胃食管反流病食管黏膜损伤程度的影响因素

目的探讨胃食管反流病（gastroesophageal reflux disease，GERD）患者中，影响食管黏膜损伤严重程度的因素。方法将消化专科门诊具有典型反流症状，并经24h食管pH监测异常或（和）胃镜检查证实的GERD患者，分为非糜烂性反流病组、轻度糜烂性食管炎组和重度糜烂性食管炎组。比较3组患者一般情况和食管pH监测指标。用logistic回归分析年龄、性别、食管裂孔疝、烟酒嗜好、幽门螺杆菌感染和食管酸暴露程度对食管损伤严重程度的影响。结果共有156例患者纳入本次研究，其中非糜烂性反流病组83例，轻度糜烂性食管炎组51例，重度糜烂性食管炎组22例。重度糜烂性食管炎组患者的平均年龄和合并食管裂孔疝比例显著高于轻度糜烂性食管炎组和非糜烂性反流病组（P〈0．05）。食管pH监测指标中卧位长反流次数在严重的食管黏膜损伤患者中显著增加（P〈0.05）。食管裂孔疝是食管黏膜损伤程度的独立相关因素（OR=15．032，95％CI：3．767-22．723，P〈0．01）。结论GERD患者中高龄、男性、合并食管裂孔疝和卧位反流增加的患者中严重的食管黏膜损伤更加常见，食管裂孔疝在食管黏膜损伤的进展过程中起着重要作用。     

酸反流与胆汁反流在胃食管反流病中的作用

目的探讨酸反流与胆汁反流在胃食管反流病(GERD)中的作用及相互关系.方法46例GERD患者(反流性食管炎组30例,胃镜阴性组16例)及26例健康对照者在完成食管测压后,应用便携式食管pH监测仪及Bilitec2000胆汁反流监测仪,同时进行24h食管内酸及胆汁反流的动态连续监测.结果GERD患者酸反流及胆汁反流各指标均明显高于健康对照者,且与食管炎严重程度一致.pH＜4总时间百分比与胆红素光吸收值(Abs)＞0.14,总时间百分比存在线性相关关系(r=0.34,P＜0.01).酸反流和胆汁反流共存的双重反流在GERD患者中最为常见,且较单纯反流更易引起严重食管炎.结论GERD患者中较为常见的双重反流对食管粘膜的损伤作用强于单纯酸或胆汁的不完全反流,酸反流与胆汁反流间可能有正性协同作用;联合应用胃镜检查及食管内酸和胆汁反流监测将为GERD的诊治提供可靠的客观依据.     

夜间酸突破现象与胃食管反流病

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导致的一系列慢性症状和食管黏膜损伤，包括非糜烂性反流性食管病(non—erosive reflx disease，NERD)和传统意义上的反流性食管炎(reflux esophagitis，RE)及其并发症如食管狭窄、食管溃疡和Barrett食管等。     

21世纪的常见病:胃食管反流病

胃食管反流病(gastroesophageal reflux disease,GERD)是指胃食管反流所致的烧心、反酸症状或食管下段组织病理学改变。糜烂性食管炎(erosive esophagitis,EE)是GERD的一个亚组,内镜下可见食管黏膜破损(参考1994年洛杉矶反流性食管炎的内镜分类)。如胃食管反流引起烧心、反酸症状,但内镜下无食管黏膜破损,而24hpH监测显示食管有异常酸暴露,这一GERD亚组称为内镜阴性反流病(endoscopic negative re-     

