老年人反流性食管炎食管外表现与酸反流的关系

目的 探讨老年人反流性食管炎(reflux esophagitis,RE)食管外表现与酸反流的关系.方法 选择经胃镜检查证实为RE老年患者69例,入选者均有胃灼热、反酸等胃食管反流症状及咳嗽、喉炎,哮喘等食管外症状.对所有患者行24 h食管pH值监测,根据监测结果将患者分为中重度病理性酸反流组(中重度组)40例和轻度病理性酸反流组(轻度组)29例.两组均给予口服埃索美拉唑治疗(20 mg,3次/d),疗程8周,观察治疗后症状改善情况. 结果酸反流中重组食管外症状总积分(14.4±2.71)分.明显高于酸反流轻度组(8.2±2.0)分,经埃索美拉唑治疗后,两组患者食管外症状比治疗前均有好转,治疗后中重度组食管外症状总积分为(12.2±1.9)分,较治疗前明显改善(P<0.01). 结论老年RE患者的食管外症状与酸反流显著相关.老年患者因慢性咳嗽、慢性喉炎及哮喘长期就诊而治疗效果不佳时,应详细询问病史,考虑到GERD的可能性,尽早行胃镜及24 h食管pH监测,以明确诊断,尽早治疗.     

Early colonic transhiatal herniation and anastomotic leak after Ivor Lewis esophagectomy

Transhiatal herniation of the abdominal organs is a rare complication after esophagectomy. Surgical treatment is usually mandatory because of the high mortality associated with this condition. We present a case of colonic herniation that could contribute to failure of the esophagogastric anastomosis. Repair of both problems was performed through a right posterior thoracotomy.     

From reflux esophagitis to Barrett's esophagus and esophageal adenocarcinoma

The occurrence of gastroesophageal reflux disease is common in the human population.Almost all cases of esophageal adenocarcinoma are derived from Barrett's esophagus,which is a complication of esophageal adenocarcinoma precancerous lesions.Chronic exposure of the esophagus to gastroduodenal intestinal fluid is an important determinant factor in the development of Barrett's esophagus.The replacement of normal squamous epithelium with specific columnar epithelium in the lower esophagus induced by the chronic exposure to gastroduodenal fluid could lead to intestinal metaplasia,which is closely associated with the development of esophageal adenocarcinoma.However,the exact mechanism of injury is not completely understood.Various animal models of the developmental mechanisms of disease,and theoretical and clinical effects of drug treatment have been widely used in research.Recently,animal models employed in studies on gastroesophageal reflux injury have allowed significant progress.The advantage of using animal models lies in the ability to accurately control the experimental conditions for better evaluation of results.In this article,various modeling methods are reviewed,with discussion of the major findings on the developmental mechanism of Barrett's esophagus,which should help to develop better prevention and treatment strategies for Barrett's esophagus.     

Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction

BACKGROUND: Recently, the rate of postoperative long-term survival has increased in cases of esophageal cancer. We report on our analysis of postoperative reflux esophagitis (RE) at Tokai University. METHODS: We enrolled 48 patients who underwent gastric tube reconstruction after esophagectomy. The diagnosis of RE was confirmed by endoscopy. RESULTS: Of the 48 patients, 28 (58.3%) were found to have RE. Among the 28 patients with RE, only four (14.3%) reported symptoms. The distribution of the severity of RE according to the Los Angeles classification in the patients was as follows: grade M, 1 (3.6%); grade A, 2 (7.1%); grade B, 6 (21.4%); grade C, 17 (60.7%); and grade D, 2 cases (7.1%). Barrett's epithelium was detected in 9 of the 28 patients (31%) with RE and in 3 of the 20 (15%) patients with no evidence of RE. CONCLUSIONS: To detect the presence of RE as well as monitor for recurrence and development of metachronous cancer, we consider it important to perform endoscopy regularly over the long term. As Barrett's epithelium is frequently encountered, care should be exercised to detect the specialized columnar epithelium showing dysplastic changes.     

