惠州地区胃食管反流病与肠易激综合征重叠的特征

目的 探讨惠州地区胃食管反流病（GERD）重叠肠易激综合征（IBS）的症状特征.方法 采用整群、分层、随机抽样的方法,收集到61例GERD症状人群,其中12例（19.7％） GERD重叠IBS患者、49例单纯GERD患者,记录其人口统计学资料以及症状严重程度,对结果进行统计分析.结果 GERD重叠IBS组男女比例为1：1.4,其症状较单纯GERD组严重（P＜0.05）.结论 GERD与IBS的重叠现象多见,患者多为女性,且症状更严重.     

陕西省农村成人胃食管反流病、功能性消化不良和肠易激综合征的重叠患病调查

目的:探讨陕西省农村成人胃食管反流病(GERD)、功能性消化不良(FD)和肠易激综合征(IBS)的重叠患病率及其危险因素。方法:于2019年2月1日至10月31日通过多阶段、分层整群抽样对随机选取的陕西省12个村进行入户问卷调查,共纳入2 423名受调查者,其中男1 037名,女1 386名,年龄为(45.3±16.9...     

胃食管反流病和肠易激综合征的异同

胃食管反流病（GERD）和肠易激综合征（IBS）的临床表现有很高的症状重叠现象，其发生机制可能与其有共同的危险因素、相同的病理生理学和遗传易感性等有关。治疗GERD和IBS时，应针对其病理机制给予综合治疗，这样才能提高疗效，改善生活质量。     

消化科就诊人群胃食管反流重叠功能性肠病的特征分析

目的 调查消化专科就诊人群症状谱的特点,以及胃食管反流病(GERD)合并功能性肠病(FBD)的比例.方法 2011年4-6月对就诊北京大学人民医院消化科门诊的患者进行问卷调查,记录患者一般信息及主诉；利用反流性疾病问卷(RDQ量表)对典型反流症状进行评分,以RDQ评分≥12分诊断GERD,并结合胃镜结果和对质子泵抑制剂治疗的反应来区分反流性食管炎(RE)和非糜烂性反流病(NERD).同时询问患者是否存在腹痛、腹胀、腹泻及便秘等症状,病程≥6个月考虑为慢性病程.按RomeⅢ标准判断是否患有FBD.结果 资料可利用的患者为1074例.具有胃食管反流症状者(RDQ评分＞0分)为351例(32.7％),诊断GERD107例(10.0％).具有慢性腹痛、腹胀、腹泻、便秘等任一种症状者404例(37.6％)；诊断肠易激综合征(IBS) 63例,功能性便秘(FC)40例,功能性腹泻28例,功能性腹胀75例,即FBD共计206例(19.2％).胃食管反流典型症状的RDQ评分越高,合并其他胃食管反流相关的食管表现及食管外表现的比例越高,合并慢性腹胀、慢性便秘及IBS、FC的比例也增高(P值均＜0.05).GERD患者合并慢性腹胀、慢性便秘的比例均高于非GERD者[25.2％ (27/107)比16.6％ (160/966),14.0％(15/107)比7.1％(69/966),P值均＜0.05]；26.2％ (28/107) GERD患者合并FBD,其中GERD合并IBS和FC的比例均高于非GERD者[10.3％ (11/107)比5.4％ (52/966),7.5％ (8/107)比3.3％ (32/966),P值均＜0.05].与RE相比,NERD合并多种FBD的比例较高,但差异无统计学意义(P＞0.05).结论 GERD患者常伴有慢性腹胀、慢性便秘等,易合并IBS及FC,且随着GERD症状加重,其重叠比例有增高的趋势.     

