibitor response in coronary artery disease patients with gastroesophageal reflux‐related chest pain

Chest pain experienced by patients with coronary artery disease can be partly due to gastroesophageal reflux‐induced chest pain (GERP). Empirical proton pump inhibitor (PPI) therapy has been recommended as an initial clinical approach for treating GERP. However, PPI use may lead to some health problems. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) may represent a noninvasive and cost‐effective approach for avoiding PPI misuse and for identifying the appropriate patients for the PPI trial test. The aim of this pilot study was to prospectively evaluate the association between GerdQ scores and PPI response in patients with coronary artery disease (CAD) and GERP to determine whether the GerdQ predicts the PPI response in patients with CAD and GERP and to further validate the clinical application value of the GerdQ. A total of 154 consecutive patients with potential GERP were recruited to complete a GerdQ with subsequent PPI therapy. Based on the PPI trial result, patients were divided into a PPI‐positive response group and a PPI‐negative response group. The difference in the GerdQ scores between the two groups was assessed. The receiver operating characteristic (ROC) curve of GerdQ score was drawn according to the PPI response as the gold standard. The ability of GerdQ to predict the PPI response was assessed. A total of 96 patients completed the entire study; 62 patients (64.6%) were assigned to the PPI‐positive response group, and 34 patients (35.4%) to the PPI‐negative response group. The GerdQ score of the PPI‐positive response group (8.11 ± 3.315) was significantly higher than that of the PPI‐negative response group (4.41 ± 2.743), and the difference was statistically significant (t = 5.863, P = 0.000). The ROC curve was drawn according to a PPI response assessment result with a score above 2 as the gold standard. The area under curve was 0.806. When the critical value of GerdQ score was 7.5, Youden index was up to 0.514, the diagnostic sensitivity was 0.661, and the diagnostic specificity was 0.853. A GerdQ score greater than 7.5 better predicts the response to the PPI trial therapy. There is a strong association between the GerdQ score and the response to PPI therapy. Higher GerdQ scores were predictive of a positive PPI response in CAD patients with GERP. The GerdQ may be a reasonable screening tool for GERP in patients with CAD who are prepared to accept PPI therapy.     

Measuring symptom distress and health-related quality of life in clinical trials of gastroesophageal reflux disease treatment: further validation of the Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS)

This study reports the reliability and validity of the distress subscale of the GERD Symptom Assessment Scale (GSAS) and the acute SF-36 Health Survey in a clinical trial setting. Patients with moderately severe GERD completed the GSAS and SF-36 at baseline and four weeks following treatment. The age (mean ± sd) of the 187 patients was 45.5 ± 11.1 years and most were female (63%) and Caucasian (78%). All scales met the 0.70 reliability criterion except for the SF-36 bodily pain scale. Mean baseline GSAS scores were significantly (P < 0.001) poorer by 10–17% among patients reporting more severe levels of all symptoms. Mean baseline SF-36 physical component summary scores were significantly (P < 0.02) poorer among patients reporting more severe levels of regurgitation, early satiety, bloating, and nausea. Patients reporting complete and satisfactory heartburn relief reported improvements in GSAS scores that were 13% and 10% greater, respectively, than patients who did not experience these levels of relief (P < 0.001). In conclusion, the GSAS and SF-36 scales were reliable and valid measures in this clinical trial. Differences of 10% in GSAS distress scores correspond to differences in symptom severity at a point in time and to changes in symptom severity over time. The SF-36 was not as useful in detecting differences in symptom severity over time.