联合食管多通道腔内阻抗-pH监测在诊断胃食管反流病中的价值

目的 了解联合食管多通道腔内阻抗pH(MII-pH)监测诊断胃食管反流病(GERD)的价值.方法 纳入具有烧心症状且食管黏膜无损伤患者44例,首先行MII-pH监测,然后行14 d的雷贝拉唑试验(试验结束时烧心症状完全消失定义为雷贝拉唑试验阳性).70名健康志愿者行MII-pH监测的结果作为正常值进行参照.结果 根据食管pH监测存在异常食管酸暴露或酸反流症状指数(SI)阳性者20例(45.4%).MII-pH监测提示弱酸反流SI阳性者2例,据此检查诊断烧心患者GERD的比例增至50%(22/44).雷贝拉唑试验阳性4例,据此则将烧心患者诊断为GERD的比例增至54.5%(24/44).结论 联合食管MII-pH监测可增加GERD检出率.     

雷贝拉唑试验对胃食管反流病的诊断价值

目的 :探讨质子泵抑制剂雷贝拉唑试验对胃食管反流病 (GERD)的诊断价值。方法 :根据临床反流症状、食管 2 4hpH监测以及胃镜检查结果 ,将 93例有反流症状的病人 (78例GERD病人和 1 5例非GERD病人 )随机分为试验组 (雷贝拉唑组 ,45例 )和对照组(安慰剂组 ,48例 )。试验组用雷贝拉唑 2 0mg/d ;对照组用维生素B1 口服 ,2 0mg/d。两组均用药 2周 ,记录服药前后病人烧心、反酸、胸骨后灼痛症状积分的改变 ,按症状积分下降值判定诊断 ,与食管 2 4hpH监测以及胃镜检查结果对比分析。结果 :试验组的GERD病人服药后 5d、7d、2周症状积分下降值分别为 5 .4± 3 .7、7.1± 5 .3、9.8± 6.4,下降率分别为 34.7%、46 .3%、62 .6 %。以症状下降 3分为标准 ,雷贝拉唑试验诊断GERD的价值最佳 ,对服药时间分析 ,则以服雷贝拉唑 5d为佳。结论 :雷贝拉唑治疗试验是GERD临床诊断的一种简单、可靠的方法     

GERD患者夜间反流特点及其影响因素

背景:夜间胃食管反流(nGER)与胃食管反流病(GERD)的严重并发症,如食管炎、食管狭窄、Barrett食管等具有相关性,并可对患者的生活质量造成一定的影响。目的:探讨GERD患者nGER特点及其影响因素。方法:纳入具有典型烧心、反流症状且食管MII-pH监测提示有nGER的GERD患者,分析性别、年龄、BMI和DBI对nGER的影响。结果:130例GERD患者中,97例(74.6%)MII-pH监测提示具有客观的nGER,其中仅18例(18.6%)具有主观的夜间烧心或反流症状。女性GERD患者和老年GERD患者的食管容量清除能力显著减弱。肥胖GERD患者的夜间pH4反流时间百分比、反流周期数均显著高于正常体重GERD患者。DBI≥2.5 h可显著降低GERD患者的夜间酸反流。随着DBI的延长,夜间食管弱酸反流可进一步降低。结论:GERD患者中普遍存在nGER,且以弱酸反流较多,但患者主观症状较少见;女性和高龄GERD患者的夜间食管容量清除能力降低;BMI≥25 kg/m2可促进nGER的发生;DBI≥2.5 h即可显著降低GERD患者的夜间酸反流指标,但以夜间弱酸反流为主的患者,需尽可能延长DBI。     

