胃食管反流性咳嗽的临床分析

目的　探讨胃食管反流 (GER)性咳嗽的临床特征、诊断和治疗。方法　对 4 1例X线胸片、组胺激发试验、鼻部检查正常的慢性咳嗽患者进行 2 4h食管 pH监测 ,并利用症状相关性概率(SAP)来分析咳嗽与反流的相关性。对Demeester总积分≥ 14 72 ,和 (或 )咳嗽与反流SAP≥ 75 %者进行为期 12周的抗反流治疗。结果　 4 1例患者中 ,有 2 6例诊断为GER性咳嗽 ,并给予抗反流治疗 ,完成疗程后 ,有 12例患者咳嗽完全消失 ,咳嗽与反流的SAP(上电极为 0 75± 0 2 1,下电极为0 91± 0 12 )显著高于另 14例对抗反流治疗反应较差或无效的患者 (上电极为 0 36± 0 31,下电极为 0 4 7± 0 30 ;P <0 0 5 )。结论　GER是不明原因慢性咳嗽的一个重要的独立原因。 2 4h食管 pH监测结合症状相关性分析有助于GER性咳嗽的诊断 ,抗反流治疗对其有较好的近期疗效。     

老年人胃食管反流病的临床特点

目的探讨老年人胃食管反流病(GERD)患者的症状、胃镜及24 h食管pH监测的特点。方法回顾性分析该院2011年3月至2013年3月就诊资料完整的老年人30例和非老年人40例GERD患者的临床特点。结果老年组典型反酸、胃烧灼积分低于非老年组(P<0.05);老年组食管外症状发生率高于非老年组(P<0.05);老年组重度食管炎比例高于非老年组(P<0.05);老年组24 h食管pH监测结果中pH<4的总时间百分比、pH<4的卧位总时间百分比、反流持续≥5 min次数、最长反流持续时间高于非老年组(P<0.05)。结论老年人典型胃烧灼、反酸症状少见,但食管外症状发生率较高,胃镜下食管黏膜损害程度较重,24 h食管pH监测食管酸暴露程度较高。     

胃酸和十二指肠胃食管反流在非糜烂性反流病中的作用

背景:胃酸和十二指肠胃食管反流(DGER)在我国非糜烂性反流病(NERD)患者发病中的作用尚不清楚。目的:探讨胃酸和DGER在NERD发病中的作用。方法:选取在消化专科门诊连续就诊的具有烧心和(或)反酸等反流症状的所有患者为研究对象,所有入选者填写一份问卷后,依顺序行胃镜检查、24h食管pH监测和24h食管胆汁联合监测。结果:共有82例NERD患者入选,平均年龄为42.7岁±11.7岁。其中,24例(29.3%)24h食管pH监测阳性[NERDpH(+)],58例(70.7%)24h食管pH监测阴性[NERDpH(-)];43例(52.4%)为DGER阳性,39例(47.6%)为DGER阴性。联合监测结果为,82例患者中15例(18.3%)病理性酸反流与DGER并存,9例(11.0%)存在单一的病理性酸反流,28例(34.1%)存在单一的DGER,30例(36.6%)则无病理性酸反流,且DGER阴性。采用24h食管pH监测组对NERD的诊断率为29.3%,而联合24h食管胆汁监测,则NERD的诊断率升高到63.4%。24例NERDpH(+)者中,15例(62.5%)存在DGER;58例NERDpH(-)者中,28例(48.3%)存在DGER;NERDpH(+)组与NERDpH(-)组DGER发生率无显著性差异(χ2=1.377,P=0.241)。结论:NERD的病理性酸反流比例相对较低,联合24h食管pH和胆汁监测可明显提高NERD的诊断率,DGER在NERD中的作用地位不容忽视。     

肠易激综合征患者胃食管胆汁反流的临床意义

目的　探讨肠易激综合征患者胆汁反流的临床意义。方法　用便携式胆红素监测仪 (Bilitec 2 0 0 0 )对 2 4例确诊为肠易激综合征和 6例健康人进行 2 4h食管腔内胆红素监测。结果　肠易激综合征患者胆汁反流总时间 % (10 .11± 5 .82 )明显高于健康对照组 (4 .0 9± 2 .3 7) ;其中便秘型患者胆汁反流总时间 % (14 .0 9± 5 .3 9)显著高于腹泻型患者 (8.48± 5 .2 9)。结论　肠易激综合征患者中存在碱反流 ,便秘型患者更为突出     

