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。     

基于“滞、郁、瘀、虚”疾病观论治胃食管反流病

<正>胃食管反流病(gastroesophageal reflux disease, GERD)是胃、十二指肠的内容物反流入食管的疾病,以反酸、烧心为主要表现,有时也会伴有胸骨后灼痛、口苦、嗳气、反胃等症状,以及咳嗽、咽喉不适、咽部异物感等食管外症状^[1],严重影响患者的日常工作、生活。近年针对中国社区人群的调查显示,中国人群GERD患病率约为7.69%,且呈逐年上升趋势^[2]。魏师临证三十余载,善用经方及对药治疗脾胃病,经过多年的观察总结,     

胃食管反流病动力障碍的诊断与治疗

胃食管反流病(GERD)是指胃内容物反流入食管,引起不适症状和(或)并发症的一种疾病,其典型症状为烧心、反酸、胸骨后疼痛.     

功能性胃肠病与胃食管反流病重叠发病的研究

目的 调查功能性胃肠病(FGIDs)患者重叠胃食管反流病(GERD)的发病率.方法 收集2006年8～10月解放军总医院消化科门诊FGIDs患者492例,调查其重叠GERD的情况.包括功能性消化不良(FD)、肠易激综合征(IBS)、慢性功能性便秘(CC)、功能性腹泻(F-D)、功能性腹胀(FB)和功能性嗳气(BD).FGIDs的诊断参照罗马Ⅲ标准;GERD的诊断按照耐信(RDQ)量表,以烧心、胸骨后疼痛感、反酸和反食症状的程度和频度积分≥12分作为判断标准.结果 492例FGIDs患者重叠GERD者达73例,重叠率为14.84%.重叠GERD组和无重叠组相比.患者的性别、年龄、病程、居住地、吸烟史及饮酒史差异无统计学意义(P>0.05).重叠率最高的3种FGIDs依次为FD、CC和IBS.FD患者重叠GERD者21.32%;CC患者重叠GERD者19.35%;12.55%的IBS患者重叠GERD.重叠率最低的FGIDs为BD,重叠率7.69%.302例单一FGIDs患者,重叠GERD者37例,重叠率为12.25%;190例重叠FGIDs患者,重叠GERD者36例,重叠率为18.95%.两组GERD重叠率比较差异有统计学意义(P<0.05).重叠GERD最多的单一FGIDs为FD,重叠率21.62%;其次为F-D和BD,单一FB未见重叠GERD患者.结论 按照罗马Ⅲ诊断标准,FGIDs患者重叠GERD常见.重叠率最高的3种FGIDs依次为FD、CC和IBS,重叠率最低的FGIDs为BD.重叠GERD最多的单一FGIDs为FD,其次为F-D和BD,单一FB未见重叠GERD患者.重叠FGIDs组GERD的重叠率明显高于单一FGIDs组.     

消化内科门诊胃食管反流病诊断问卷诊断胃食管反流病的状况及症状特征分析

目的利用胃食管反流病诊断问卷（Reflux disease questionnaire,RDQ）分析消化专家门诊胃食管反流病（GERD）患病情况及患者症状特征。方法对就诊于我院消化专家门诊的1636例患者进行RDQ问卷调查,得分≥12分者诊断为GERD。根据RDQ内容对GERD患者症状特点进行分析。结果1636例消化专家门诊的患者中,GERD的发生率为10．8％。男女发病无差异（11．0％VS10．5％,P〉0．05）。60岁以上年龄组GERD的患病率最高（14．6％）,而15～30岁年龄组患病率最低（7．7％）。各年龄组内患病率性别间比较差异无显著性。GERD症状中,烧心与反酸为最常见的症状。症状频率积分比严重程度积分更重要（P〈0．05）。结论消化门诊就诊患者GERD患病率较高。GERD患病无性别差异。老年人的GERD患病率高于其他年龄组。烧心和反酸为GERD最常见的症状。症状发生频率比严重程度对GERD的诊断更有意义。     