食管pH和胆汁监测用于十二指肠胃食管反流的诊断及对治疗的评价

目的探讨十二指肠胃食管反流(DGER)的诊断方法和胆汁反流在胃食管反流病(GERD)中的临床意义.方法用便携式pH监测仪及胆红素监测仪(Bilitec 2000)对20例健康人及52例有烧心、反酸等症状的患者行24 h食管腔内pH和胆红素同步监测,以光吸收值≥0.14作为发生胆汁反流的阈值,计算24 h反流总时间%等指标.并对15例酸和胆汁混合反流者用铝碳酸镁加西沙必利治疗4周,然后复查两项监测.结果20例健康人中未发现病理性酸反流,52例患者中有47例(包括食管炎12例)存在病理性酸反流,诊为GERD.胆汁反流总时间%在健康人组及反流症状组分别为(0.47±0.71)%及(2.67±3.23)%(P＜0.05),在食管炎及非食管炎者分别为(5.41±4.93)%及(1.68±1.76)%(P＜0.05).47例GERD中15例(32%)为酸及胆汁混合反流,另32例为单纯酸反流,前者有食管炎8例而后者仅为4例(P＜0.05).15例混合反流经治疗后酸和胆汁反流总时间%均明显降低,8例食管炎中有7例炎症消退,1例减轻.结论Bilitec 2000是评价DGER的有用工具,32%的GERD存在酸和胆汁混合反流;胆汁反流在GERD食管黏膜损害中起重要作用.     

胃食管反流病中非酸反流的比例及其与烧心的关系

目的 应用食管联合阻抗-pH监测技术探讨胃食管反流病中非酸反流的比例及其与烧心的相关程度.方法 选取消化专科门诊以烧心为主诉的连续病例,通过上消化道内镜将上述患者分为糜烂性食管炎(EE)组和非糜烂性反流病(NERD)组,并进一步通过24 h食管多通道腔内阻抗-pH监测及雷贝拉唑试验性治疗予以确诊.比较两组的联合阻抗-pH监测指标.结果 EE组36例,NERD组62例.两组患者酸反流次数、酸反流时间百分比差异有统计学意义(P值分别=0.001和0.002).EE组和NERD组中非酸反流次数的百分比分别为37.3%(663/1777)和44.3%(1220/2754),差异有统计学意义(x=21.723,P=0.000).EE组酸反流烧心症状指数阳性、非酸反流烧心症状指数阳性及总反流烧心症状指数阳性的百分比分别为36.1%(13/36)、19.4%(7/36)和55.6%(20/36),NERD组则为27.4%(17/62)、6.4%(4/62)和33.8%(21/62).结论 EE组和NERD组患者中非酸反流次数的比例分别为37.3%及44.3%,非酸反流与烧心关系密切.     

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。     

问询表诊断老年人胃食管反流病的临床评价

目的探讨问询表调查在我国诊断老年胃食管反流病( GERD)的临床价值. 方法选取有烧心,反酸,胸痛等症状,且连续发作一周以上的老年患者.进行胃镜检查,胃镜阳性者归入反流性食管炎组( RE组),胃镜阴性者进一步行食道测压及 24小时胃食管 pH监测,根据结果分为非糜烂性胃食管反流病组( NERD组)和正常对照组( Normal组).所有患者均填写 Carlsson- Dent自我症状问询表并给予 PPI试验一周,以胃镜及 24小时胃食管 pH监测阳性为 GERD确诊标准,统计问询表诊断胃食管反流病的敏感性、特异性和准确率. 结果共 78例老年患者入选,经检查分为 RE组 21例、 NERD组 31例和正常对照组 26例.三组的问询表得分分别为 5.86± 2.90、 5.00± 3.14和 3.69± 1.57, RE组和 NERD组得分与 Normal组比较有显著差异( P< 0.05); RE组和 NERD组比较无明显差异.以 4分为临界值, Carlsson- Dent问卷诊断胃食管反流病的敏感性为 69.23%、特异性为 38.46%、准确率为 58.97%; PPI抑制试验结合 Carlsson- Dent问卷诊断胃食管反流病的敏感性为 88.46%、特异性为 26.92%、准确率为 67.94%. 结论 Carlsson- Dent问卷可用于筛选老年 GERD,结合 PPI试验可提高诊断的敏感性.     

