中西医结合对反流性食管炎患者食管动力学的影响研究

目的 探讨中西医结合对反流性食管炎患者食管动力学的影响.方法 反流性食管炎患者80例随机分为实验组和对照组,每组40例.对照组口服雷贝拉唑肠溶胶囊,实验组在对照组基础上口服枳术宽中胶囊,两组均连续服用8周.两组治疗总有效率比较,治疗前后食管动力学变化,不良反应和复发情况.结果 实验组总有效率(92.50％)高于对照组(70.00％),差异有统计学意义(P＜0.05);实验组患者治疗后食管括约肌压力(2.98±0.47) kPa高于对照组(2.21±0.43) kPa,立位反流时间百分比(2.28±0.47)％和卧位反流时间百分比(2.09±0.56)％低于对照组立位反流时间百分比(4.19±0.59)％和卧位反流时间百分比(6.17±1.08)％,差异均有统计学意义(均P＜ 0.05);两组患者用药8周期间均未出现明显药物不良反应;实验组复发率(10.00％)低于对照组(32.50％),且差异有统计学意义(P＜0.05).结论 中西医结合治疗反流性食管炎患者疗效明显,且可改善患者食管动力学.     

越鞠丸合旋覆代赭汤对非糜烂性反流病气郁痰阻证胃蛋白酶原和食管动力的影响

目的：观察越鞠丸合旋覆代赭汤对非糜烂性反流病气郁痰阻证胃蛋白酶原和食管动力的影响。方法：选择2020年1月—2023年3月收治的非糜烂性反流病气郁痰阻证患者110例,按治疗方案不同分为观察组(56例)和对照组(54例)。对照组接受常规西医治疗,观察组在对照组治疗基础上给予越鞠丸合旋覆代赭汤治疗。记录两组治疗前后主要中医症候积分(胃脘胀满、呃逆嗳气、吞咽不利、朝食暮吐和苔白腻脉弦滑),检测胃分泌因子指标值[胃分泌因子胃泌素17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)和胃蛋白酶原Ⅱ(PGⅡ)],测定食管动力指标(下括约肌静息压、下段蠕动波压力、卧位反流时间百分比和立位反流时间百分比),统计两组临床治疗总有效率、毒副反应发生率和复发率。结果：治疗后两组主要中医症候积分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组胃分泌因子指标值、下括约肌静息压和下段蠕动波压力均高于治疗前,卧位和立位反流时间百分比低于治疗前,且观察组上述指标数值均显著优于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率和复发率均明显优于对照组,差异有统计学意义(P<0...     

胃食管反流病量表与食管阻抗-pH监测在胃食管反流病诊断中的作用

目的 探讨胃食管反流病量表与食管阻抗-pH监测在胃食管反流病诊断中的作用。方法 将60例确诊为胃食管反流病患者作为研究组,将60例健康体检的健康人作为对照组,依次给予胃食管反流病量表与食管阻抗-pH监测,对比两组诊断结果。结果 两组食管阻抗-pH监测结果比较差异显著(P<0.05)。研究组的胃食管反流病量表评分高于对照组,差异有统计学意义(P<0.05)。不同亚型胃食管反流病的胃食管反流病量表评分显著高于对照组,差异有统计学意义(P<0.05)。结论 胃食管反流病量表与食管阻抗-pH监测均可用于胃食管反流病诊断,联合应用可进一步确诊患者的疾病,可及时辅助临床有效治疗患者疾病,改善患者的生存质量。     

不同年龄段胃食管反流病患者临床特点的对比研究

目的探讨不同年龄段胃食管反流病患者临床特点。方法选取在该院门诊就诊的胃食管反流病患者80例,对患者进行检查和问卷调查,分析临床特点。结果老年组B级及以上食管炎、食管外症状发生率明显高于青年组(P<0.05);老年组卧位食管pH<4时间、立位食管pH<4时间及DeMeester评分均明显高于青年组和中年组(P<0.05);老年组在活力、总体健康2个维度的评分明显低于青年组和中年组(P<0.05)。结论随着年龄增长,食管酸暴露时间逐渐延长,中重度食管炎和食管外症状发生率逐渐增加,患者生活质量逐渐下降。     