陕西省农村成人胃食管反流病、功能性消化不良和肠易激综合征的重叠患病调查

目的探讨陕西省农村成人胃食管反流病(GERD)、功能性消化不良(FD)和肠易激综合征(IBS)的重叠患病率及其危险因素。方法于2019年2月1日至10月31日通过多阶段、分层整群抽样对随机选取的陕西省12个村进行入户问卷调查,共纳入2 423名受调查者,其中男1 037名,女1 386名,年龄为(45.3±16.9)岁。依据蒙特利尔标准诊断GERD,依据罗马Ⅳ标准诊断FD和IBS,计算3种疾病的重叠患病率,分析GERD、FD和IBS重叠的危险因素。统计学方法采用多因素logistic回归分析。结果 2 423名受调查者中,624例患有GERD(302例)、FD(377例)或IBS(167例),其中30.77%(192/624)的患者存在≥2种疾病的重叠;GERD与FD重叠、GERD与IBS重叠、FD与IBS重叠、GERD与FD和IBS重叠的患病率分别为2.56%(62/2 423)、1.61%(39/2 423)、2.52%(61/2 423)、1.24%(30/2 423)。多因素分析显示女性、无先兆偏头痛与GERD和FD重叠、FD和IBS重叠、GERD和IBS重叠均呈正相关[比值比...     

胃食管反流病食管外表现的临床研究

目的探讨胃食管反流病（GERD）食管外表现（EED）的临床特征和质子泵抑制剂对EED的治疗效果。方法本研究为多中心、开放、前瞻性临床研究,在上海市的4家医院同期入选GERD患者,均符合内镜下有反流性食管炎（RE）的诊断标准,无RE者则为24h食管pH监测阳性的非糜烂性反流病（NERD）。进行GERD典型症状和EED相关症状的问卷调查并记录积分,有EED症状者行电子喉镜检查并记录有关征象,然后对上述资料进行统计、比较分析。结果共分析200例符合标准的GERD患者,伴有EED者95例,无EED者105例;NERD患者66例,RE134例,其中65例为具有EED的RE患者。EED的症状最常见的为咽球感和（或）咽部异物感,发生率为27％,其他常见的依次为咳嗽、咽喉灼痛、声音嘶哑,哮喘较少,其发生率分别为21％、16％、11％、3％。有EED的患者中并存典型GERD症状的发生率为56％,EED症状的严重程度在RE和NERD患者间差异无统计学意义。喉镜检查示声带红斑、水肿32％,杓区红肿25％,咽后壁淋巴增生20％,未见明显异常的42％。95％的EED患者治疗8周后症状基本消失。结论较大比例的GERD患者中有EED存在,而喉镜、常规24hpH监测对诊断的阳性预测值不高,高剂量质子泵抑制剂对EED的治疗有效。     

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     

胃食管反流病与功能性肠病关系的研究

目的探讨胃食管反流病与功能性肠病的关系。方法随机选取2004年北京大学人民医院消化科门诊有上腹症状的病人168例,填写反流性疾病诊断问卷(耐信量表),以Sc≥12为症状性胃食管反流标准,将病人分为两组,Sc≥12组及Sc<12组,记录病人身高、体重、计算体重指数、吸烟史、饮酒史、手术史、用药史,按照功能性肠病罗马Ⅱ诊断标准筛选功能性肠病病人,包括肠易激综合征(IBS)、功能性便秘、功能性腹胀、功能性腹泻等病人。结果按照罗马Ⅱ标准,两组患IBS及患功能性便秘差异无显著统计学意义,但两组发生功能性腹泻的差异有显著统计学意义,经logistic回归分析,发现体重指数与发生和胃食管反流病程相伴的下消化道功能异常有一定关系。结论胃食管反流可以合并不同程度下消化道功能异常,但具体机制尚有待进一步研究。     

惠州地区肠易激综合征与功能性消化不良重叠的症状特征

目的探讨惠州地区肠易激综合征(1BS)重叠功能性消化不良(FD)的症状特征。方法采用整群、分层、随机抽样的方法,收集到173例符合罗马Ⅱ标准的lBS症状人群,其中59例lBS重叠FD患者114例单纯lBS患者,记录其人口统计学资料,以及过去一年内的腹痛或腹部不适和排便习惯等方面的情况,对结果进行统计分析。结果lBS重叠FD组男女比例为1∶1.6,其症状较单纯lBS组严重(P<0.05)。结论 lBS与FD的重叠现象多见,患者多为女性,且症状更严重。     

