慢性咳嗽合并胃食管反流病和/或食管裂孔疝抗反流手术的疗效分析

目的 评估接受抗反流手术治疗的胃食管反流病(GERD)和/或食管裂孔疝(HH)患者中,慢性咳嗽症状的总体疗效,并探索其相关预测因素.方法 2014年1月1日至2019年6月30日于本中心行腹腔镜下胃底折叠术的230例患者资料.收集性别、年龄、身体质量指数、高血压、糖尿病、冠心病等人口统计学变量;反流、烧心、咳嗽、嗳气、...     

胃镜下腔内折叠术配合技术的研究

目的探讨和总结胃镜下腔内折叠术的配合技术，评价配合技术在这项新的内镜治疗术巾的重要性。方法94例胃食管反流病（GERD）患者，行胃镜下腔内折叠术（ELGP）118例次，根据是否合用射频治疗分为两期，一期32例次（单纯ELGP治疗），二期86例次（ELGP基础上合用射频治疗）、通过对助手配合方法进行回顾，比较两期器械战障发生率、器械安装牦时及单个皱褶缝合耗时（含排除仪器突发故障耗时）的差异，评价熟练及规范配合技术对ELGP术的影响，，结果一期平均器械安装时间（30±5）min，术中出现器械故障9次：缝线脱出2次、缝合又脱落3次、重新调整针壳和导丝的位置2次、缝合坠子脱落2次。二期改进后器械安装顺利，平均器械安装时间缩减到（5±2）min。仪器安装牢固可靠，术中基本无器械故障发生，二期单个皱褶耗时（30±5．5）min，明显低于一期（45±10．4）min（P〈0．05）。结论助手熟练规范的配合技术对保证ELGP的顺利进行起着重要作用。     

腹腔镜Nissen和Toupet胃底折叠术治疗食管裂孔疝合并胃食管反流病的术后效果评价

目的探讨腹腔镜Nissen和Toupet胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效和术后并发症。 方法回顾性分析2014年7月至2016年7月,在中国医科大学附属盛京医院行腹腔镜下食管裂孔疝修补联合胃底折叠术的57例食管裂孔疝合并胃食管反流病患者的临床资料,其中24例行Nissen胃底折叠术式(Nissen组),33例行Toupet胃底折叠术式(Toupet组)。观察并比较2组患者的术后抗反流效果及发生术后并发症情况。 结果57例均顺利完成腹腔镜下手术,无中转开腹,手术时间68～115 min,平均手术时间(75.8±6.4)min;术中出血量15～30 ml,平均出血量(22±5)ml;2组患者均使用补片行食管裂孔疝修补术;术后24 h进流食,术后平均住院日(10.5±3)d。2组患者手术时间,出血量,住院日无明显差别。57例患者均得到随访,随访时间为6个月至2.5年,平均随访时间为18个月。术后均未出现反酸,烧心等胃食管反流病典型症状,无复发病例。Nissen组术后有2例(8.2%)患者出现吞咽困难,Toupet组术后有8例(24.2%)出现吞咽困难,Toupet组术后并发症发生率明显高于Nissen组。术前伴有胃食管反流病的患者行胃镜检查均有不同程度的食管炎症,所有患者术后均复查胃镜、食管测压及食管24 h pH值监测。复查结果显示,2组患者术后较术前食管下括约肌压力均有明显改善,食管下括约肌长度也均明显延长。 结论腹腔镜下Nissen术式在术后出现吞咽困难发生率上少于Toupet术式,但2种术式抗反流效果无明显差异。     