非糜烂性反流病患者食管24h pH值及压力测定的临床意义

目的研究非糜烂性反流病（NERD）患者食管酸暴露与动力学改变特征的临床意义。方法选取有反酸、烧心、胸痛等典型胃食管反流症状而内镜检查阴性的52例（NERD）患者作为研究组,选择无上消化道症状的20例体检者作为对照组,分别行食管24hpH监测检查和食管测压。结果 52例患者中,24hpH监测阳性为40例（76.92%）,且有反流症状患者pH值〈4立位百分比、pH值〈4卧位百分比、反流次数、长反流次数、最长酸反流时间、DeMeester积分均显著高于正常对照组,各指标比较差异有统计学意义（P均〈0.05）。NERD组下食管括约肌（LES）压力显著低于正常组（P〈0.05）,且NERD组食管体部蠕动振幅及频率均低于正常组（P〈0.05）。结论食管长时间的酸暴露,LES压力低下,LES的松弛,食管体部动力障碍可能在NERD的发病中起重要的作用。     

内镜下胃食管阀瓣分型与胃食管反流病食管动力的关系

目的探讨内镜下胃食管阀瓣(GEFV)分型与胃食管反流病(GERD)食管动力的关系。方法回顾性分析 2015年 1月至 2018年 12月就诊于芜湖市第二人民医院诊断为 GERD病人 76例,均行内镜、食管高分辨测压、 24 h食管 pH监测,根据内镜下 HILL分级,将 GEFV分为 Ⅰ~Ⅳ级, Ⅰ级、 Ⅱ级为正常组, Ⅲ级、 Ⅳ级为异常组,比较两组内镜下表现、食管测压、 24 h食管 pH监测相关指标。结果异常组反流性食管炎(RE)、 Barrett食管(BE)检出率为 73.0%,高于正常组(41.0%)差异有统计学意义(P＜0.05)两组食管上括约肌静息压(UESP)［(57.69±32.65)mmHg比(56.32±28.50)mmHg］差异无统计学意义P＞0.05),异常组食管下括静息压(LESP)［(7.93±3.85)mmHg比(19.64±5.95)mmHg］、远端收缩积分(DCI)［(223.59±195.67)mmHg·s-1·cm-1比(,约肌,(533.64±289.71)mmHg·s-1·cm?1］、 4s综合松弛压(IRP4s)［4.0(3.3,4.8)比 5.6(4.6,6.8)］低于正常组,差异有统计学意义(P＜0.05)。两组食管收缩模式、食管蠕动力度相比,差异无统计学意义(P＞0.05),异常组 Demeester评分［9.02(7.28,16.28)分比 3.57(1.65,5.60)分］、酸反流次数［45.00(25.00,56.50)次比 15.00(10.00,32.00)次］、pH＜4所占的总时间百分比高于正常组,差异有统计学意义(P＜0.05)。结论 GEFV异常者内镜下阳性表现发生率高, GEFV可能参与食管抗反流机制,可以有效的预测反流。     

兰索拉唑联合竹叶石膏汤加减治疗反流性食管炎60例疗效分析

目的观察兰索拉唑联合竹叶石膏汤加减治疗反流性食管炎的临床效果。方法 60例反流性食管炎患者随机分为对照组和观察组,各30例。对照组采用兰索拉唑治疗,观察组在对照组的基础上加用竹叶石膏汤加减治疗。比较两组的治疗效果及治疗过程中并发症发生情况。结果观察组治疗总有效率为93.3%,高于对照组70.0%,差异具有统计学意义(P<0.05)。观察组治疗后治疗后食管括约肌压力、总反流时间百分比、立位反流时间百分比、卧位反流时间百分比均显著优于对照组,差异具有统计学意义(P<0.05)。结论兰索拉唑联合竹叶石膏汤加减治疗反流性食管炎临床效果显著,不良反应少,值得临床推广应用。     

莫沙必利联合兰索拉唑治疗反流性食管炎的效果观察

目的探究莫沙必利联合兰索拉唑治疗反流性食管炎的临床疗效。方法84例反流性食管炎患者,随机分为对照组和试验组,各42例。对照组给予兰索拉唑进行治疗,试验组在对照组基础上联合莫沙必利进行治疗。比较两组的临床治疗效果、治疗前后食管动力学指标和不良反应发生率。结果试验组治疗总有效率95.24%高于对照组的80.95%,差异有统计学意义(P<0.05)。治疗前,两组患者食管括约肌压力、食管括约肌松弛率、蠕动性收缩比比较,差异无统计学意义(P>0.05);治疗后,两组患者食管括约肌压力、食管括约肌松弛率、蠕动性收缩比优于治疗前,且试验组患者食管括约肌压力(18.32±2.77)mm Hg(1mm Hg=0.133 kPa)、食管括约肌松弛率(91.01±3.55)%、蠕动性收缩比(61.22±3.41)%均优于对照组的(13.07±2.87)mm Hg、(82.89±3.48)%、(54.33±3.86)%,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论采用莫沙必利联合兰索拉唑治疗反流性食管炎可改善患者病情,促进食管动力恢复,且安全性理想,值得推荐。     