胃食管反流病患者酸反流与食管运动功能障碍的关系

背景：异常酸反流和食管运动功能障碍与胃食管反流病（GERD）密切相关。目的：研究GERD患者的食管运动和酸反流与食管黏膜损害的关系，以及两者之间的相关性。方法：选取有反酸、烧心、胸痛等典型胃食管反流症状的患者72例行上消化道内镜检查、食管测压和24hpH监测。根据pH〈4总时间百分比〈4．5％且DeMeester计分〈14．7的标准。将食管炎患者分为生理性酸反流组（pH^-组）和病理性酸反流组（pH^＋组）。结果：内镜下食管炎组24hpH监测各项指标较无食管炎组显著增高（P〈0．05），病理性酸反流的发生率显著高于无食管炎组（P〈0．01）。两组食管测压各项指标无显著差异，食管炎组pH^＋者的食管下括约肌压力（LESP）较pH^-者显著降低，食管体部蠕动波传导速度减慢，湿咽成功率减少（P〈0．05）。结论：GERD患者食管炎的发生与酸反流密切相关，有病理性酸反流的GERD患者易见食管运动功能障碍。     

非特异性食管动力障碍与胃食管反流病的关系研究

目的探讨非特异性食管动力障碍(NEMD)常见的临床类型,各类型与胃食管反流病(GERD)的关系。方法对食管测压检出的52例NEMD患者分别进行胃镜、食管内24h动态pH和胆汁监测,埃索美拉唑(耐信)治疗试验。结果NEMD主要类型有非传导性收缩43例、低幅性收缩39例、LES不松弛或松弛不全致LES残余压增高31例,多峰收缩9例。食管内24h动态pH和胆汁监测证实17例(32.7%)伴有病理性胃食管反流,伴有反流者多为不伴LES松弛功能障碍者,而LES松弛障碍者反流不明显,耐信治疗试验进一步证实了pH和胆汁监测的结果。结论NEMD部分与GERD相关,但更多可能为原发性食管动力障碍。     

24h食管pH监测在胃食管反流病的临床应用

目的　应用 2 4h食管 pH监测仪 ,检测食管下段 pH值 ,旨在为胃食管反流病 (GERD)提供灵敏性和特异性较高、先进而方便、快捷的诊断方法。方法　正常对照组 2 0例 ,消化性溃疡 5 4例及GERD组 85例 ,均采用Digi trapperMKⅢ 2 4hpH监测仪记录下食管括约肌 (LES)上 5cm处 pH。 结果　GERD组 2 4h食管pH监测有关指标均分别显著高于对照组和消化性溃疡组 (P <0 0 1) ,后二者间比较差异无显著性 (P >0 0 5 ) ;GERD组中有 2 4例内镜无异常的异常反流患者 ,其 2 4h食管 pH监测与 6 1例反流性食管炎比较 ,无显著性差异 (P >0 0 5 )。结论　GERD的症状分析和内镜诊断均有其局限性 ,2 4h食管 pH监测是GERD诊断的确切标准。     

食管静脉曲张出血硬化治疗后患者胃食管酸反流研究

肝硬化伴食管静脉曲张(esophogeal varices，EV)患者，胃食管反流阳性率明显高于正常。自2001年8月至2003年10月，我们对21例肝硬化食管静脉曲张出血硬化治疗后的患者，进行24h食管pH监测，观察胃食管反酸情况．现报道如下。     

动态食管内pH及胆汁反流检测用于危重症患者胃食管反流的可行性分析

[目的]研究动态食管内pH及胆汁反流检测用于危重症患者胃食管反流的可行性。[方法]收集我院ICU病房2012年1月~2014年1月的危重症患者120例,期间发生胃食管反流患者80例,作为观察组,另选取同期我院内科住院具有反流症状并且进行pH及胆汁反流检测患者50例,作为对照组,利用动态便捷pH检测仪和胆汁检测仪,检测2组反流情况。[结果]观察组单纯酸反流和单纯性胆汁反流发生率分别为10.0%、38.8%,而对照组分别为34.0%,10.0%,2组之间差别具有统计学意义(P0.05);观察组混合性反流发生率为43.8%低于对照组的56.0%,但是2组之间差异无统计学意义(P0.05)。观察组病例性反流的63例(78.8%),非病理性反流17例(21.2%)。2组经过24h动态食管pH检测,观察组病理性反流比例为78.8%低于对照组的94.0%,差异具有统计学意义(P0.05),观察组酸反流次数少于对照组,差异具有统计学意义(P0.05),观察组反流时间短于对照组以及最长反流时间长于对照组,但是2组之间差异无统计学意义(P0.05)。观察组胆汁反流次数少于对照组,但是2组之间差异无统计学意义(P0.05),反流时间和最长反流时间均长于对照组的,2组之间差异具有统计学意义(P0.05)。[结论]动态食管内pH及胆汁监测不仅应用于普通胃食管反流,而且可应用于危重患者胃食管反流。危重症患者胃反流发生率较高,并且反流时间长,反流量大。     