塞来昔布辅助治疗肿瘤患者难治性胃食管反流病的探讨并文献复习

目的探索提高肿瘤患者所患难治性胃食管反流病(GERD)及其反流性食管炎(RE)治疗效果的措施。 方法回顾性分析2008年2月至2010年7月,盐城市肿瘤医院按GERD共识意见和RE指南中多种药物治疗8周以上无效且伴有难治性GERD及合并RE的14例肿瘤患者,在继续服用或改服质子泵抑制剂雷贝拉唑,H2受体拮抗剂雷尼替丁或法莫替丁、胃动力剂莫沙必利,同时继续服用抗生素克拉霉素缓释片、庆大霉素注射液基础上,加服选择性环氧化酶-2(COX-2)抑制剂塞来昔布200～400 mg,每天2次,连服14 d观察近期疗效。 结果14例(100%)患者均于3～7 d内嗳气、反酸、胃灼热、胸骨后或剑突下灼痛,夜间不能平卧等症状锐减,食欲随之改善;其中12例(85.71%)于7～10 d内上述症状消失,2例疗程未满14 d即出院;2例症状复发。 结论GERD和RE的发生、发展及其程度与COX-2的高表达呈正相关已为多项研究所证实,故对肿瘤患者合并难治性GERD、RE,在常规药物治疗基础上加用选择性COX-2抑制剂塞来昔布可提高其疗效。     

Surgical treatment of superficial esophageal cancer, its result and perspective

Background  Our objective was to review the results of surgical treatment for superficial esophageal cancer to obtain the proper indications for the recently proposed esophagus-preserving strategies. Methods  The clinicopathological data of 290 consecutive patients with superficial thoracic or abdominal esophageal cancer who underwent esophagectomy with radical lymph node dissection without preoperative adjuvant treatment from 1984 to 2005 were examined in terms of tumor depth (ep, lpm, mm, sm1, sm2, sm3) and TNM pStage. The category sm1 was subclassified into sm1(0–200): lesions with 200 μm or less vertical tumor invasion depth in the submucosal layer, and sm1(200-): deeper sm1, to make our results referable to endoscopically resected lesions. Results  About 8% of the patients with mm or deeper tumors were classified as TNM pStage IV. Around 20% of mm and sm1(0–200) tumors were associated with lymph node involvement. The 5-year survival rate of the 211sm cancers was 74.8% ± 3.3%; the mean survival time was 11.47 ± 0.68 years. The survival of TNM pStage IV patients was no worse than that of pStage IIB patients. Conclusions  Endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is definitely indicated for ep or lpm lesions. Any tumors with deeper invasion including mm and sm1(0–200) should be regarded as potentially lymph node positive, and the most reliable treatment is still radical esophagectomy. Recent attempts to treat superficial esophageal cancer while preserving the esophagus should be performed with caution and with informed consent. A randomized controlled trial is necessary to compare the results of the recent esophagus-preserving strategies to the results of radical esophagectomy. Review articles on this topic also appeared in the previous issue (Volume 4 Number 3). An editorial related to this article is available at .     

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     

胃食管反流病伴或不伴食管损伤与食管动力及酸反流之间的关系

目的 研究胃食管反流病(GERD)患者伴或不伴食管损伤与食管动力和酸反流之间的相关性.方法 对符合GERD诊断标准的25例受试者行胃镜检查,随后进行高分辨率食管测压检查,并检测进食标准试验餐后的动态食管pH值变化.比较伴或不伴食管损伤组患者之间的食管动力和餐后食管酸反流时间的差异.同时按DeMeester评分将受试者分为非酸反流组和酸反流组,比较两组食管动力学指标的变化.统计学处理采用t检验和秩和检验.结果 伴或不伴食管损伤组之间下食管括约肌(LES)压力基础值、LES压力残余平均值、食管蠕动传播速度、食管pH＜4的时间和DeMeester评分均差异无统计学意义(P均＞0.05),但是伴食管损伤组的食管收缩幅度明显弱于不伴食管损伤组(31.9 mm Hg比64.2 mm Hg,1 mm Hg=0.133 kPa;Z=-2.37,P=0.02).酸反流组和非酸反流组之间LES压力基础值、LES压力残余平均值、食管蠕动传播速度差异均无统计学意义(P均＞0.05),但酸反流组的食管收缩幅度明显弱于非酸反流组(36.4 mm Hg比71.8mm Hg;Z=2.25,P=0.02).结论 GERD患者LES压力及食管酸反流与食管损伤之间无显著关系,食管蠕动性收缩功能可能与食管损伤及酸反流有关.     