Barrett食管的动力学研究

目的对比研究Barrett食管（BE）与正常对照组的动力学差异，揭示BE的动力学改变。方法对比分析22例BE患者与18例正常对照的动力学数据。结果食管动力学检查提示，食管下括约肌压力及屏障压明显降低，酸反流总时间、酸反流总次数以及食管下段pH〈4时间百分比均明显增加（P〈0．05或P〈0．01）。结论屏障压的降低及食管廓清能力的下降导致酸反流的产生，进而促进BE的发生。     

胃食管反流性咳嗽患者精神心理因素与食管动力的相关性研究

目的：调查胃食管反流性咳嗽( GERC)患者精神心理状况,探讨其与食管动力的相关性。方法对海军总医院确诊的196例GERC患者行高分辨率食管测压检查,并根据抑郁自评量表( SDS)、焦虑自评量表( SAS)得分情况将其分为4组。 A组无焦虑、抑郁,B组轻度焦虑、抑郁,C组中度焦虑、抑郁,D组重度焦虑、抑郁,观察不同类型、不同程度的精神心理状况对GERC患者食管动力的影响。结果78.1%的GERC患者有不同程度的焦虑、抑郁;焦虑、抑郁的GERC患者食管下括约肌(LES)静息压、远端收缩积分(DCI)下降更明显;大型蠕动中断百分比增加更明显;焦虑、抑郁情况越重以上指标差异越明显,结果均有统计学意义( P<0．05)。结论 GERC患者焦虑、抑郁发病率高,精神心理状态与食管动力之间存在相关性,随着焦虑、抑郁状态加重,食管下端LES静息压及食管运动功能降低。     

反流性食管炎pH值监测正常的原因探讨

目的探讨反流性食管炎（RE）患者食管pH值监测正常的原因。方法经内镜确诊为RE的46例患者，根据食管监测结果分为pH正常组12例和pH异常组34例。比较2组患者食管裂孔疝罹患率、幽门螺杆菌（Hp）感染以及患者食管动力学的改变。结果2组患者食管裂孔疝的构成比无统计学意义，Hp感染率一致。2组下食管括约肌静息压力（LESP）及食管体部中下点及肛侧收缩幅度的比较有统计学意义（P=0．016和P=0．043，P=0．007），均为pH正常组高于pH异常组。剔除食管裂孔疝患者后，食管体部肛侧的收缩幅度（P=0．011）和LESP（P=0．036）仍有明显差异。结论Hp感染对RE患者pH监测并无影响，较强的屏障功能以及清除功能可能是部分RE患者pH监测正常的原因。     

内镜下贲门间隙增宽在诊断反流性食管炎中的价值

目的　探讨贲门间隙增宽在内镜诊断反流性食管炎 (RE)的价值。方法　 2 4例经内镜诊断 RE患者 ,根据反看贲门间隙的大小分为贲门间隙增宽组 (A组 ,12例 )、贲门间隙不增宽组 (B组 ,12例 ) ,分别行食管测压及 2 4h p H监测并与正常对照组 (C组 ,2 0例 )比较。结果　 A组、B组的食管下端括约肌压力 (L ESP)、食管原发蠕动收缩波幅、2 4h p H监测 6项指标均与 C组比较差异有显著性 (P<0 .0 1)。A组与 B组比较 ,食管炎程度差异有显著性 (P<0 .0 5 ) ,L ESP(P<0 .0 1)、食管原发蠕动收缩波幅 (P<0 .0 5 )及 2 4h p H监测 6项指标 (P<0 .0 1)比较差异均有显著性。不同程度 RE与贲门间隙宽度有相关性 (P<0 .0 5 )。结论　内镜下贲门间隙是否增宽是内镜诊断 RE的重要形态学特征 ,在内镜诊断 RE中有一定的价值     