食管裂孔疝合并胃食管反流病合并胃间质细胞瘤的外科治疗

目的探讨食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者的围手术期处理及安全性。 方法统计新疆维吾尔自治区人民医院2012年10月至2015年1月收治的17例食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者的病案资料,均采用腹腔镜下微创手术,其中单纯食管裂孔疝缝合者13例,生物补片修补者3例,强生PHY补片修补者1例。抗反流术式中行Nissen式胃底折叠术者8例,Dor式胃底折叠术者6例,Toupet式胃底折叠术者3例。病理结果提示极低危险度胃间质细胞瘤8例,低度危险度者4例,中度危险度者3例,高度危险度者1例,极高危险度者1例,回顾性总结分析该类患者围手术期的处理措施。 结果本组患者无围手术期死亡,术后无严重并发症发生,术后患者反流症状均较术前明显改善,反流时间、反流次数、酸反流时间百分比、长反流次数及DeMeester评分较术前明显降低(P<0.05),术后GERD Q量表评分较术前明显减低(P<0.05);LES压力较术前明显提高(P<0.05)。术后切口感染1例,慢性疼痛1例,给予换药、理疗后好转。2例患者术后出现进食哽噎,1例患者术后出现腹泻,嘱其少量多餐、细嚼慢咽,1个月后症状消失。合并贫血患者术后血红蛋白恢复至95 g/L,术后随访中位数10个月,无复发病例。 结论食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者病情较复杂使得手术风险大,难度高,但只要作好充分的术前准备,采用恰当的手术方式,术中谨慎、细致操作,针对性的处理术后出现的各种问题,仍是安全可行的。     

食管测压指导Nissen胃底折叠术31例

目的:评价食管下括约肌压力(LESP)、食管下括约肌总长度(LESL)在Nissen胃底折叠术中的监测价值.方法:2003-2007年利用食管测压指导短松式Nissen手术治疗滑动型食管裂孔疝31例.采用台式高分辨八通道胃肠动力监测系统液导法测定.对患者术前、术中及术后LESP和LESL、术后并发症、手术远期疗效等进行观察记录.结果:术中LESP较术前升高10-12 mmHg.LESL较术前长1-1.5 cm.术后随访2年以上,手术有效率96.5%.全组仅1例24 h pH监测有明显酸反流,但无症状.结论:通过抗反流手术加术中测压,能够更准确判断胃底折叠缝合的松紧程度,有利于避免或减少术后并发症.     

胃食管反流病的内镜治疗进展

胃食管反流病(gastroesophageal reflux disease，GERD)是指胃或十二指肠内容物反流入食管，引起症状或并发症。主要表现为胸骨后痛、烧心、反酸或食物反流；可引起食管糜烂、溃疡、出血、狭窄等，称反流性食管炎。GERD非常常见，西方国家约10％的人患有此病，老年人约1／4患有GERD。我国该病的发病率具体不详，京沪二地调查约6％的人患有GERD。GERD的发病机制尚不完全清楚，一般认为食管下括约肌功能障碍或食管运动减弱，胃肠内容物的化学损伤及食管黏膜防御功能减弱等与其有关。其治疗主要有药物治疗、外科治疗、腹腔镜下治疗及近年开展的胃镜下治疗等。     

内镜下贲门缩窄术治疗胃食管反流病患者的护理体会

目的讨论内镜下贲门缩窄术治疗胃食管反流病（GERD）围手术期的全面护理在临床中的作用。 方法选取郑州大学第一附属医院介入科病房2017年12月至2018年1月共22例GERD患者,12例患者选择胃镜下贲门缩窄手术治疗,10例患者选择腹腔镜下胃底折叠术。分析整个手术前后的全程护理状况并评估其疗效。 结果胃镜下贲门缩窄手术与腹腔镜下胃底折叠术有相同的临床效果,全程护理能改善患者症状,减少副作用的发生。 结论加强内镜下贲门缩窄术围手术期的全程护理是治疗GERD的有效保障。     