胃食管阀瓣与反流性食管炎的关系初步探讨

目的 探讨胃食管阀瓣（GEFV）与反流性食管炎（RE）的关系.方法 分析2007年1月至2009年12月我院内镜诊断的BE 239例,按洛杉矶标准进行食管炎分级,按Hill分类法进行GEFV的分级.通过对照分析,探讨GEFV与RE之间的关系.结果 入组的960人中,异常GEFV发生率32.9%,RE发生率24.9%.重症RE（C级、D级）发生率GEFV异常组明显高于GEFV正常组（23.1%比2.4%,P=0.000）;RE分级与GEFV级别呈正相关（r=0.308,P=0.000）.RE患者的异常GEFV发生率高于非食管炎者（65.3%比22.2%,P=0.000）.RE患者和异常GEFV组均为男性多于女性（63.6%、60.1%比36.4%、39.9%,P=0.000）.各年龄段中,随着年龄的增长,RE巳的发生率逐渐升高,年龄增长与RE发生率呈正相关,（r=0.214,P=0.000）.30岁以上,随着年龄的增长,异常GEFV的发生率逐渐升高,年龄增长与异常GEFV的发生率呈正相关（r=0.129,P=0.000）.结论 GEFV异常和RE发生存在相关性,观察GEFV可作为评估和预测患者反流状态的有效方法.     

杭州市184例反流性食管炎的临床特点及生存质量分析

目的通过症状量表和汉化版SF-36生存质量量表研究杭州市1年内经胃镜诊断的反流性食管炎(RE)患者的临床特点和生存质量状况。方法收集2004年9月至2005年9月杭州市七家省市级医院消化科门诊就诊的RE患者184例,记录患者的临床特点和生存质量状况,并进行相关因素的分析。结果REA级和B级的患者明显多于C级和D级患者。性别、吸烟、饮酒以及RE分级对症状评分无显著影响(P>0.05),年龄对症状评分有显著影响(P<0.05)。RE患者在SF-36各个维度的积分均有下降。吸烟、饮酒、年龄、性别以及内镜下分级对生存质量量表综合得分影响无显著性意义(P>0.05)。患病时间、症状量表评分对生存质量量表综合得分影响有显著性意义(P<0.05)。结论杭州市RE患者病情多较轻,年龄对RE症状的严重程度有显著影响,症状的严重程度和患病时间是影响患者生存质量的主要因素。     

老年人食管癌的外科治疗

1材料和方法1.1研究对象1999年3月至2003年2月的238例食管癌根治手术患者,男157例,女81例。年龄60～84岁,平均(66±3.5)岁。其中年龄≥70岁患者36例,包括男24例,女12例,平均(75±3.4)岁。病变长度2.5～8cm。病变位于食管上段19例,中段141例,下段78例。病理类型:鳞癌206例,腺癌2     

Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

AIM： To analyze the spectrum and risk factors of gastroesophageal reflux disease （GERD） based on presenting symptoms and endoscopic findings. METHODS： A cross-sectional survey in a cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version Reflux Disease Questionnaire （RDQ） and other items recording the demographic characteristics and potential risk factors for GERD. Subjects were defined as having GERD symptoms according to the RDQ score （〉 12）. All subjects were endoscopied and the definition and severity of erosive esophagitis were evaluated by Los Angeles classification. The statistical analysis was performed with SPSS13.0 programs. RESULTS： Of 2231 recruited participants, 701 （31.40%） patients were diagnosed as having GERD while 464 （20.80%） patients had objective findings of reflux esophagitis （RE）. Of those 464 patients, only 291 （13.00%） were reported as subjects with GERD symptoms. A total of 528 （23.70%） patients were found to have GERD symptoms, including 19.50% patients with grade A or B reflux esophagitis, 0.90% with grade C and 0.40% with grade D. On multivariate analysis, old age, male, moderate working burden, divorced/widowed and strong tea drinking remained as significant independent risk factors for erosive esophagitis. Meanwhile, routine usage of greasy food and constipation were considered as significant independent risk factors for non-erosive reflux disease （NERD）. CONCLUSION： GERD is one of the common GI diseaseswith a high occurrence rate in China and its main associated factors include sex, anthropometrical variables and sociopsychological characteristics.     

酸袋在反流性食管炎中作用的研究

目的 探讨酸袋在反流性食管炎中的作用.方法 应用胃食管反流病问卷(RDQ量表)和胃镜检查确诊15名健康者和24例反流性食管炎患者.使用4通道食管测压系统确定受试者下食管括约肌(LES)位置,将单通道pH电极置于LES远端下方1 cm处监测空腹pH值o.5 h,给予标准餐后继续监测pH值2 h,然后将探针移至LES近端上方5 cm处行24 h动态pH临测.结果 16例反流性食管炎患者(66.67%)与10名健康者(10/15)存在酸袋.反流性食管炎组较健康组酸袋出现时间早[11.00(4.25～17.00)min比30.00(15.50～54.25)min,P＜0.05]、平均pH值低[1.84(1.59～2.19)比2.32(1.96～2.71),P＜0.05].而餐前胃食管连接部平均pH值及酸袋持续时间差异无统计学意义.结论 反流性食管炎患者有异常食管酸反流,且酸袋出现时间早、平均pH值低,其食管黏膜损伤可能与此有关.     

Characteristic pathological findings and effects of ecabet sodium in rat reflux esophagitis

AIM： To explore the pathological findings in the entire esophagus in rats with reflux esophagitis, and the effects of ecabet sodium （ES）. METHODS： A rat model of chronic acid reflux esophagitis was used. In the treatment group, ES was administered after surgery （n = 16）. No drug was administered postoperatively to the esophagitis group （n = 9）. Shamoperated rats were used as a control group （n = 5）. Rats were sacrificed on day 7 after the operation. The epithelial thickness and leukocyte infiltration were examined in the upper, middle and lower areas of the esophagus. The survival rate, incidence of esophageal ulcer, and mean surface area and number of esophageal ulcers were determined in the esophagitis and ES groups. Esophageal histology was assessed in all three groups. RESULTS： Leukocyte infiltration in the esophagitis group was 26.3 ± 22.0 in the middle esophagus and 8.2 ± 4.9 in the upper esophagus, which was significantly greater than that in the controls （1.3 ± 1.1 and 1.4 ±1.0, respectively） （P 〈 0.05）. The thickness of the epithelium in the esophagitis group was 210.8 ± 47.7 μm in the lower esophagus and 204.2 ± 60.1 μm in the middle esophagus, which was significantly greater than that in the controls （26.0 ± 5.5 and 21.0 ± 6.5 μm, respectively） （P 〈 0.05）. The mean number of ulcers per animal in the ES group in the entire esophagus was 5.4 =1= 2.5, which was significantly less than that in the esophagitis group （9.0 ± 3.5） （P 〈 0.05）. The epithelial thickness in the ES group was 97.5 ± 32.2 μm in the lower esophagus, which was decreased compared with that in the esophagitis group （210.8 ± 47.7 μm） （P 〈 0.05）. CONCLUSION： Mucosal inflammation extended to the upper esophagus close to the hypopharynx. Our study suggested that ES may have a useful defensive role in reflux esophagitis.     