肥胖与食管动力障碍及酸反流的相关性研究

目的：探讨肥胖与下食管括约肌压力（LESP）、食管体部远端收缩压及酸反流之间的关系。 方法：对146例患者进行胃食管反流病（GERD）症状问诊、标准食管测压及24 h食管动态pH监测,分为GERD组和对照组。每组根据体重指数（BMI）又分为非肥胖组（BMI≤27.9 kg/m2）及肥胖组（BMI≥28 kg/m2）。 结果：GERD组中,肥胖者的LESP高于非肥胖者（16.4±4.7 vs. 14.4±3.2 mmHg,P=0.014）。对照组与GERD组两组中的肥胖者的食管体部远端收缩压均显著高于非肥胖者（对照组：107±48 vs. 77±20 mmHg,P=0.04;GERD组：98±44 vs. 79±39 mmHg,P=0.017）。对照组中,肥胖者胡桃夹食管发生率显著高于非肥胖者（25% vs. 0,P=0.031）。GERD组中,肥胖者中无效食管运动（IEM）的发生率显著低于非肥胖者（7% vs. 20%,P=0.035）。两组中肥胖者pH＜4时间百分比均高于非肥胖者（对照组：pH＜4总时间百分比3.0%（0.9~5.6） vs. 1.3%（0.3~2.7）,P=0.003;GERD组：立位pH＜4时间百分比13.2%（5.1~19.2） vs. 10.4%（2.9~18.1）,P=0.001）。BMI与pH＜4时间百分比（P＜0.001）、食管体部远端收缩压（P=0.007）、和LESP（P=0.006）呈正相关。 结论：肥胖者与非肥胖者在食管生理学检查中存在多方面差异,肥胖者的食管动力更强,食管pH＜4时间百分比更高。     

三种不同检查方法在胃食管反流病诊断中的应用比较

目的:探讨电子胃镜、24 h食管pH值监测及胃食管反流病(GERD)Q评分三种方法在GERD诊断中的临床应用价值。方法:将于2011年4月—2012年6月因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为胃镜组、24 h食管pH值监测组及GERD Q评分组,每组40例,分别接受电子胃镜、24 h食管pH值监测及GERD Q问卷评分,比较分析各种方法对GERD的检出情况。结果:24 h食管pH值监测组40例患者中病理性反流者19例,生理性反流者5例,GERD阳性率显著高于胃镜组及GERD Q评分组,差异具有统计学意义(P<0.05);胃镜组与GERD Q评分组之间差异无统计学意义(P>0.05)。结论:24 h食道pH值监测可以对食管内反流情况进行实时、动态监测,为GERD的临床诊断及不同类型的反流治疗方案提供客观、准确的依据。     

Cisapride in the treatment of gastro-oesophageal reflux disease

Prokinetic agents are being used increasingly in medical therapy for gastro-oesophageal reflux disease (GERD). This study examined the effect of 10 mg q.d.s., oral cisapride, or placebo, taken for 12 weeks, on 48 patients with symptoms and endoscopic evidence of GERD. Objective evaluation of benefit was obtained by endoscopy and biopsy, oesophageal manometry, acid reflux provocation test and 24-h oesophageal pH monitoring. Cisapride significantly increased lower oesophageal sphincter pressure (P= 0.003) against baseline and also against placebo, in patients (n= 9) with an hypotensive lower oesophageal sphincter pressure (P < 0.01). The frequency of dyspeptic symptoms was significantly improved in the cisapride group (P= 0.03). Antacid intake, global evaluation of symptoms and a VAS score for symptoms were all better than placebo but failed to reach significance (global evaluation by patients, P= 0.07). Overall, there was no significant improvement in oesophagitis at either 6 weeks (P < 0.05 > 0.3) or 12 weeks (P= 0.07). However, if patients with grades I and II oesophagitis at entry were excluded, cisapride had a significantly greater effect than placebo, 6 weeks (P= 0.05), 12 weeks (P= 0.04). In those with oesophageal ulceration, cisapride was significantly more effective than placebo in inducing healing. Gastro-oesophageal reflux was very variable on both 24-h pH monitoring and acid reflux provocation test. In spite of a 50% decrease in acid exposure on 24-h pH monitoring (cisapride group, mean % pH < 4 day: entry 18.9%, 12 weeks 9.6%), there were no significant intra- or intergroup differences for percentage of time < pH 4, or frequency and duration of episodes, neither pre- or post-prandially, day or night, except for the number of post-prandial episodes during acid reflux provocation tests, which decreased significantly more with cisapride than with placebo (P < 0.05). Thus, oral cisapride when taken for 12 weeks promoted healing of oesophagitis and improved symptoms in patients with GERD; although an increase in lower oesophageal sphincter pressure was observed and a reduction in acid reflux was measured, no significant decrease of acid exposure was seen.     