胃食管反流病的全球定义和分类-胃食管反流病的蒙特利尔共识意见介绍

胃食管反流病（Gastro-Esophageal Reflux Disease，GERD）是指胃十二指肠内容物反流至食管，引起食管症状和并发症的一类疾病。GERD在西方国家属常见病，患病率为7％～15％。北京、上海流行病学调查，估计我国GERD患病率为5．77％，广东省社区人群中调查发现，每周至少有1次烧心和（或）反酸症状者占6．2％。6％～14％的GERD可能演变为Barrett食管（Barrett＇s Esophagus，BE），而0．5％～1．0％的BE又可能与食管腺癌的发生有关。GERD的典型症状为烧心、反流；还有一些不典型症状如嗳气、上腹痛、恶心、胸骨后痛；食管外表现如哮喘、慢性咳嗽、咽部异物感、声音嘶哑等。近年来，GERD的诊断与心血管和呼吸系统疾病的关系及其鉴别诊断受到临床医生的重视。     

反流性疾病问卷表在军人胃食管反流病中的诊断价值

[目的]探讨反流性疾病问卷表(RDQ)在军人胃食管反流病(GERD)中的诊断价值。[方法]采用多阶段、分层、整群随机抽样的方法对驻闽某部军人进行反流性疾病问卷调查,记录被调查者过去4周内烧心、非心源性胸痛、反酸和反流4种症状出现的频率和程度积分,以RDQ评分≥12分作为GERD的诊断标准,计算军人中GERD的患病率,同时分析经电子胃镜检查证实为反流性食管炎(RE)患者的RDQ评分情况。[结果]研究得出军人GERD的患病率为6.77%,经胃镜检查420例中明确诊断为RE 60例(RE组)和内镜检查正常360例(非RE组)的RDQ评分差异有统计学意义(P0.01),说明评分与发生RE之间有较大关联。[结论]RDQ评分量表可以作为初步诊断军人GERD的一个良好的筛选试验。     

胃食管反流病和口腔相关疾病的研究

胃食管反流病（gastroesophageal reflux disease，GERD）是由于下食管括约肌功能障碍引起胃内容物反流导致的一系列慢性症状和食管黏膜损害。与GERD相关的症状多种多样，如烧心、反酸、胸骨后疼痛、哮喘、慢性咳嗽、咽部球样感、声音嘶哑、肺炎等。Fass等^[1]提出将其分为三类，即典型症状、不典型症状与消化道外症状。     

质子泵抑制剂治疗持续不卧床腹膜透析患者胃食管反流症状的疗效观察

目的 评估慢性肾功能衰竭持续不卧床腹膜透析(CAPD)患者的胃食管反流症状及质子泵抑制剂治疗的疗效.方法 选取2008年1月至7月一般情况良好、透析充分的CAPD患者58例,采用胃食管反流病诊断问卷(RDQ)评估其胃食管反流症状.RDQ累积评分≥6分且<12分者给予埃索美拉唑镁肠溶片20 mg每日 1次,对于RDQ累积评分≥12分者给予上述药物每日2次,每次20 mg.4周后再次评估RDQ评分,判断疗效.结果 各种消化道症状的出现频率中反流症状出现频率最高(64.7%),其次为反酸(52.9%)、非心源性胸痛(47.1.%)和烧心(17.6%).PPI治疗4周后RDQ分值较治疗前降低(P<0.05);治疗前RDQ评分总分≥12分者和<12分者疗效比较差异无统计学意义(P=0.059).结论 PPI能缓解CAPD患者的胃食管反流症状,但其疗程以及疗效评估尚需进一步研究证实.     

