胃食管反流病的诊治进展

胃食管反流病（GERD）是指胃内容物反流入食管、口腔（包括喉部）或肺所致的症状和并发症[1]。流行病学显示,GERD在西方国家的发病率为10%～20%[2];在亚洲的发病率已上升至10.5%。GERD主要包括非糜烂性胃食管反流病（NERD）、反流性食管炎（RE）和Barrett食管。1 GERD的典型症状烧心和（或）反流是GERD的典型症状,但需注意的是它们并不是GERD所特有的症状。烧心和（或）反流在GERD中的特异性约为70%,亦可见于消化性溃疡、功能性烧心、嗜酸性细胞性食管炎、食管癌或胃癌等患者。     

胃食管反流病的诊断

胃食管反流病是消化系统常见病，是指胃十二指肠内容物反流入食管引起的烧心等症状。其诊断治疗存在很多争议。24h食管pH检测被认为是胃食管反流病的金标准，质子泵抑制剂治疗检测也具有较高特异性。内镜检查及食管黏膜活检对诊断食管黏膜破损严重者具有较高的诊断治疗价值。食管的X线表现同样也是安全方便的检测方法，应予以重视。     

胃食管反流病的临床类型及表现

本文简介了胃食管反流病（GERD）的蒙特利尔全球定义、食管综合征和食管外综合征,重点叙述了GERD的三个类型及其临床表现,对提高理论认识有帮助。     

胃食管反流病的诊断进展

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,临床可分为非糜烂性反流病（NERD）,反流性食管炎（RE）和Barrett食管（BE）三种类型。GERD是消化科门诊最常见疾病之一,在欧美的发病率达到10％～20％,年发病率约为0．38％～0．45％,在我国的发病率也呈逐年上升的趋势。     

胃食管反流病的病理生理学与治疗进展

胃食管反流病（Gastroesophageal reflux disease，GERD）是由胃内容物反流引起不适和（或）并发症的一种疾病，是影响胃肠道的常见病之一。GERD可分为以下三种类型：非糜烂性反流病（Non-erosive reflex disease，NERD）、糜烂性食管炎（Erosive Esophagitis，EE）和Barrett食管（Barrett＇s Esophagus，BE），也可称为GERD相关疾病。本文拟对近年来NERD和EE的病理生理学和治疗的研究作一综述。     

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。     

老年人胃食管反流病

胃食管反流病是指反流至食管的胃或十二指肠内容物（主要是胃酸或／和胆汁）过多,或在食管内停留时间过长,腐蚀食管黏膜,致使胃食管反流病发生。根据内镜下表现的不同,胃食管反流病可分为非糜烂性和糜烂性胃食管反流病（后者又称反流性食管炎）,据有关资料报告,     

非糜烂性反流病的认识现状

胃食管反流病（gastroesophageal reflux disease，GERD）是临床常见病，严重影响患者的生活质量。亚太地区GERD的患病率较西方国家低，我们采用中国GERD研究协作组改良的中文版反流性疾病问卷在广东省社区人群中调查发现，社区人群中GERD的患病率为2．3％，而每周至少有一次烧心和（或）反酸症状者占6．2％。GERD包括糜烂性食管炎（erosive esophagitis，EE）、非糜烂性反流病（nonerosive reflux disease，NERD）和Barrett食管（BE），约70％的GERD表现为NERD。     

加强对胃食管反流病几个热点问题的研究

胃食管反流病（GERD）是一种常见胃肠道疾病。近年研究进展，尤其是内镜下食管炎的洛杉矾分类、蒙特利尔GERD全球定义和分类以及Barrett食管的布拉格C＆M分类标准，使我们对该病的认识逐步深入，但仍有诸多问题有待进一步研究。内镜下“微小病变”食管炎的诊断、非糜烂性反流病（NERD）的特点及其与功能性烧心的鉴别、非酸性反流的检测及其意义以及Barrett食管的诊断和治疗均为今后研究的热点。     