Barrett食管、反流性食管炎和非糜烂性胃食管反流病的反流物特点

目的应用食管24 h pH-阻抗(MII-pH)等检查方法,分析具有胃食管反流病(GERD)典型症状、并且食管MII-pH检查结果异常的GERD患者,比较分析其各亚型,即Barrett食管(BE)、反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者的胃食管反流特点。 方法入选具有典型胃食管反流症状(烧心/反流),并且食管24 h MII-pH检查结果异常的GERD患者,根据内镜检查结果分为BE、RE、NERD三组,收集患者24 h的食管pH-阻抗信息,应用SPSS16.0统计软件进行组间Mann Whitney检验、多因素方差分析,P< 0.05认为具有统计学差异。 结果共入组103例具有典型反流症状且MII-pH监测阳性的GERD患者,其中有15例BE患者、32例RE患者、56例NERD患者。三组患者的平均年龄、性别构成、以及BMI无显著差异性。将三组患者的各项胃食管反流指标数值进行Mann-Whitney检验,显示RE、BE患者的DeMeester评分、pH<4反流时间百分比、长反流周期数显著高于NERD患者,具有显著性差异。BE患者的反流周期数显著多于RE和NERD患者,具有显著性差异。阻抗相关指标在三组患者之间均没有统计学差异。 结论与NERD相比,酸反流对于RE和BE具有更重要的致病意义。     

胃食管反流病问卷评分对胃食管反流病患者食管酸暴露的预测意义

目的 确定胃食管反流病问卷(GerdQ)症状评分能否反映胃食管反流病(GERD)患者由24 h食管动态pH监测显示的酸暴露情况,进一步验证GerdQ的临床应用价值.方法 纳入2008年11月至2010年3月因烧心等上消化道症状就诊的门诊GERD病例134例,均完成胃镜检查、24 h食管动态pH监测和GerdQ量表.根据...     

非糜烂性胃食管反流病食管酸暴露和雷贝拉唑对其诊断价值研究

目的 研究非糜烂性胃食管反流病（NERD）各亚型食管酸暴露特点,探讨雷贝拉唑对其诊断价值。方法 32例NERD患者分成3组,异常酸反流组14例,食管对酸高敏组11例,功能性烧心组7例,并以雷贝拉唑10mg,2次／d治疗2周。结果 （1）各组酸暴露：异常酸反流组酸反流总次数、长反流次数、pH〈4时间及其百分比较其他两组明显增加;食管对酸高敏组症状指数显著高于功能性烧心组[（81．0±22．5）％比（8．6±14．8）％,P〈0．01]。（2）症状比较：各组间治疗前典型症状积分和总积分相比差异均无统计学意义;食管对酸高敏组患者食管外症状积分显著高于异常酸反流组患者（4．0±3．8比0．9±2．2,P〈0．05）。（3）疗效：异常酸反流组、食管对酸高敏组患者在雷贝拉唑治疗1、2周后均有食管外症状积分、总积分的显著下降;而功能性烧心组患者仅有下降趋势,与治疗前比较差异无统计学意义;异常酸反流组与其他两组治疗后2周比较,症状积分差异有统计学意义。（4）雷贝拉唑对NERD患者1、2周治疗后总体有效率分别为56．3％、68．8％;雷贝拉唑诊断试验对异常酸反流和食管酸高敏的敏感性和特异性,在1周时分别为64．0％、71．4％,在2周时分别为80．0％、71．4％。结论 （1）异常酸反流组酸暴露主要表现在酸反流的总次数、长反流次数增多,pH〈4时间延长。（2）食管对酸高敏患者可能更易发生食管外症状。（3）雷贝拉唑诊断试验对NERD有较好的诊断和分型价值。     

Reflux profile of Chinese gastroesophageal reflux disease patients with combined multichannel intraluminal impedance-pH monitoring

Background and Aims:  To investigate the reflux profile of Chinese gastroesophageal reflux disease (GERD) patients with the aid of combined multichannel intraluminal impedance-pH (MII-pH) monitoring technique.
Methods:  Consecutive patients presented with GERD symptoms were enrolled to erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group and functional heartburn (FH) group after upper endoscopy, combined MII-pH monitoring and rabeprazole test. Another 20 healthy controls (HC) were recruited.
Results:  Sixty-four GERD patients (EE:20, NERD:22, FH:22, HC:20) were enrolled. There were more episodes of liquid reflux and proximal reflux in EE and NERD groups than that in FH and HC groups ( P  < 0.05). Patients in FH and HC groups had higher proportion of mixed reflux ( P  = 0.000). The percentage of acid reflux in EE and NERD was much higher, while there was a higher percentage of weakly acidic reflux in FH and HC ( P  = 0.000). No significant difference was found in MII-pH parameters between groups with and without response to rabeprazole test except recumbent percentage time of esophageal pH value below 4 and episodes of proximal reflux.
Conclusion:  Erosive esophagitis and NERD patients had more liquid and proximal reflux episodes than FH patients and healthy controls. Acid and liquid reflux was predominant in the former two groups, while weakly acidic and mixed reflux was predominant in the latter two groups.     