质子泵抑制剂(奥美拉唑)试验在胃食管反流病中的诊断价值

目的　探讨质子泵抑制剂奥美拉唑 (商品名 :洛赛克 )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、胃镜检查结果 ,将 15 2例有反流症状的GERD(12 3例 )与非GERD病人 (2 9例 )随机、双盲分成奥美拉唑 2 0mg/d(A组 ,5 0例 )、40mg/d(B组 ,5 1例 )及对照组 (C组 ,5 1例 ,第一周用安慰剂 ,第二周改用奥美拉唑 40mg/d) ,服药时间为 1周和 2周 ,记录服药前后病人烧心、反酸、反食、胸骨后疼痛症状积分的改变 ,按症状积分下降值判定诊断 ,与食管 2 4hpH监测、胃镜检查结果进行对比分析。结果　A、B、C三组的GERD病人 ,服药 1周后反流症状积分下降分别为 :5 .0± 4.8、4.9± 4.6、2 .3± 4.0 ,下降率分别为 35 .5 %、34 .9%、15 .3%。以症状积分下降 2分为标准 ,奥美拉唑试验诊断GERD的价值最佳。不同服药剂量分析 ,2 0mg/d服 1周组 ,试验敏感性、特异性分别为 82 .5 %、40 .0 %,符合率 76 .7%;40mg/d组则分别为88.1%、44 .4%和 81.0 %。两者比较差异无显著性。对服药时间分析 ,则以服奥美拉唑 2 0mg/d 1周为佳。结论　奥美拉唑试验是GERD临床诊断的一种可靠方法。     

不同症状评估方式对胃食管反流病诊断价值比较研究

目的比较反流性疾病问卷的不同评价方式,评价问卷价值。方法对2007年3月至2010年12月北京大学人民医院消化科300例患者进行反流性疾病问卷调查、胃镜及动态食管pH监测,比较常用问卷积分、蒙特利尔定义及各症状频率×程度评分之和的差异。结果 (1)"蒙特利尔定义"诊断GERD敏感度最高(67.4%),"各症状频率×程度积分之和"特异度最高(61.2%),取"RDQ总分≥14分"时,Youden指数最大。经Kappa检验,3种方式差异无统计学意义。(2)以"RDQ≥12分"为阳性标准,食管炎阴性预测值为75.4%;阳性患者总反流次数、餐后反流次数、餐后长反流次数、pH<4总时间及立位时间百分比、DeMeester评分及反流面积指数增加(P<0.05);RDQ总分与总反流及餐后反流次数、立位pH<4时间百分比及反流面积指数呈正相关。结论不同问卷评价方式差异无统计学意义。症状问卷对反流性食管炎阴性预测意义较大,问卷总分与pH监测指标呈正相关。     

福建省人群胃食管反流病流行病学调查

目的 探讨福建省人群胃食管反流病(GERD)发病情况,分析与之相关的危险因素.方法 采用整群分层随机抽样的方法,对福建省福州市人群进行GERD症状及危险因素问卷调查.按反流病诊断问卷(RDQ)评分定义,总积分≥12分为GERD组,＜12分为非GERD组,对两组行相关因素分析.结果 共调查1347例对象,GERD患病率为8.76%(118/1347).男女比例为1∶1.09,差异无统计学意义(x2=0.243,P＞0.05).40岁以上人群GERD患病率较40岁以下人群明显增高(P＜0.05).不同职业GERD患病率统计显示,商人患病率最高[17.91%(12/67)]、离退休者次之[13.48%(12/89)]、军人最低[2.94%(2/68)].GERD组中腹胀、嗳气、恶心、呕吐、纳差等症状的发生率及喉炎、咽炎、口腔溃疡等疾病的发生率均高于非GERD组(P＜0.01).年龄、肥胖、吸烟、常食油腻、进食过饱、常食辛辣食物、常进甜食、常饮咖啡、常饮浓茶和便秘等可能是GERD的危险因素.结论 福建省人群GERD患病率较高,且多种因素与反流密切相关.     

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.     