老年人胃食管反流病的治疗

胃食管反流病（GERD）患病率随增龄而增加,老年人是GERD的高危高发人群。老年人GERD治疗的目标是：缓解症状（食管症状及食管外症状）、愈合食管破损黏膜、预防和治疗并发症、防止复发。[第一段]     

老年胃食管反流病患者高分辨率食管测压压力特点分析

目的探讨老年胃食管反流病患者高分辨率（HRM）测压压力特点。方法2011年6月至2012年9月对反酸、烧心伴胸骨后不适等症状的老年患者行HRM检测,分析其食管动力特点。结果老年反流性食管炎（RE）组的下食管括约肌（LES）总长度、腹腔内LES长度、LES平均静息压分别为（2．50±0．62）cm、（1．90±0．19）cm和（21．48±8．48）mmHg,低于老年非糜烂性反流病（NERD）组的（3．33±0．43）cm、（2．50±0．46）cm和（24．83±O．64）mmHg（P〈0．05）。结论老年RE患者存在明显的抗反流机制障碍,在其发病机制中可能发挥重要作用。而老年NERD患者的食管运动功能失调不明显,推测其他机制可能参与了其发病过程。     

老年胃食管反流病临床特征的研究

目的分析老年胃食管反流病（GERD）患者的临床症状和治疗反应的特点,为提高老年GERD诊治水平提供依据。方法选取2011年2月22日至2012年9月23日期间在仁济医院门诊确诊并进行药物治疗的老年GERD患者（≥60岁）55例,随机抽取同期诊治的非老年GERD患者（〈55岁）55例作为对照。比较分析2组GERD患者的临床症状、内镜下表现、食管运动、酸反流特征以及药物治疗反应等方面的差异。结果老年组GERD患者烧心症状少于非老年患者（P〈0．001）;老年组食管体部运动缺乏、下食管括约肌压力（LESP）较低,但两组酸反流DeMeester评分相当（P=0．112）。两组质子泵抑制剂（PPI）治疗反应均较好（P=0．85）。但PPI初治疗效不理想的老年GERD对加用莫沙必利有治疗反应的患者少于非老年组。结论老年GERD与非老年GERD存在诸多不同特点,了解这些特点对改善老年GERD治疗效果有益。     

Symptoms of gastro-oesophageal reflux disease in elderly people.

The frequency and the possible age-related characteristics of gastro-oesophageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p less than 0.001). The occurrence of heartburn and regurgitation did not differ significantly between patients with or without oesophagitis, although the mean symptom scores were higher in those with oesophagitis. Dyspepsia and chest pain were not typical symptoms in oesophagitis. Of patients with oesophagitis 29% had no typical symptoms of GORD; only 24% of patients with regurgitation had oesophagitis. In 24-hour pH monitoring, a significant increase in the occurrence of symptoms was not seen until total reflux time pH less than 4 exceeded 10%. The occurrence of heartburn did not correlate with the extent of reflux in the pH study. In conclusion, typical symptoms of GORD in the aged were regurgitation, dysphagia, respiratory symptoms and vomiting rather than heartburn.     

老年胃食管反流病的诊断及治疗进展

1老年胃食管反流病的流行病学特征 胃食管反流病（gastroesophageal reflux diseases,GERD）是指胃内容物反流引起的不适症状和／或并发症的一种疾病。GERD是老年人常见的消化系统疾病之一。     

Pulmonary function in gastro-oesophageal reflux disease of elderly people.