反流性疾病问卷在胃食管反流病诊断中的价值

目的 探讨以反流症状为主的问卷调查(RDQ)在诊断胃食管反流病(GERD)中的价值。方法 上海、北京等10家医院多中心研究，对128例有烧心、胸骨后疼痛、反酸、反食等四种消化道症状的患者，按症状程度与发作频率为记分标准(5级记分制)，最高分可达40分，取症状6分以上为人选患者，以内镜检查有否反流性食管炎(RE)及24h食管pH检测为诊断(3ERE)的金标准，并与RDQ分值进行比较，计算出诊断GERD的临界值。结果 RDQ分值与RE严重程度呈正相关，食管pH检测异常组DeMeester积分显著高于正常组(20．18／16．84)。以RDQ分值12为临界值，Youden指数最大，ROC曲线下面积(Az)为0．71，对GERD诊断阳性符合率达88．07％，阴性符合率为68．42％，敏感度为94．12％，特异度为50．00％。结论 RDQ调查是诊断GERD的一个良好的筛选试验。     

埃索美拉唑诊断性试验对胃食管反流病诊断价值的随机、双盲、多中心研究

目的 探讨埃索美拉唑诊断性试验对胃食管反流病(GERD)的诊断价值.方法 采用随机、双盲、多中心临床研究.选择三家消化专科治疗中心门诊有烧心或(和)反酸症状的患者作为研究对象.先行胃镜检查,将入选患者分为反流性食管炎和非糜烂性反流病,所有患者均行24 h食管pH监测,以内镜下显示反流性食管炎和(或)24 h pH监测阳性诊断为GERD.采用随机方法分别将入选患者分成治疗组和对照组,治疗组予埃索美拉唑40 mg,每天1次,对照组予安慰剂治疗,疗程均为2周.治疗前及治疗过程中,患者和医师记录烧心程度和频率.结果 完成研究者共217例(治疗组105例,对照组112例).治疗组和对照组第1周的第6、7天无症状及第2周症状完全消失比例分别为76.2%和7.1%(χ2=107.175,P=0.000),73.3%和4.5%(χ2=109.337,P=0.000).以第1周的第6、7天无症状作为埃索美拉唑诊断性试验阳性标准,治疗组的敏感性和特异性分别为87.7%和42.5%;以第2周症状完全消失作为埃索美拉唑诊断性试验阳性标准,治疗组的敏感性和特异性分别为84.6%和45.0%;以上两种判断方法的Youden指数分别为0.362和0.296.分别以症状下降至治疗前的50%、75%及100%为阳性判断标准的敏感性和特异性,分别为95.4%和32.5%,87.7%和32.5%,84.6%和45.0%.结论 埃索美拉唑诊断性试验诊断GERD的敏感性和特异性达87.7%和42.5%,对GERD诊断价值高;疗程7 d,以第6、7天无症状作为判断方法更符合经济成本-效益的原则.     

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE).RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m². All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P < 0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extra-esophageal symptoms (P < 0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively).CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.     

Esophageal Motility in Nonacid Reflux Compared with Acid Reflux

Esophageal motility has been well studied in gastroesophageal reflux disease (GERD) and acid reflux, but not in nonacid reflux. Consecutive patients who had both 24-h multichannel intraluminal impedance-pH (MII-pH) and esophageal motility tests for suspected GERD were studied. Patients were grouped into nonacid refluxers, acid refluxers, and nonrefluxers based on positive symptom correlation and objective findings of acid reflux. Of 96 patients enrolled, 21 patients (22%) were nonacid refluxers, 44 patients (46%) were acid refluxers, and 31 patients (32%) had no objective evidence of reflux. Normal motility was recorded in 86% of nonacid refluxers, 71% of acid refluxers, and 60% of nonrefluxers. Ineffective esophageal motility was seen in 24% of acid refluxers, and 5% of nonacid refluxers (P = 0.11). Symptomatic nonacid reflux events comprised 22% of patients studied for GERD symptoms by MII-pH. Esophageal motility in nonacid reflux is normal 86% of the time.     