胃食管反流病与颈椎病相关性研究

目的探讨颈椎病患者是否为胃食管反流病(gastroesophageal reflux disease,GERD)的高发人群。方法 321例经临床及磁共振诊断为颈椎病的患者作为颈椎病组,同期选取249名健康体检者作为对照组,进行RDQ评分问卷调查,比较颈椎病组及对照组的RDQ评分及GERD发生率差异是否有统计学意义,颈痛程度与RDQ评分是否相关,并对可能危险因素及颈椎病分型情况进行统计学分析。结果颈椎病组RDQ评分明显高于对照组(P0.05);以RDQ评分≥12分作为GERD评判标准,颈椎病组GERD 43例(13.4%),对照组GERD 17例(6.8%),颈椎病组GERD发生率明显高于对照组(P0.05);不同颈痛程度组间RDQ评分差异有统计学意义(P0.05);各型颈椎病中,交感神经型发生GERD的风险明显高于其他各型(P0.05);颈椎病合并GERD的危险因素主要为女性、非甾体抗炎药和精神心理因素。结论颈椎病患者发生GERD的风险较高,且以交感神经型最为显著。女性、药物和精神心理因素是颈椎病合并GERD的主要危险因素。     

Comparison of central and intraesophageal factors between gastroesophageal reflux disease (GERD) patients and those with GERD‐related noncardiac chest pain

Gastroesophageal reflux disease (GERD) causes a wide range of symptoms. Some patients present with typical symptoms such as heartburn and regurgitation and others with atypical symptoms such as chest pain. The mechanism responsible for the varying clinical presentation of GERD is still not fully elucidated. The aim of this study was to prospectively evaluate differences in central and local intraesophageal factors between patients with typical GERD symptoms and those with noncardiac chest pain (NCCP). Patients presenting with typical and atypical symptoms suspicious of GERD underwent upper endoscopy and 24‐hour pH monitoring with four sensors, each positioned at a different esophageal level. All patients completed GERD symptom, Hospital Anxiety and Depression Scale, and Symptom Stress Rating questionnaires. From January 2006 to December 2009, 50 patients were recruited, 29 with typical symptoms, and 21 with NCCP. Patients with proven GERD and NCCP had higher proximal extension of acid during reflux episodes than patients with typical symptoms. They were found to be older, had a shorter history of symptom onset, worse anxiety scores, and more endoscopic findings compatible with gastritis. Proximal extension of acid during the reflux episodes in patients with GERD presenting with NCCP may play a role in symptom generation.     

Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea

BACKGROUND AND AIMS: This study estimated the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Asan-si, Korea, as the prevalence is believed to be lower than in Western countries. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed on randomly selected 2,240 Asan-si residents aged between 18 and 69 yr. All respondents were interviewed at their homes or offices by a team of interviewers. RESULTS: Of the 1,902 eligible subjects, 1,417 (78.4%: male 762; female 655) were surveyed. The prevalence of heartburn occurring at least once a month, at least once a week, and at least twice a week was 4.71% (95% confidence interval (CI), 3.6-5.8), 2.0% (95% CI, 1.2-2.7), and 1.3% (95% CI, 0.7-1.9), respectively. The corresponding figures for acid regurgitation were 4.4% (95% CI, 3.3-5.5) and 2.0% (95% CI, 1.3-2.8), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). No significant difference was detected between sexes. The prevalence of heartburn was associated with increasing age (p < 0.001). Nineteen percent of our population reported at least one of the atypical symptoms, for instance, chest pain, dysphagia, globus sensation, asthma, bronchitis, pneumonia, or hoarseness. The frequency of frequent GERD among subjects reporting any of the atypical symptoms was 12.6%, which was higher than that of the subjects without atypical symptoms. Patients with typical reflux symptoms were more common among those with atypical symptoms, compared to those without such symptoms (p < 0.001). Using a logistic regression model after adjusting for age and sex, typical reflux symptoms were associated with chest pain (odds ratio (OR), 9.3; 95% CI, 5.9-14.7), dysphagia (OR, 6.4; 95% CI, 2.8-14.7), globus sensation (OR, 3.9; 95% CI, 1.5-9.7), hoarseness (OR, 4.3; 95% CI, 1.4-13.1), asthma (OR, 2.6; 95% CI, 1.4-4.8), and bronchitis (OR, 1.2; 95% CI, 0.6-2.3). CONCLUSION: The prevalence of GERD was 3.5% in this Korean population. Heartburn and acid regurgitation were significantly associated with chest pain, dysphagia, globus sensation, hoarseness, and asthma.