胃十二指肠混合反流在食管黏膜损伤中的作用

胃食管反流病 (GERD)临床常见。研究表明 ,近 5 0 %有反流症状的患者有食管黏膜损伤即反流性食管炎 (RE)。胃酸能导致食管炎 ,但十二指肠胃食管反流 (DGER)在食管黏膜损伤中的作用尚存有争议[1] 。本文对有典型胃食管反流症状伴食管黏膜损伤和无食管黏膜损伤的患者进行同步食管 2 4hpH及胆汁监测。旨在了解混合反流在食管黏膜损伤中的作用。一、对象与方法1.对象 :正常对照组 10例 ,无任何胃食管反流症状 ,上消化道内镜检查无异常发现。 4 3例有典型胃食管反流症状(烧心或反食或两者并存 )患者 ,根据内镜检查结果和LA内镜下食管炎的分…     

胃食管反流性疾病的研究回顾

0 引言胃食管反流性疾病(gastroesophageal reflux disease,GERD)常见.据近年对北京、上海成人的调查资料统计,GERD 的患病率为5.77%,反流性食管炎(reflux esophagitis,RE)的患病率接近2%.广义的 GERD 主要包括十二指肠胃反流(duodenogastricreflux,DGR),胃食管反流(gastro-oesophageal reflux,GOR)和十二指肠胃食管反流(duodenogastro-oesophageal reflux,DGOR).     

Barrett's食管、糜烂性食管炎及非糜烂性反流病发生机制的比较

目的:比较糜烂性食管炎(EE)、非糜烂性反流病(NERD)及Barrett's食管(BE)患者反流发生特点,探讨不同类型GERD的可能发病机制.方法:105例GERD患者根据胃镜及病理情况分为:EE组(35例)、BE组(34例)及NERD组(36例),对照组30例为健康志愿者.比较4组受检者食管测压与24 h食管pHT及胆汁反流同步监测结果的差异.结果:与对照组相比,GERD各组LES静息压均有不同程度减低,以EE组最明显(P<0.05).EE与BE组患者远段食管收缩波幅及有效蠕动百分比明显低于NERD组与对照组(均P<0.05).DeMeester评分等酸反流指标在EE组最高.BE组Abs>0.14时间百分比等长时间胆汁反流指标最高.NERD患者中仅52.8%存在病理性反流.各组中混合反流类型占各组病理性反流总人数的比例分别为68.57%(EE组)、84.38%(BE组)及63.15%(NERD组).结论:胃酸与胆汁的混合反流是GERD患者中最常见病理性反流类型,且对食管黏膜的损害较单纯酸或胆汁反流为重,胆汁反流在BE的发病机制中占有重要地位.     

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。     

病证结合确立胃食管反流病中医辨证分型标准的思考

胃内容物（包括十二指肠液）反流入食管产生症状或并发症时，称为胃食管反流病（gastroesophageal reflux disease，GERD）。酸（碱）反流导致的食管黏膜破损称为反流性食管炎（reflux esophagitis，RE）。GERD广义地包括了食管黏膜破损或无破损，因此，可分为内镜阳性GERD和内镜阴性GERD即非糜烂性反流病（Non-erosive reflux disease，NERD）。     

胃食管反流病的症状诊断

胃食管反流病(gastroesophageal reflux disease.GERD)是常见病.在西方人群,每周出现烧心和/或反酸等胃食管反流症状者高达20%[1].近年来,GERD在亚洲的发病率呈上升趋势[2],我国部分地区胃食管反流症状的发生率也高达10%以上.     

Associations among gastroesophageal reflux disease,psychological stress,and sleep disturbances in Japanese adults

Background and aim: Gastroesophageal reflux disease (GERD) and psychological stress are associated with sleep disturbances. The aim of the present study was to examine the prevalence of sleep disturbances, anxiety, and depression by GERD subtypes and to identify factors associated with sleep disturbances in general population.

Methods: A total of 2002 Japanese subjects, who underwent annual health checkups, were enrolled and asked to fill out a questionnaire, including the frequency scale for the symptoms of GERD (FSSG), Athens Insomnia Scale (AIS), Rome III questionnaire, and Hospital Anxiety and Depression Scale (HADS). GERD was divided into asymptomatic erosive reflux disease (a-ERD), symptomatic ERD (s-ERD), and non-erosive reflux disease (NERD), according to the presence or absence of esophageal mucosal injury on endoscopy, and the FSSG scores. Sleep disturbances were diagnosed in subjects with AIS score ≥6.