Impact of 24-h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: defining the gold standard

BACKGROUND AND AIMS: The tests that are currently available for the diagnosis of gastroesophageal reflux disease (GERD) lack the desired diagnostic accuracy. To date, only pH monitoring has been shown to have a good sensitivity and specificity, but recent studies have failed to confirm this. Thus there is a need to find a test with acceptable sensitivity and specificity for diagnosing GERD. The present study aimed to find a single test or a combination of tests that could serve as a gold standard for the diagnosis of GERD and to identify an evidence-based diagnostic work-up for GERD in clinical and research settings. METHODS: A prospectively conducted masked study was carried out in which 109 GERD patients were recruited on the basis of symptom score evaluation (heartburn and/or regurgitation). After informed consent was given, the patients underwent various tests, including esophagogastroduodenoscopy with biopsy from the lower esophageal mucosa during the first visit, followed by omeprazole challenge test (OCT), radionuclide scintigraphy, barium swallow and finally 24-h esophageal pH monitoring. A positive concordance of three or more tests was taken as the gold standard. RESULTS: The results of all six tests were available for 70 patients. As a single diagnostic test, pH testing had the best combination of sensitivity and specificity (Youden's J = 0.69). Even in cases of endoscopy-negative reflux disease, pH monitoring was the most sensitive and specific test (93.3% and 90.4%, respectively; J = 0.83). OCT, endoscopy and histopathology also had good sensitivity (84.4%, 64.4%, 82.2%, respectively). A combination of OCT, endoscopy and histopathology achieved a sensitivity of 100%. CONCLUSIONS: A combination of OCT, endoscopy and histology will identify all cases of GERD. As these investigations are easily available, they should form the diagnostic work-up in clinical situations. 24-h esophageal pH testing, despite being the gold standard, has no utility in routine clinical settings and hence its availability should be limited to tertiary care settings.     

To Bravo or not? A comparison of wireless esophageal pH monitoring and conventional pH catheter to evaluate non-erosive gastroesophageal reflux disease in a multiracial Asian cohort

OBJECTIVE: Non-erosive reflux disease (NERD) constitutes the majority of patients with gastroesophageal reflux disease (GERD). Esophageal pH monitoring is useful in distinguishing patients with NERD from functional heartburn. The gastroenterologist often faces the dilemma of choosing the most appropriate investigative modality. The wireless Bravo® capsule allows prolonged 48 hour monitoring with improved patient tolerance, but concerns regarding its reduced sensitivity compared to conventional pH catheter have been raised. We compared the prevalence of high esophageal acid exposure and positive symptom correlation profiles (using the symptom index [SI] and symptom association probability [SAP]) in patients who underwent Bravo® compared to patients who underwent conventional pH catheter, and evaluated the efficacy of Bravo® monitoring in a multiracial Asian cohort. METHODS: Retrospective analysis of all pH studies performed between January 2004 and February 2009 for patients with persistent reflux symptoms and a normal gastroscopy. RESULTS: 66 (27 Male, 42.4 ± 13.4 years) and 55 (24 Male, 47.1 ± 13.3 years) patients underwent wireless and pH catheter evaluation respectively. “True NERD” (abnormal acid exposure) was diagnosed in 26 (39.4%) and 20 (36.4%) patients (pNS) while “acid-sensitive esophagus” (SI ≥ 50% and/or SAP ≥ 95%) occurred in 14 (21.2%) and 12 (21.8%) patients (pNS) using the wireless and pH catheter respectively. Extended recording time with Bravo® led to an incremental diagnostic yield of 30%. CONCLUSION: The wireless capsule was well tolerated. The diagnostic yield was similar using both modalities. With the increasing availability of impedance-pH technology, it is uncertain if devices that detect only acid-reflux events will be surpassed.