核素显象在慢性支气管炎、支气管哮喘并胃食道返流中的应用

为探讨慢性支气管炎（慢支）、支气管哮喘（哮喘）与胃食道返流（ＧＥＲ）的关系，我们采用放射性核素显象对２９例慢支、３２例哮喘患者及９例正常对照者进行研究。结果：慢支组和哮喘组并发ＧＥＲ的发生率分别为５ｌ．７４％和３７．５０％，而对照组未发现ＧＥＲ；胃食道核素显象诊断ＧＥＲ的敏感性为１００％，特异性为６８．４２％，诊断正确率为８０％；慢支、哮喘并发ＧＥＲ者与其无ＧＥＲ者之间肺通气功能值差异无显著性（Ｐ＞０．０５）；肺核素显象未发现肺吸入返流物现象。提示：慢支和哮喘患者伴有较高的ＧＥＲ发生率，从而推测慢支、哮喘与ＧＥＲ之间有密切的关系。     

Chronic cough and gastroesophageal reflux.

We reviewed the charts of 20 patients with chronic cough of unknown cause who had been referred to a tertiary care respiratory centre from 1980 to 1984 to determine whether gastroesophageal reflux (GER) was a contributing factor. Fifteen of the patients complained of symptoms suggestive of GER: radiologic investigation of the upper gastrointestinal tract revealed hiatus hernia and GER in four, hiatus hernia alone in three, GER alone in two, decreased esophageal peristalsis in one and normal findings in four. Fibreoptic bronchoscopy in the four former smokers and one nonsmoker showed diffuse mucosal erythema. A chest x-ray film in one patient showed an infiltrate at the base of the right lung; transbronchial biopsy revealed vegetable material, which confirmed pulmonary aspiration. A 3-month course of medical antireflux treatment (dietary and lifestyle changes, elevation of the head of the bed and administration of cimetidine, antacid and metoclopramide) relieved the chronic cough in 14 of the 20 patients. Of the remaining patients one was lost to follow-up and five had GER confirmed by means of esophagoscopy, esophageal motility testing and long-term intraesophageal pH monitoring; four of the five patients underwent fundoplication and were asymptomatic 3 months after surgery. Antireflux therapy should be considered in patients with chronic cough when other causes have been ruled out, even if there are no GER symptoms. If the treatment fails, full investigation for GER is recommended; if GER is confirmed, surgery should be considered.     

Gastroesophageal reflux and recurrent/chronic pulmonary disease in infants and children

It is now widely recognized that gastroesophageal reflux (GER) causes many symptoms in infants and children; however, the implication of a causal relationship between GER and pulmonary disease still raises skepticism in many clinicians. Recurrent or chronic pulmonary disease (CPD) is a significant cause for morbidity and mortality in infants and children. There is no single, reliable, diagnostic test that consistently demonstrates that pulmonary symptoms are caused directly by GER. This contributes to lack of firm association between GER and CPD. Is GER a contributory factor to the severity of the pulmonary disease, as in chronic asthma? Is it the primary cause of all the respiratory pathophysiology? Or, is GER the result of altered pulmonary mechanics? These are questions that remain unanswered. The purpose of this article is to review the literature raising skepticism among clinicians, paving the way for future directions of research.     

胃食管返流病并支气管哮喘17例临床分析

目的:探讨胃食管返流(GER)与哮喘的关系。方法:对17例以哮喘为主要表现的胃食管返流病(GERD)患者进行食管24 h pH值监测及胃镜检查并进行抗返流治疗,以19例无呼吸系统症状的GERD患者作为对照。结果:以哮喘为主要表现的GERD患者食管24 h pH监测的各项指标与对照组比较差异有显著性,胃镜结果差异无显著性,抗返流治疗对哮喘治疗有效,提示哮喘症状与酸返流密切相关。结论:胃食管返流病并哮喘症状的患者酸返漉比普通GERD患者重;24 h食管pH监测有助于了解哮喘患者的症状与GER的相关性;对有GER并哮喘症状的患者,抗返流治疗可显著改善其症状。     