西少必利治疗婴幼儿胃食管反流分析

目的：评价西沙必利治疗婴幼儿胃食管反流（ＧＥＲ）的疗效。方法：将８０例ＧＥＲ病儿随机分为２组,Ｂ组为西沙必利治疗组,Ｃ组为体位治疗组,取２０例无症状儿为对照组（Ａ组）,观察指标取症状恢复时间,食管ｐＨ值,ＬＥＳＰ检测变化。结果：西沙必利ＧＥＲ疗效确实。Ｂ组总有效率（９０．０％）与Ｃ组（６０．０％）比较有显著性差异（Ｐ〈０．０１）。结论：西沙必利治疗ＧＥＲ确实有效,并无明显副作用。     

Pharmacoeconomic issues of the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist’s practice. Gastroesophageal reflux (GER) describes the retrograde movement of gastric contents through the lower oesophageal sphincter (LES) to the oesophagus. GER can occur physiologically and may be accompanied by symptoms. The introduction of endoscopes and ambulatory devices for continuous monitoring of oesophageal pH (24 h pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes transient lower oesophageal sphincter relaxations (TLESRs), incompetent LES because of a decreased lower oesophageal sphincter pressure (LESP) and deficient or delayed oesophageal acid clearance. Uncomplicated GERD may be treated by modification of lifestyle and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H₂-blockers, prokinetics and proton pump inhibitors (PPIs). Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the oesophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD stressing on pharmacoeconomic issues of the treatment and discusses the advantages and disadvantages for step-up and step-down therapy.     

Pharmacoeconomic issues of the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist's practice. Gastroesophageal reflux (GER) describes the retrograde movement of gastric contents through the lower oesophageal sphincter (LES) to the oesophagus. GER can occur physiologically and may be accompanied by symptoms. The introduction of endoscopes and ambulatory devices for continuous monitoring of oesophageal pH (24 h pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes transient lower oesophageal sphincter relaxations (TLESRs), incompetent LES because of a decreased lower oesophageal sphincter pressure (LESP) and deficient or delayed oesophageal acid clearance. Uncomplicated GERD may be treated by modification of lifestyle and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H2-blockers, prokinetics and proton pump inhibitors (PPIs). Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the oesophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD stressing on pharmacoeconomic issues of the treatment and discusses the advantages and disadvantages for step-up and step-down therapy.     

Clinical trial: persistent gastro-oesophageal reflux symptoms despite standard therapy with proton pump inhibitors - a follow-up study of intraluminal-impedance guided therapy

BACKGROUND: Persistent gastro-oesophageal reflux disease (GERD), despite proton pump inhibitor (PPI) therapy, is a common problem. Combined pH/impedance monitoring (pH/MII) enables detection of reflux episodes. Aim To identify patients with objective episodes of persistent reflux and second, to evaluate the effect of modified therapy based on the results of pH/MII. METHODS: In all, 143 patients were examined with pH/MII because of GERD-symptoms resistant to PPI-therapy. Patients with pathological pH/MII (group 1) and with normal results (group 2) were identified. Therapy modifications were evaluated after a minimum follow-up of 3 months. RESULTS: In 56 of 143 (39.1%) patients, pathological findings in pH/MII were identified. Therapy was escalated in 33/52 patients (group 1) and in 30/71 patients (group 2). Escalating therapy led to symptomatic relief in 90.9% of the patients in group 1 and 43.3% of the patients in group 2 (P < 0.001). CONCLUSIONS: GERD symptoms refractory to PPI-therapy could be objectively identified with pH/MII in almost 40% of all patients. Furthermore, escalating anti-reflux therapy if pH/MII was pathological is associated with a significantly higher rate of successful treatment compared to the patients with normal findings. Therefore, pH/MII facilitates a more focussed therapeutical approach to patients with PPI-resistant GERD.     

食管癌术后残余食管和胸腔胃运动功能对胃食管反流的影响

目的探讨食管癌术后残余食管和胸腔胃运动功能改变对胃食管反流的影响。方法定期对食管中段癌术后患者46例(A组)进行食管测压、显示子胃排空和24-h食管pH监测,结果与健康志愿者11例(B组)作比较。结果 A组手术后和术后12个月残余食管和胸腔胃运动功能均低于B组(P<0.01和P<0.05)。A组胸胃排空率与DeMeester评分之间以及长于5min反流评分与残余食管原发蠕动幅度、蠕动次数之间均无相关关系(P>0.05)。结论食管癌术后胸腔胃和残余食管运动功能的恢复不足以减轻胃食管反流以及改善食管酸清除功能。