以慢性咳嗽为主要表现的胃食管反流病患者的食管功能及反流特点

目的 通过对以慢性咳嗽为主要表现的胃食管反流病(GERD)患者行高分辨食管内压力-阻抗联合测定(MII-HRM)及24h联合多通道腔内阻抗-pH( MII-pH)监测的结果分析,探讨此类患者食管运动功能及胃食管反流的特点.方法 选取2010年3-11月在首都医科大学附属北京朝阳医院就诊的19例GERD伴慢性咳嗽患者为研究对象.应用MII-HRM及24 h MII-pH监测系统测定上食管括约肌(UES)和下食管括约肌压力、食管体部蠕动功能、对液体和黏液性物质的传输功能、立位及卧位酸及非酸反流的次数、近端反流的次数、酸暴露时间、酸清除时间以及食团清除时间.以同期仅表现为典型胃食管反流症状的17例GERD患者作为对照,比较两组间食管运动功能以及胃食管反流参数的差异.结果 与仅表现为典型胃食管反流症状的GERD患者相比,以慢性咳嗽为主要表现的GERD患者的UES静息压力明显更低[(122.55 ±60.48)mm Hg比(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],食管体部异常蠕动的比例更高[(9.47±15.63)％比(22.16±17.45)％,P＜0.05],食管体部对液体物质传输能力减低[(88.82±12.23)％比(71.68±23.06)％,P＜0.05],卧位时酸及非酸反流次数及卧位近端非酸反流次数明显增多(P＜0.05),卧位食团清除时间延长(P＜0.05).结论 以慢性咳嗽为主要表现的GERD发病机制可能与单纯典型GERD不同,其与UES静息压力减低、卧位酸及非酸反流、近端反流的增多以及食管清除功能障碍密切相关.     

非糜烂性反流病与反流性食管炎症状及食管酸暴露情况

目的比较非糜烂性反流病（NERD）与反流性食管炎（RE）的临床症状及食管酸暴露情况。方法具有反流症状的患者155例,进行胃镜检查和食管24hpH动态监测。结果155例患者中诊断RE76例（49．0％）,其中A、B、C、D级分别为40、24、8和4例;诊断NERD79例（51．0％）;RE组中pH监测阳性57例（75．0％）,NERD组26例（32．9％）,差异有统计学意义（P〈0．05）;NERD组食管外症状发生率较RE组高,差异有统计学意义（P〈0．05）,而典型的反流症状发生率两组比较差异无统计学意义（P〉0．05）;RE组各项酸反流指标均大于NERD组,差异有统计学意义（P〈0．05）;轻度RE（LA-A）组各项酸反流指标低于中度RE（LA—B）和重度RE（LA—C＋D）,差异有统计学意义（P〈0．05）,但中度RE（LA—B）与重度RE（LA—C＋D）之间的差异无统计学意义（P〉0．05）;79例NERD中,依据监测当日症状计算SI值,pH阴性sI阳性（NERDpH^-SI^＋）15例,pH阴性sI阴性（NERDpH^-SI^-）28例,NERDpH^-SI^＋组的pH〈4．0（％）和酸反流次数明显高于NERDpH^-SI^-组,差异有统计学意义（P〈0．05）。结论胃酸反流是RE形成的重要因素,其中胃酸的浓度及长反流与食管黏膜接触的次数是直接造成食管黏膜损伤的重要因素;酸反流的程度与RE的严重程度之间可能相关;NERD根据酸反流与症状的关系可分为不同的亚型,病理性酸反流所占比例相对较低,酸反流的强弱在其发病机制中可能未起到决定性作用。     