聚丙烯补片在腹腔镜下食管裂孔疝修补联合胃底折叠术的临床应用

目的探讨聚丙烯补片在腹腔镜下食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效。 方法回顾性分析新疆维吾尔自治区人民医院2013年5月至2015年3月,住院治疗并使用聚丙烯补片(强生PHY补片)行腹腔镜下食管裂孔疝修补术联合胃底折叠术的38例患者临床资料,总结上述患者术前、术后6个月24 h食管pH监测、高分辨率食管测压、胃食管反流病调查问卷(GERD-Q)量表评分及术后并发症特点。 结果全部患者手术顺利无中转术式等情况,其中Nissen术式27例,Toupet术式8例,Dor术式3例。术后患者反流症状均较术前明显改善,术后反流时间、反流次数、DeMeester评分、GERD-Q量表评分等较术前明显降低,差异有统计学意义(P<0.05),术后出现吞咽困难3例,腹部胀气2例,随访过程中无严重并发症发生,无复发。 结论使用聚丙烯补片行腔镜食管裂孔疝修补联合胃底折叠术是治疗食管裂孔疝的有效方法,具有微创、恢复快、并发症少、复发率低等特点。     

内镜黏膜下剥离术治疗巨大滑动型食管裂孔疝合并难治性胃食管反流病的初步探索（含视频）

目的　初步探讨食管裂孔疝内镜黏膜下剥离术（hiatal hernia?endoscopic submucosal dissection,HH?ESD）治疗巨大食管裂孔疝（长径>3 cm）合并难治性胃食管反流病的安全性和疗效。方法　2018年4月—2020年3月,因巨大食管裂孔疝合并难治性胃食管反流病自愿在内蒙古医科大学附属人民医院消化内镜中心接受HH?ESD治疗患者纳入临床试验,观察手术完成情况和并发症发生情况,并随访观察治疗前后各项指标的变化情况,包括胃食管反流病健康相关生活质量评价（gastroesophageal reflux disease?health related quality of life,GERD?HRQL）评分、胃食管反流病问卷量表（gastroesophageal reflux disease?questionnaire,GERD?Q）评分、胃镜检查结果、24 h食管pH值监测结果、食管高分辨率测压结果和质子泵抑制剂使用情况。结果　研究期间共收集到10例患者,病史2～10年,均顺利完成HH?ESD治疗,术中无穿孔、大出血等不良事件,住院时间6～12 d。术后3例出现吞咽困难,分别于3或6个月内自行缓解。术前GERD?HRQL评分19～29分,术后3和12个月分别为0～14分和0～8分,较术前均有较大幅度下降;术前GERD?Q评分9～17分,术后3和12个月均为6～9分,较术前均有较大幅度下降。胃镜随访提示,10例患者的食管炎较术前均有不同程度好转,疝囊较术前均有不同程度缩小,Hill分级较术前均有不同程度降低。术前DeMeester评分30.3～247.1分,术后12个月时为0.2～29.9分,较术前有较大幅度下降;术前食管裂孔疝长径3.0～6.0 cm,术后12个月时为0～5.0 cm,较术前均有不同程度缩小。随访12个月时,7例已停用质子泵抑制剂,其余3例已改为间断口服。结论　初步结果显示,HH?ESD治疗巨大食管裂孔疝合并难治性胃食管反流病安全、有效。     

胃食管反流性疾病的研究进展

胃食管反流病(GERD)是由于胃、十二指肠内容物反流入食管引起反酸、烧心等症状或组织损害，常合并食管炎。北京、上海两地对5000例18--70岁普通人群的流行病学调查显示^[1、2]，胃食管反流(GER)症状发生率为8．97％，GERD的患病率为5．77％，反流性食管炎(RE)的发生率为1．92％。     

Endoluminal gastroplication for treatment of patients with classic gastroesophageal reflux symptoms and borderline 24-h pH studies