Results: Prevalence of sleep disturbances was significantly higher in GERD subjects than in controls (35.9 and 14.7%, respectively), especially, in the NERD group (45.1%). Sleep duration was significantly shorter in the s-ERD group compared with other groups. Subjects in the NERD and s-ERD groups showed higher HADS scores, resulting in higher incidences of anxiety and depression than those in the control and a-ERD groups. Reflux symptoms, anxiety, depression, and coexisting functional dyspepsia, but not the presence of esophageal mucosal injury, were associated with an increased odds ratio for sleep disturbances.

Conclusion: There were significant positive associations among reflux symptoms, psychological stress, and sleep disturbance in Japanese adults. Further studies investigating the efficacy of therapy are needed.     

Comparison of gastroesophageal reflux in 100 patients with or without prior gastroesophageal surgery

Background and purpose  The role of duodenogastroesophageal reflux (DGER) in gastroesophageal reflux disease (GERD) remains controversial. Few studies of reflux have compared patients with an intact stomach to those without intact stomach after gastroesophageal surgery. This study aimed to investigate differences of the refluxate between patients with and without prior gastroesophageal surgery and to assess the role of DGER in GERD. Methods  One hundred patients (34% with reflux symptoms) were divided into four groups: 23 with an intact stomach, and 27, 42, and 8 with esophagectomy followed by gastric tube reconstruction, distal gastrectomy, and total gastrectomy, respectively. Reflux symptoms were evaluated, and endoscopy and simultaneous 24-h monitoring of esophageal pH and bilirubin were performed. Results  Of 44 patients with increased DGER but without increased acid reflux, three had severe reflux esophagitis and seven had Barrett’s esophagus. DGER was most frequent under weakly acidic conditions in the intact stomach, esophagectomy, and distal gastrectomy groups. Pure acid reflux and DGER at any pH were elevated in GERD patients with an intact stomach, while weakly acidic and alkaline DGER were elevated in GERD patients after gastrectomy. Esophagectomy patients had reflux with the combined characteristics of those in the intact stomach and gastrectomy groups. Weakly acidic or alkaline DGER was correlated with symptoms and esophageal mucosal changes in gastrectomy patients. Conclusion  The refluxate causing GERD differed between patients with and without prior gastroesophageal surgery. Weakly acidic or alkaline DGER may cause both symptoms and esophageal mucosal damage.     

Laryngopharyngeal reflux in patients with symptoms of gastroesophageal reflux disease

Laryngopharyngeal reflux (LPR) has been extensively studied in patients with laryngeal signs and symptoms, gastroesophageal reflux being identified in approximately 50%. Few studies have investigated the incidence and significance of LPR in GERD patients. Two-hundred and seventy-six consecutive patients referred with symptoms of gastroesophageal reflux had dual probe 24 h pH, esophageal manometry, GERD and ENT questionnaires. LPR was defined as at least three pharyngeal reflux events less than pH 5.0 with corresponding esophageal reflux, but excluding meal periods. Fourty-two percent of patients were positive for LPR on 24 h pH monitoring and 91.3% corresponded with an abnormal esophageal acid score. Distal esophageal acid exposure was significantly greater (P < 0.001) in patients with LPR but symptoms of GERD and regurgitation scores showed no significant differences between patients with positive and negative LPR on 24 h pH. There was no significant difference between the incidence of LPR in patients with or without laryngeal symptoms. There is a high incidence of LPR in patients with GERD but its significance for laryngeal symptoms is tenuous. Fixed distance dual probe pH monitoring allows documentation of conventional esophageal reflux and LPR.     