胃食管反流病与会厌囊肿关系初探

目的探讨胃食管反流病（GERD）与会厌囊肿的关系。方法随机选择经胃镜检查诊断为反流性食管炎或具有典型的反酸烧心症状并经试验性治疗有效而确诊的GERD患者150例（观察组）,经胃镜诊断为慢性浅表性胃炎的患者150例（对照组）。观察两组合并会厌囊肿的比率。结果观察组共发现会厌囊肿7例（4.77%）,对照组发现1例（0.67%）。两组比较有统计学差异。结论GERD与会厌囊肿之间存在密切关系。     

Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome

Several studies indicate a significant degree of overlap between irritable bowel syndrome(IBS)and gastroesophageal reflux disease(GERD).Likewise,both functional heartburn(FH)and IBS are functional digestive disorders that may occur in the same patients.However,data establishing a solid link between FH and IBS are lacking,mainly because the clinical definition of FH has undergone substantial changes over the years.The available literature on the overlap between GERD or FH and IBS highlights considerable heterogeneity in terms of the criteria and diagnostic procedures used to assess heartburn and IBS.In particular,several epidemiological studies included patients with concomitant IBS and GERD without any attempt to distinguish FH(as defined by the RomeⅢcriteria)from GERD via pathophysiological investigations.Independent of these critical issues,there is preliminary evidence supporting a significantdegree of FH-IBS overlap.This underscores the need for studies based on updated diagnostic criteria and accurate pathophysiological classifications,particularly to distinguish FH from GERD.This distinction would represent an essential starting point to achieving a better understanding of pathophysiology in the subclasses of patients with GERD and FH and properly assessing the different degrees of overlap between IBS and the subcategories of heartburn.The present review article intends to appraise and critically discuss current evidence supporting a possible concomitance of GERD or FH with IBS in the same patients and to highlight the pathophysiological relationships between these disorders.     

Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease

AIM： To investigate the influence of irritable bowel syndrome （IBS）-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease （GERD） in a real life setting. METHODS： For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire （ReQuest） short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive（ERD） and non-erosive reflux disease （NERD）] and the presence of IBS-like symptoms. RESULTS： IBS-like symptoms were more prevalent in NERD than in ERD （18.3% vs 12.7%, P = 0.0015）. Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD （Week 4： P 〈 0.0001, Week 8： P 〈 0.0339） and NERD （Week 8： P = 0.0088）. At baseline, ReQuest ＂lower abdominal com- plaints＂ symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups. CONCLUSION： IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.     

Concomitant functional dyspepsia and irritable bowel syndrome decrease health-related quality of life in gastroesophageal reflux disease

Objective. Previous studies have reported an overlap between gastroesophageal reflux symptoms, functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of FD and IBS in gastroesophageal reflux disease (GERD) and the effect on health-related quality of life (HRQoL). Material and methods. FD and IBS prevalence and HRQoL were assessed by means of questionnaires in 215 referred and 48 non-referred (non-care-seeking) GERD patients, proven with 24-h pH-metry. HRQoL in 131 matched controls was used for comparison. Results. In this group of GERD patients 25% had FD (Dutch general population 13–14%), 35% had IBS (Dutch general population 0.6–6%) and 5% had both FD and IBS. Only 35% had neither FD nor IBS. Among referred GERD patients, the prevalence of FD and IBS was higher (p=0.002 versus non-referred). Compared with controls, GERD patients without FD/IBS had lower HRQoL scores on only one of the nine SF-36 subscales (p≤0.001); GERD+FD patients had lower scores on six subscales (p≤0.0005); GERD+IBS patients had lower scores on eight subscales (p <0.0005) and GERD+FD+IBS patients had lower scores on seven subscales (p≤0.001). Compared with patients with GERD only, GERD+FD patients had lower scores on five subscales (p≤0.001); GERD+IBS patients had lower scores on eight subscales (p <0.0005) and GERD+FD+IBS patients had lower scores on six subscales (p≤0.001). Conclusions. In patients with proven GERD, FD and IBS are more prevalent than in the general population. This prevalence is higher among care-seeking GERD patients. Only those GERD patients with concomitant FD/IBS have a much lower HRQoL. This suggests that in GERD, when properly treated, HRQoL is affected mainly by concomitant functional disorders and not by GERD itself.     