BACKGROUND: Patients with classic gastroesophageal reflux disease (GERD) symptoms and borderline 24-h pH studies are not considered to be good candidates for surgical fundoplication. Endoluminal gastroplication (ELGP) is a new endoscopic treatment for patients with GERD. The aim of this study was to evaluate the efficacy of ELGP in these patients. METHODS: Patients with heartburn, regurgitation symptoms and a DeMeester score of less than 30 were studied. ELGP involved placement of two or three plications within 2 cm of the gastroesophageal junction. Clinical outcomes measured were heartburn symptom score (HSS), regurgitation frequency score (RFS) and medication use. RESULTS: Twenty-five patients (11 M, 14 F, mean age of 51 years) had a medication use of 11.5 doses of proton-pump inhibitors per week prior to ELGP. Average lower esophageal sphincter pressure measured 15 +/- 8 mmHg, and average DeMeester score was 18 +/- 8. Nine patients had hiatal hernias and 11 had esophagitis. Twenty-four patients were available for a mean follow-up of 12 months. HSS significantly decreased from 48 to 17 (P < 0.01) and RFS was reduced from 1.8 to 0.7 (P < 0.01). Proton-pump inhibitor use was 5.3 doses per week (P < 0.01) post-ELGP; 12 patients (50%) were off medications, 3 (13%) had a 50% reduction in medication use, and in 9 (37%) there was no change. Complications were bleeding in one patient and aspiration pneumonia in another patient. CONCLUSIONS: Endoluminal gastroplication provides symptomatic relief for patients with classic GERD symptoms despite medical therapy and borderline 24-h pH studies.     

Endoluminal gastroplication for treatment of patients with classic gastroesophageal reflux symptoms and borderline 24‐h pH studies

Background: Patients with classic gastroesophageal reflux disease (GERD) symptoms and borderline 24‐h pH studies are not considered to be good candidates for surgical fundoplication. Endoluminal gastroplication (ELGP) is a new endoscopic treatment for patients with GERD. The aim of this study was to evaluate the efficacy of ELGP in these patients. Methods: Patients with heartburn, regurgitation symptoms and a DeMeester score of less than 30 were studied. ELGP involved placement of two or three plications within 2?cm of the gastroesophageal junction. Clinical outcomes measured were heartburn symptom score (HSS), regurgitation frequency score (RFS) and medication use. Results: Twenty‐five patients (11 M, 14 F, mean age of 51 years) had a medication use of 11.5 doses of proton‐pump inhibitors per week prior to ELGP. Average lower esophageal sphincter pressure measured 15?±?8?mmHg, and average DeMeester score was 18?±?8. Nine patients had hiatal hernias and 11 had esophagitis. Twenty‐four patients were available for a mean follow‐up of 12 months. HSS significantly decreased from 48 to 17 (P?P?P?Conclusions: Endoluminal gastroplication provides symptomatic relief for patients with classic GERD symptoms despite medical therapy and borderline 24‐h pH studies.     

Extraesophageal gastroesophageal reflux disease. Presentations and approach to treatment

Prevalence of gastroesophageal reflux disease (GERD) is common in the adult US population, but likely is underestimated as many patients present with symptoms other than heartburn or regurgitation. Ears, nose, throat, pulmonary, and cardiac symptoms also frequently are related to GERD. The diagnosis of GERD as a cause of these symptoms can be difficult and treatment strategies are much less clear than in patients presenting with heartburn or regurgitation. This article discusses the epidemiology, pathogenesis, diagnosis, and treatment of some of the manifestations of extraesophageal reflux disease.     

Is the severity of gastroesophageal reflux dependent on hiatus hernia size?

AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small(n = 25), medium(n = 25) or large(n = 25) hiatus hernia(assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain. RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm(P < 0.002), and the group with a hernia of 3 to < 5 cm(P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups. CONCLUSION: Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.     