雷贝拉唑对胃食管反流病患者生活质量的影响

目的比较反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者在雷贝拉唑治疗后生活质量的变化。方法2002年12月至2003年6月在国内进行了多中心观察雷贝拉唑(10mg,每天2次口服)8周治疗RE和NERD患者的疗效。共入选RE患者74例和NERD患者37例。治疗前后采用问卷调查方式了解生活质量,问卷包括胃食管反流病-生活质量问卷量表(GERD-HRQL)和SF-36健康量表。结果(1)治疗后所有患者症状改善均为显效,RE患者糜烂愈合率达94.6%。(2)RE患者在SF-36健康量表中7个维度有明显改善,与治疗前比较差异有统计学意义(P<0.05)。NERD患者仅在总体健康和活力2个维度有明显改善(P<0.05)。(3)RE和NERD两组比较,治疗前在SF-36健康量表中NERD患者在活力、躯体疼痛和总体健康3个维度上低于RE患者;治疗后RE患者6个维度值高于NERD患者(P<0.05),GERD-HRQL评分也明显低于NERD组。结论有效抑酸治疗可以理想地控制GERD患者的症状,但是NERD患者生活质量的改善不如RE患者,说明NERD患者的发病是多因素的,在治疗上更应强调综合整体治疗。     

Gastroesophageal reflux disease:From heartburn to cancer

About 10%-15% of patients with gastroesophageal reflux disease develop Barrett’s esophagus. This is considered a premalignant condition because it can progress from metaplasia to high-grade dysplasia, and eventually to adenocarcinoma. Recently, major advances have been made in the endoscopic treatment of Barrett’s esophagus, therefore limiting the role of surgery in the treatment of this disease.     

小儿食管裂孔疝反流和手术抗反流机制的研究

目的了解小儿食管裂孔疝（ＨＨ）发生反流和手术抗反流的作用机制。方法２０例经钡餐造影确诊的ＨＨ患儿进行手术前后食管２４小时ｐＨ监测和食管动力功能检查。结果２０例患儿均有病理性胃酸反流；术后各项反流指标除了平均反流周期外均显著改善，下食管括约肌长度（ＬＥＳＬ）显著增加（从１．１７ｃｍ增加到１．９４ｃｍ．Ｐ＜０．０１）．主要是腹内食管段增加明显（从０．５４ｃｍ增加到１．３０ｃｍ，Ｐ＜０．０５）。胃内压降低（从２．８６ｍｍＨｇ降到１．７８ｍｍＨｇ，Ｐ＜０．０１）：术后腹内食管段长度影响治疗效果，长度长则疗效好（Ｐ＜０，０５）；手术前后下食管括约肌压力（ＬＥＳＰ）无显著差别（Ｐ＞０．０５）。结论小儿ＨＨ发生反流的机制是由于ＬＥＳ长度不足，主要是腹内食管段长度不足甚至消失及胃内压增高引起；手术抗反流的机制定增加了ＬＥＳ的长度，主要是增加了腹内食管段的长度。     

轻度反流性食管炎与非糜烂性反流病远端食管酸暴露和食管动力学变化

目的:探讨轻度反流性食管炎(RE)与非糜烂性反流病(NERD)食管远端酸暴露及食管动力变化特点.方法:符合洛杉矶诊断标准的RE30例(LA-A16例,LA-B14例),NERD16例,健康对照组10例被纳入本研究,所有患者及对照组均接受24h食管pH监测及压力测定,比较食管pH监测及测压结果.结果:LA-A组、LA-B组、NERD组DeMeester评分明显高于对照组,差异显著(P<0.05).LA-A组与NERD组比较DeMeester评分无明显差异,但NERD组的立位反流时间百分比与长反流周期数多于LA-A组,差异显著;LA-B组DeMeester评分比LA-A组和NERD组明显增高,LA-B组与LA-A组比较食管pH监测各项指标均存在明显差异.LA-A组、NERD组及对照组比较下食管括约肌静息压(LESP)、食管体部蠕动波幅度(PA)无显著差异,LA-A组和NERD组食管下段PA有增高趋势;LA-B组与LA-A组、NERD组及对照组比较LESP明显降低(P<0.05),LA-B组食管下段PA明显低于LA-A组(P<0.05).RE组无效食管运动(IEM)明显高于对照组,差异显著.结论:轻度RE(LA-B)与NERD远端食管酸暴露存在差异.DeMeester评分、LES功能不全及食管蠕动功能障碍与RE的严重程度呈正相关.LES功能不全及食管蠕动功能障碍可能不是轻度RE(LA-A)及NERD的主要致病因素.IEM与RE关系密切,且与RE有关的食管动力异常主要为IEM.