胆汁反流检测在胃食管反流病中的意义

目的 研究食管胆汁反流的发生情况,探讨其与酸、碱反流的关系及其对胃食管反流病（ＧＥＲＤ）的诊断意义。方法 应用便携式２４小时ｐＨ监测仪及胆汁监测仪同步检测反流性食管炎（ＲＥ）、胃切除术后者及健康志愿者共３４例的食管内２４小时ｐＨ变化及胆汁反流情况。结果 ＲＥ组食管酸暴露时间比对照组及胃手术后组均显著增加。各组间ｐＨ〉８总时间百分比结果相似,均较低。食管胆汁反流用胆红素吸收值≥０．１４的时间百分比表     

Prevalence of Gastroesophageal Reflux in Asthma

A high prevalence of gastroesophageal reflux disease (GER) in asthma patients has been shown in several reports from North America and Europe. However, no data from Southern Europe are available. This paper evaluates the prevalence of abnormal reflux in asthmatics, the pattern of acid reflux when present, and the relationship between asthma and GER. Eighty-one consecutive ambulatory patients with clinically stable asthma (41 women; median age 40 years, range 17-69 years) were prospectively evaluated. All patients had a thorough digestive history; baseline pulmonary function studies, including bronchoprovocation methacholine test; and ambulatory 24-hr esophageal pH monitoring. Reflux symptoms were present in 40 patients (49%). Twelve patients had abnormal GER as defined by pH testing, giving a prevalence rate of 15% (95% confidence interval 8%-24%). The presence of acid reflux was not associated with a more severe respiratory disease.

Abnormal GER seems not to be a clinically significant problem in many patients with asthma in our area.     

19例胃食管反流病患者根除幽门螺杆菌后食管酸反流的变化

目的：在胃食管反流病(GRED)患者根除幽门螺杆菌(Hp)是否会加重胃食管反流目前存在很大争议。本研究将采用食管内24h pH监测及食管测压检查的方法，定量观察GERD患者根除Hp治疗前后食管酸暴露及食管动力的变化。方法：连续选取我院门诊就诊的Hp阳性GERD患者。Hp感染诊断依据RUT和UBT或UBT和血清学检查。所有入选对象均在内镜检查后1～3d内行食管内24h pH监测和食管测压检查，同时评估反流症状。给予1周三联根除Hp治疗(奥美拉唑20mg，克拉霉素0．25g，阿莫仙1．0g，均bid)。疗程结束3个月后^14C—UBT检查，证实Hp根除者复查食管内24h pH监测和食管测压，同时重新评估反流症状。随访期间不用抑酸剂及促动力剂。结果：共23例Hp阳性GERD患者入选了本研究，其中19例患者完成了根除Hp前后的对比研究。在入选时有6例患者内镜下表现符合反流性食管炎，24h食管内pH监测提示病理性反流者10例。在确定根除Hp3个月后反酸、腹痛症状明显改善，食管24h pH监测各项参数与根除前相比均无显著性差异。LESP根除前10mm Hg(7．7—15．9)，根除后15mm Hg(10—20．6)，前后相比有显著性差异。食管体蠕动无明显改变。结论：本研究在GERD患者根除Hp3个月后反流症状有改善，食管酸暴露情况无明显变化，LESP较根除前增高，提示在GERD患者根除Hp有可能改善胃食管反流症状。     

A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms

Obese patients with gastroesophageal reflux disease (GERD) may experience resolution of symptoms utilizing a very low-carbohydrate diet. The mechanism of this improvement is unknown. This studied aimed to prospectively assess changes in distal esophageal acid exposure and GERD symptoms among obese adults initiating a very low-carbohydrate diet. We studied obese individuals with GERD initiating a diet containing less than 20 g/day of carbohydrates. Symptom severity was assessed using the GERD Symptom Assessment Scale—Distress Subscale (GSAS-ds). Participants underwent 24-hr esophageal pH probe testing and initiated the diet upon its completion. Within 6 days, a second pH probe test was performed. Outcomes included changes in the Johnson-DeMeester score, percentage total time with a pH<4 in the distal esophagus, and GSAS-ds scores. Eight participants were enrolled. Mean Johnson-DeMeester score decreased from 34.7 to 14.0 (P=0.023). Percentage time with pH<4 decreased from 5.1% to 2.5% (P=0.022). Mean GSAS-ds score decreased from 1.28 to 0.72 (P=0.0004). These data suggest that a very low-carbohydrate diet in obese individuals with GERD significantly reduces distal esophageal acid exposure and improves symptoms.     