Visceral sensitivity in gastroesophageal reflux

Symptomatic gastroesophageal reflux disease (GERD) is characterized by a wide spectrum of symptoms. The variance of GERD symptoms may be due to a decreased threshold for symptom elicitation/perception described as visceral sensitivity. In this study GERD symptoms were scored for presence/frequency. The symptom score was weighted for the presence/frequency of typical reflux symptoms: heartburn, retrosternal pain, and regurgitation. The weighted GERD symptom score was used to assess symptom expansion and the hypothesis of GERD visceral sensitivity. One hundred five subjects with heartburn/retrosternal pain underwent esophageal pH studies. Subjects with abnormal esophageal pH studies reported more GERD-related symptoms, occurring more frequently, compared to subjects with normal esophageal pH studies. Symptom scores correlated with the number of reflux episodes but not with the length of time of mucosal exposure to acid. Therefore, aggregation of symptoms in gastroesophageal reflux is associated with frequent alternation between low and normal pH values in the distal esophagus.     

胆汁在胃食管反流病中的作用

随着24 h食管pH监测和胆汁监测技术的开展,胃、十二指肠液混合反流在胃食管反流病(GERD)的发生、发展中的作用已被逐步认识.胆汁反流在GERD发病过程中所扮演的角色,成为近年来人们研究的焦点之一.基础研究证明胆汁在不同酸碱环境、不同浓度对食管黏膜的损伤作用是不同的.不少临床试验对GERD进行研究发现,胆汁反流与症状和食管损伤严重度存在一定关系,但研究结果不尽一致,胆汁在GERD中的作用仍有争议.明确胆汁在GERD中的作用,有助于为预防此类疾病开辟新的道路.本文就有关胆汁反流在胃食管反流病中的作用的研究进展作一综述.     

胃及十二指肠液对食管粘膜损伤的实验研究

目的：通过动物实验,研究胃及十二指肠液反流对食管粘膜的损伤情况及其分别在胃食管反流病（ｇａｓｔｒｏｅｓｏｐｈａｇｅａｌ ｒｅｆｌｕｘ ｄｉｓｅａｓｅ,ＧＥＲＤ）发病中所占的地位。方法通过不同手术方式制作三种食管反流动物模型,分别为单纯胃液反流（Ｇ组）、单纯十二指肠内容物反流（Ｄ组）及十二指肠胃内容物混合反流（ＤＧ组）。于不同病程分批取得食管标本进行大体及光镜下形态学。结果各实验组出现程度不等的反流     

食管粘膜阻抗在诊断胃食管反流病的意义

胃食管反流病（GERD）是一种复杂的疾病,具有异质的症状特征和多方面的致病基础。食管粘膜阻抗是反流的标志。受损的食管粘膜完整性在引起GERD症状中起作用。测量了沿食道的粘膜阻抗的变化程度,可用于诊断GERD患者反流对食管粘膜造成的影响。使用食管多通道腔内阻抗pH实验测量食管基线阻抗被认为是检查食管粘膜完整性研究的替代技术,有助于鉴别GERD与非GERD。内镜引导下粘膜阻抗试验是一项新技术,它利用一根直视导管接触食管内壁,以确定慢性胃十二指肠内容物引起的上皮细胞变化。这个测试本质上是测量食管上皮细胞对电流的传导能力。慢性GERD患者的食管上皮细胞改变,细胞间的间隙扩大和长期处于湿润状态,导致高导电性和低粘膜阻抗。内窥镜检查指导下的粘膜阻抗和粘膜导纳的实时测量可能有助于估计粘膜完整性,并可能以类似于24 h食管多通道腔内阻抗pH监测的方式成为GERD患者的有用诊断工具。     