An effect of gastro-oesophageal reflux disease (GORD) on respiratory function was studied in elderly patients. Twenty-seven patients with, and 29 patients without, abnormal gastro-oesophageal reflux (GOR) in 24-hour pH monitoring were included in the study. Symptoms suggestive of gastrooesophageal reflux disease were recorded and spirometry was performed in all the patients. Patients with abnormal GOR had lower vital capacity (percentage of predicted value) (VC%) than those with normal pH monitoring result (92 vs 102, p = 0.032). Forced vital capacity (FVC%) and forced expiratory volume in one second (FEV1%) did not differ between these two groups. Thirty-two per cent of patients with slight and 73% of patients with moderate or severe reflux in pH monitoring had abnormal VC%, FVC%, or FEV1% (less than 80% of predicted value) at spirometry (vs 30% of patients without reflux, p = 0.039). When patients were divided according to their symptoms suggestive of GORD, lower VC%, FVC%, and FEV1% were found in patients with than in those without symptoms (87 vs 102, p = 0.0018; 76 vs 91, p = 0.0099; 80 vs 93, p = 0.0026). In conclusion, mainly a restrictive ventilatory defect was associated with GORD in elderly patients.     

Clinical analysis of endoscopy negative gastroesophageal reflux disease in the elderly]

The purpose of this study was to describe the clinical analysis of endoscopy negative gastroesophageal reflux disease (EN-GERD) in the elderly. 35 elderly patients of both sexes, 60 years or older with EN-GERD, 33 elderly patients with reflux esophagitis and 41 elderly patients as control group were included in this study. All patients witnessed verbal informed consent to participate in the study. EN-GERD was defined as the patients with normal endoscopy despite of heartburn as their chief complaint and who were completely relieved with heartburn after one-week omeprazole treatment. Helicobacter pylori infection between EN-GERD, reflux esophagitis and control were 37.1%, 24.2% and 56.1%, respectively. The gastric mucosal atrophy under endoscopic findings and the serum pepsinogen I, II ratio in EN-GERD had no significant differences with control. A hiatus hernia with EN-GERD was diagnosed 37.1%, which was lower significantly than 87.9% with reflux esophagitis. The motility of the stomach using the acetaminophen method was the same in patients with EN-GERD, reflux esophagitis and control. The anxiety score of the Hospital Anxiety and Depression Scale was significantly higher in the patients with EN-GERD than in those with reflux esophagitis and control. On the other hand, the severity of reflux symptoms in the patients with EN-GERD was similar as those with reflux esophagitis. We concluded that general anxiety plays an important role in the severity of the reflux symptoms in the patients with EN-GERD. As such symptoms in EN-GERD significantly impair the quality of life, further studies of patients with EN-GERD are greatly needed.     

Prevalence and characteristics of symptomatic gastroesophageal reflux disease in the elderly.

OBJECTIVE: To study prevalence and characteristics of symptomatic gastroesophageal reflux disease in the elderly. DESIGN: Survey by questionnaire of stratified random sample. SETTING: City of Turku, Finland. SUBJECTS: Population-based random sample consisting of non-institutionalized subjects aged 65 years or over. A questionnaire was sent to 559 subjects. The response rate was 92%. Twenty-nine incompletely filled forms were rejected. Thus, the questionnaires from 487 subjects, representing 87% of the original number, constitute the basis for the study. MEASUREMENTS: The questionnaire inquired about the following symptoms: heartburn, regurgitation, chest pain, dysphagia, dyspepsia, respiratory symptoms, vomiting, and belching. RESULTS: The age-adjusted prevalence of daily symptoms suggestive of gastroesophageal reflux disease was 8% in men and 15% in women (P < 0.05). Fifty-four percent of men and 66% of women reported that they had symptoms at least once a month (P < 0.05). The prevalence of symptoms was roughly the same across age groups. The occurrence of chest pain, dyspepsia, vomiting, belching, dysphagia, chronic cough, hoarseness, and wheezing were associated with symptoms suggestive of gastroesophageal reflux disease. CONCLUSIONS: Symptoms suggestive of gastroesophageal reflux disease are common in elderly subjects. Women suffer from these symptoms more frequently than men. Typical reflux symptoms are often associated with atypical complaints, such as abdominal symptoms, chest pain, or respiratory symptoms.