危重症患者胃食管反流相关问题的研究进展

危重症患者由于存在气管插管/机械通气、鼻饲/肠内营养等诊疗操作加之存在程度不等的意识障碍,长期卧床,腹内压升高等高危因素,使胃食管反流十分常见,其危害性不但引起胃食管反流病,更重要的引起吸入性肺炎、急性肺损伤、源性呼吸窘迫等呼吸系危象,还可导致非心源性胸痛,新生儿猝死.其诸多不良反应并同原发病一起影响患者预后,提高对胃...     

Role of Esophageal Function Tests in Diagnosis of Gastroesophageal Reflux Disease

Clinicians typically make the diagnosis of gastroesophageal reflux disease (GERD) from the clinical findings and then prescribe acid-suppressing drugs. Endoscopy is usually done for persistent or severe symptoms. Esophageal function tests (EFTs: esophageal manometry and 24-hr pH monitoring) are generally reserved for patients who have the most severe disease, including those being considered for surgery. We hypothesized that EFTs are more accurate than symptoms and endoscopy in the diagnosis of GERD. This was a retrospective study undertaken in a university tertiary care center. Between October 1989 and November 1998, 822 patients with a clinical diagnosis of GERD (based on symptoms and endoscopic findings) were referred for EFTs. The patients were divided into two groups depending on whether the 24-hr pH monitoring score showed GERD (group A, GERD^–; group B, GERD⁺). The groups were compared with respect to the incidence and severity of symptoms, presence of a hiatal hernia on barium x-rays, presence and severity of esophagitis on endoscopy, and esophageal motility. In all, 247 patients (30%) had normal reflux scores (group A, GERD^–), and 575 patients (70%) had abnormal scores (Group B, GERD⁺). Eighty percent of group A and 88% of group B had been treated with acid-suppressing medications. The incidence of heartburn and regurgitation was similar in the two groups. Grade I–II esophagitis was diagnosed by endoscopy in 25% of group A and 35% of group B, and grade III esophagitis in 4% of group A and 11% of group B. Esophageal manometry showed that group B more often had esophageal dysmotility, consisting of a hypotensive lower esophageal sphincter and abnormal esophageal peristalsis. These data show that: (1) symptoms were unreliable for diagnosing GERD; (2) endoscopic evidence of grade I–II esophagitis was diagnostically nonspecific, and grade III was much less certain than claimed in other reports; and (3) pH monitoring identified patients with GERD and stratified them according to the severity of the disease. We conclude that esophageal manometry and pH monitoring are important in diagnosing GERD accurately. More liberal use of these tests early in patient management would avoid much improper and costly medical therapy and would help single out for special attention the patients with GERD who have the most severe disease.     

Percutaneous Endoscopic Gastrostomy Prevents Gastroesophageal Reflux in Patients with Nasogastric Tube Feeding: A Prospective Study with 24-Hour pH Monitoring

Background/Aims

Percutaneous endoscopic gastrostomy (PEG) has been widely used for patients with swallowing dysfunction. However, its beneficial effects in the treatment of gastroesophageal reflux (GER) are controversial. The aim of this study was to evaluate the effect of PEG on the prevention of GER in patients with nasogastric tube (NGT) feeding.

Methods

Continuous 24-hour pH monitoring was performed prospectively in 21 patients receiving NGT feeding before and 7.3±2.2 days after PEG placement to compare the severity of GER.

Results

We studied 21 patients with a mean age of 59.8±14.1 years. The mean duration of NGT placement was 5.8±5.4 months. The causes of swallowing dysfunction included cerebral infarction, cerebral hemorrhage and other central nervous system (CNS) lesions. When all of the patients were considered, there were no significant differences in reflux parameters after PEG placement compared to before PEG placement. However, all seven patients who had preexisting GER showed significant improvement (p<0.05) of the reflux parameters, including the frequency of acid reflux, duration of acid reflux, total time with a pH below 4.0 and the fraction of time with a pH below 4.0, after PEG placement.

Conclusions

PEG might prevent GER in patients receiving NGT feeding, especially in those patients with GER.     

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.     

The Diagnosis of Gastroesophageal Reflux Disease

Background

Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed.

Methods

A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using “gastroesophageal reflux” and “adults” with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles.

Results

Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests.

Conclusion

The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.     

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。