伊托必利联合富马酸伏诺拉生片治疗胃食管反流病的疗效及对患者CGRP、5-HT水平变化的影响

目的:探讨伊托必利联合富马酸伏诺拉生片治疗胃食管反流病(GERD)的疗效及对患者降钙素基因相关肽(CGRP)、5-羟色胺(5-HT)水平变化的影响。方法:选取2018年12月—2020年12月收治的86例GERD患者进行前瞻性研究,以简单随机化法分为观察组(n=43)、对照组(n=43)。对照组给予伊托必利联合埃索美拉唑治疗,观察组给予伊托必利联合富马酸伏诺拉生片治疗。比较2组疗效、不良反应及治疗前后食管黏膜损伤程度、食管24 h pH值监测参数、血清炎性因子[白细胞介素6(IL-6)、IL-1β、肿瘤坏死因子α(TNF-α)]、CGRP、5-HT水平。结果:观察组总有效率高于对照组(97.67%vs 81.40%,P<0.05);治疗后2组食管黏膜损伤程度均改善,且观察组优于对照组(P<0.05);治疗后2组>5 min反流次数、4 h反流次数、pH值<4总时间百分比、最长反流时间低于治疗前,且观察组低于对照组(P<0.05);治疗后2组血清CGRP、5-HT、IL-6、IL-1β、TNF-α水平低于治疗前,且观察组低于对照组(P<0.05);2组...     

十二指肠胃食管反流在胃食管反流病中的作用

目的　研究十二指肠胃食管反流 (DGER)在胃食管反流病发病机制中的作用及其对非糜烂性反流病 (NERD)的诊断价值。方法　 95例患者根据内镜检查的结果分为反流性食管炎和NERD组 ,对其均进行 2 4h食管 pH和胆汁联合监测。 结果　反流性食管炎患者DGER的各项指标 :吸光度值 >0 14时间百分比 (% )、总反流次数和反流 >5min的次数分别为 19 0 5± 2 3 4 4、30 5 6±34 0 4和 5 90± 6 37,均显著高于NERD组相应的 7 2 6± 11 0 8、15 6 8± 2 0 92和 2 5 9± 3 5 7(P <0 0 5 ) ,而酸反流差异无显著性 ,随着反流性食管炎的程度加重DGER发生率增高 ;18 2 %的NERD患者存在单纯DGER ,联合胆汁监测可使NERD诊断阳性率由 6 5 9%升高到 84 1%。结论　DGER可以单独发生 ,在引起反流性食管黏膜损伤或症状方面都有作用 ,2 4h食管 pH和胆汁联合监测有助于NERD的诊断。     

Increased esophageal mucosal/submucosal blood flow in patients with gastroesophageal reflux disease: normalization by treatment with a proton pump inhibitor

Background and Aim: Mucosal injury caused by gastroesophageal reflux may result in changes in esophageal mucosal blood flow. Little is known about esophageal mucosal blood flow in patients with gastroesophageal reflux disease (GERD). Here we examined esophageal mucosal blood flow and the effects of treatment in patients with GERD. Methods: The subjects included 41 cases (21 males and 20 females, mean age 64.2 years) in whom endoscopy was warranted in patients complaining of heartburn and/or regurgitation. We also studied six normal control subjects. Patients underwent endoscopy, laser Doppler flow meter measurements, and endoscopic ultrasonography before and after treatment. Results: Esophageal mucosal/submucosal blood flow was increased in patients with GERD compared with the control patients. The thickness of the whole esophageal wall and that of the mucosal and submucosal layers of the esophagus correlated significantly with esophageal mucosal/submucosal blood flow. The increased esophageal mucosal/submucosal blood flow significantly decreased after 4 weeks' treatment with lansoprazole, a proton pump inhibitor. Conclusion: Our results indicated that the pathophysiology or underlying mechanisms of GERD includes increased esophageal mucosal/submucosal blood flow, which correlates with the thickness of the esophageal wall, but is reversible and responds to treatment with lansoprazole. This suggests that proton pump inhibitors can effectively treat GERD and promote histological normalization of the mucosa and submucosa in the lower esophagus.