反流性食管炎与非糜烂性反流病食管酸暴露的特点比较

目的　比较反流性食管炎 (RE)与非糜烂性反流病 (NERD)各亚组食管酸暴露特点。方法　具有典型反酸 烧心等症状的 12 8例患者 ,经胃镜等系统检查诊断为胃食管反流病 (GERD)。便携式 pH监测仪行胃食管 2 4hpH监测 ,DeMeester积分≥ 15分为存在病理性酸反流。 结果　 12 8例患者中 ,37例 (2 8 9% )存在RE ,91例 (71 1% )为NERD。pH监测阳性在RE组和NERD组中分别为 2 5例 (6 7 6 % )和 4 6例 (5 0 5 % ) ,差异无统计学意义 ;两组DeMeester积分均值差异亦无统计学意义 (5 3 4 5± 6 2 0 4比 4 0 0 4± 6 1 80 ,P >0 0 5 )。RE组长反流次数显著高于NERD组 (8 16±10 2 7比 3 96± 6 87,P =0 0 0 4 )。以症状指数 >5 0 %为阳性 ,NERD阳性组 (pH值监测异常 )症状指数阳性率显著高于NERD阴性组 (pH值监测正常 ) (43 5 %比 15 6 % ,P <0 0 0 1)。NERD阴性组中具有阳性症状指数的患者 7例 (15 6 % ) ,阴性症状指数者 38例。前者总反流次数及立位反流时间百分比显著高于后者。RE患者中 ,12例 pH监测阴性者食管及胃内pH的中位值显著高于 pH监测阳性者。结论　RE患者长反流发生率高于NERD患者 ;症状的发生与酸反流相关 ;NERD患者根据酸反流与症状关系可分为不同的亚组。RE阴性组可能存在混合反流或胆汁反流     

Overlapping gastroesophageal reflux disease and irritable bowel syndrome:Increased dysfunctional symptoms

AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4±11.5 years) met Rome or Rome crit...     

Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia： A prospective study

AIM:To evaluate the prevalence of Giardia lamblia(G.lamblia)infection in patients with irritable bowel syndrome(IBS)and dyspepsia and to establish which is the mostaccurate test to diagnose the infection in this setting.METHODS:One hundred and thirty-seven patients whoconsecutively attended the Outpatient GastroenterologyClinic for the first time between January 2002 and De-cember 2003 due to symptoms of IBS and/or dyspepsiawere recruited.All patients underwent clinical evaluation,first-step haematology and chemistry tests,serologic as-says for celiac disease,lactose-H2 breath test,abdominalultrasonography,and esophagogastroduodenoscopy.Helicobacter pylori status was evaluated.In patients withsymptoms of IBS older than 45 years,colonoscopy wasalso performed.In all patients,duodenal biopsies andstool samples were examined for trophozoites and cystsof G.lamblia by several methods.RESULTS:G.lamblia was identified in 9 patients.Thefollowing diagnoses were also made:IBS(100/137,73%),functional dyspepsia(62/137,45%),organicdyspepsia(33/137,24%),and lactose intolerance(75/137,55%).A significant association was foundbetween giardiasis and H pylori infection(X~2=6.632,OR=12.4,CI=1.5-68.1).There were no symptomsthat reliably allowed the recognition of giardiasis.Direct search of the parasite in duodenal biopsy andstool sample examinations gave concordant results inall cases while histological examination of duodenal biopsies displayed a low sensitivity(e.g.,22.2%).CONCLUSION:In this consecutive series,diagnosisof G.lamblia infection accounted for 6.5% of patientswith IBS and dyspepsia.Duodenal biopsies for diag-nosis of giardiasis may be unnecessary if stool sampleexamination is performed.