Short-term and long-term outcome of endoluminal gastroplication for the treatment of GERD: the first multicenter trial in Japan

Purpose  Endoluminal gastroplication (ELGP) was the first endoscopic therapy for gastroesophageal reflux disease (GERD). Data on the long-term outcomes, including the plication status and data from Asian populations, are limited. The aim of this study was to evaluate the short-term and long-term effectiveness and safety of ELGP for GERD in the Japanese population. Methods  This was an open-label, prospective, multicenter trial of ELGP. Forty-eight patients with GERD were enrolled. The procedure involved placing circumferential plications 1–2 cm below the GE junction using the EndoCinch system. Outcome measurements were improvement of heartburn, medication use, endoscopic Los Angeles grade, durability of plications, 24-h esophageal acid exposure, esophageal manometry, and frequency of adverse events. Results  During the 24-month follow-up, the rate of complete resolution of heartburn ranged from 54 to 66%, the rate of discontinuation or reduction of PPI/H₂RA use ranged from 65 to 76%, and the rate of endoscopic classification to grade O ranged from 66 to 81%. The status with more than one plication remaining was associated with higher rates of improvement of heartburn, PPI/H₂RA use, and endoscopic findings as compared with those associated with the loss of all plications. A modest decrease of the esophageal acid exposure level, but no change of the manometric parameters, was observed after ELGP. No serious adverse events were observed. Conclusions  In this 24-month follow-up study conducted in Japanese subjects, ELGP was found to be effective in about 60% of patients with GERD, and the procedure was safe.     

Extraesophageal gastroesophageal reflux disease (GERD) symptoms are not more frequently associated with proximal esophageal reflux than typical GERD symptoms

Extraesophageal (EE) symptoms such as cough and throat clearing are common in patients referred for reflux testing, but are less commonly associated with gastroesophageal reflux disease (GERD). Patients with reflux associated EE symptoms often lack typical GERD symptoms of heartburn and regurgitation. Our aim was to compare the frequency of proximal esophageal reflux between esophageal (typical) symptoms and EE (atypical) symptoms. Combined multichannel intraluminal impedance‐pH (MII‐pH) tracings were blinded by an investigator so that symptom markers were relabeled with a number without disclosure of symptom type. We selected 40 patients with at least five reflux‐related symptom events for one of four symptoms (heartburn, regurgitation, cough, or throat clearing). A blinded investigator analyzed all 200 reflux episodes, reporting the proximal esophageal extent of the reflux for all symptoms. The percentage of symptom‐related reflux extending proximally to 17 cm above the LES was similar among all four symptom types. At least 50% of all symptoms were associated with proximal esophageal reflux to 17 cm, with regurgitation having the highest frequency at 60%. Our data indicate that EE symptoms are not more frequently associated with proximal esophageal reflux than typical esophageal symptoms.     

Endoluminal gastroplication for the treatment of gastroesophageal reflux disease: a 2-year prospective pilot study from Taiwan

Background and Aim: Endoluminal gastroplication (ELGP) offers a minimally invasive option for the treatment of gastroesophageal reflux disease (GERD) in Western countries. However, long‐term outcomes of ELGP in Asian populations have not been investigated. The aim of this prospective study was to evaluate the long‐term benefits of ELGP in Asian patients with GERD. Methods: Taiwanese patients diagnosed with GERD were enrolled and had the procedure performed with EndoCinch. The assessment included symptom scoring, validated GERD questionnaires, esophagogastroduodenoscopy, esophageal manometry and 24‐h pH monitoring before and after the procedure over a 2‐year period. Results: Twenty‐one consecutive patients were recruited and underwent ELGP. Patients reported improved heartburn symptom score (mean 64.0 vs 21.1, P < 0.001), regurgitation frequency score (mean 2.4 vs 1.3, P < 0.001), and GERD health‐related quality of life (mean 23.1 vs 10.1, P < 0.001) at 24 months. The mean total time of pH < 4 reduced from 121.7 min to 67.1 min (P = 0.008) and mean DeMeester score reduced from 32.9 to 17.6 (P = 0.011) at 3 months. Antisecretory drug discontinuation rate was 81%, 57%, 52% and 48% at 1, 6, 12 and 24 months, respectively. Of the patients who had a favorable initial response to ELGP at 1 month, 41% resumed antisecretory medications at 24 months follow‐up. All adverse events were mild and transient. Conclusions: Endoluminal gastroplication is a safe and modestly effective endotherapy for patients with GERD. It significantly improved symptoms in an Asian population. Approximately one in two patients continues to be off medication at 24 months follow‐up. However, the long‐term efficacy and durability are still to be determined.     

Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study

BACKGROUND: Overweight and obesity are believed to be risk factors for gastroesophageal reflux disease (GERD). The aim of the present study was to analyze the impact of body mass index (BMI) on the severity and frequency of reflux symptoms and esophagitis in a large cohort of reflux patients. METHODS: As part of the Progression of Gastroesophageal Reflux Disease (ProGERD) study, 6215 patients with clinically assessed GERD were included in the present investigation (53% male, 52 +/- 14 years; 47% female, 56 +/- 14 years). Heartburn and regurgitation symptoms were assessed using the validated Reflux Disease Questionnaire. Endoscopies were performed and patients were subsequently classified as having non-erosive or erosive disease. To examine the association between BMI, GERD symptoms, and esophagitis, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression models. RESULTS: In patients with GERD, higher BMI was associated with more frequent and more severe heartburn and regurgitation, as well as with esophagitis. The effects were more pronounced for regurgitation than for heartburn. The strongest association was between obesity and severity of regurgitation symptoms (women: OR 2.11, 95%CI 1.60-2.77; men: OR 2.15, 95%CI 1.59-2.90). Obese women, but not men, had an increased risk of severe esophagitis compared to women with normal weight (OR 2.51, 95%CI 1.53-4.12). CONCLUSIONS: In patients with GERD, higher BMI was associated with more severe and more frequent reflux symptoms and esophagitis.     

多中心临床观察雷贝拉唑联合多潘立酮治疗胃食管反流病的症状缓解情况

目的 观察雷贝拉唑联合多潘立酮治疗胃食管反流病(GERD)的临床疗效.方法 采用多中心、随机、开放、观察性研究方法,将收集的130例GERD门诊患者随机分为观察组(雷贝拉唑联合多潘立酮)64例和对照组(单用雷贝拉唑)66例,以胃食管反流病诊断问卷(GERD Q量表)和一般资料调查方式进行症状评分,症状评分根据烧心、反流、上腹痛等发生的频率和程度.随访4周,比较治疗后2周末和4周末两组患者症状的改善情况.结果 治疗前观察组和对照组GERD Q评分值基线一致,治疗2周末,两组GERD症状GERD Q评分值均有明显下降,分别为8.45±2.53和9.17±2.42;治疗4周末疗效更明显,分别为6.03±1.54和6.70±1.78;治疗前后差异有统计学意义(t=16.113,t=14.149;P值均＜0.01).观察组在治疗2周和4周末GERD Q分值较对照组下降更快,差异有统计学意义(t=-1.658,P=0.050;t=-2.292,P=0.012).观察组和对照组治疗2周后GERD症状分值均明显下降(t=2.006,P=0.047),4周后反流症状分值有明显下降,差异有统计学意义(t=2.287,P=o.022).治疗2周末观察组烧心和反流症状总有效率为79.0％和73.0％,对照组为67.7％和69.7％,观察组优于对照组;但治疗4周末观察组和对照组总有效率相似.结论雷贝拉唑联合多潘立酮能更快缓解GERD烧心和反流症状.     

Refractory Heartburn: A Challenging Problem in Clinical Practice

Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Heartburn and regurgitation are the typical symptoms of GERD. The treatment of GERD encompasses lifestyle modifications, pharmacological, endoscopic, and surgical therapy. The majority of the patients respond to 4–8 weeks of proton-pump inhibitors therapy, but 20–42% will demonstrate partial or complete lack of response to treatment. While these patients have been considered as having refractory heartburn, a subset of them does not have GERD or have not been adequately treated. The main causes of refractory heartburn include: poor compliance; inadequate proton-pump inhibitors dosage; incorrect diagnosis; comorbidities; genotypic differences; residual gastroesophageal reflux; eosinophilic esophagitis and others. Treatment is commonly directed toward the underlying cause of patients’ refractory heartburn.