Lipid-laden alveolar macrophage index in sputum is not useful in the differential diagnosis of pulmonary symptoms secondary to gastroesophageal reflux

BACKGROUND: Gastroesophageal reflux (GER) is frequently associated with pulmonary diseases. Esophageal acid-induced bronchoconstriction and recurrent microaspirations of gastric content are the proposed mechanisms. At present there is not a sensitive test available to prove a causal relationship between pulmonary symptoms and GER. In this study we aimed to investigate the value of a marker of aspiration: lipid-laden alveolar macrophage index (LLAM) in induced sputum, in the diagnosis of pulmonary symptoms highly suspected to be due to GER. METHODS: Twenty-two patients with the endoscopic diagnosis of erosive esophagitis who had various pulmonary symptoms that could not be attributed to any apparent etiology constituted the study group. Fifteen healthy volunteers with no prior diagnosis of gastroesophageal and lung disease constituted the control group. Subjects were questioned for pulmonary and abdominal symptoms and underwent physical examination, chest radiography, pulmonary function tests, and sputum induction. Prepared cytospins were stained with oil red-O to detect cytoplasmic lipid droplets and LLAM index was calculated. RESULTS: There was no statistically significant difference between the LLAM indexes of the study (1.9 +/- 3.3) and control group (4.2 +/- 4.5). LLAM index had a significant positive correlation with the duration of reflux symptoms (p=0.01, r=0.5). CONCLUSIONS: LLAM index is not found to be a valuable method in the differential diagnosis of pulmonary symptoms suspected to be due to GER.     

胃食管反流病的研究进展

胃食管反流病在国内十分常见,发病率也逐年升高,患者的临床表现复杂多样,大部分表现为典型的胃烧灼感及反流症状,少部分患者表现为咽喉或呼吸系统等食管外症候,极少部分并发Barrett食管及食管腺癌。该病发病机制复杂,危险因素众多,严重影响人们的生活质量,且目前对该病的诊断标准尚未达成统一意见。国内外关于本病的发病机制及危险因素的研究较多,这些深入研究也促进了胃食管反流病诊断技术的不断发展。     

24-hour gastroesophageal double pH monitoring acid and alkaline gastroesophageal and duodenogastric refluxes in pediatric patients

ｎｏｒｄｅｒｔｏｕｎｄｅｒｓｔａｎｄｔｈｅｐｈｙｓｉｏｐａｔｈｏｌｏｇｉｃｎａｔｕｒｅｏｆａｃｉｄｇａｓｔｒｏｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘ（ａｃｉｄＧＥＲ）,ａｌｋａｌｉｎｅｇａｓｔｒｏｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘ（ＡＧＥＲ）ａｎｄｄｕｏｄ...     

以呼吸道症状为主的胃食管反流病的临床分析

目的探讨胃食管反流病（gastroesophageal reflux disease,GERD）患者中呼吸道症状与胃食管反流（gas-troesophageal reflux,GER）之间的关系。方法对30例有咳嗽、哮喘等呼吸道症状,胸部X线检查及鼻部检查正常,怀疑有胃食管反流的患者进行内镜检查,行24h食管pH监测,记录患者反流与呼吸道症状;记录24h食管pH〈4的反流次数、反流时间〉5min的次数、最长反流时间,Demeester积分,计算总、立位、卧位pH〈4的时间占监测时间的百分比,并与健康对照组（12例）进行比较;并利用症状相关概率（symtom association probability,SAP）分析症状与反流的相关性。对Demeester总积分≥14.72,和（或）症状与反流SAP≥75%者进行相应抗反流治疗。结果30例患者中胃镜检查示反流性食管炎6例,24h食管pH监测中SAP≥75%有17例,根据Demeester总积分≥14.72及SAP≥75%有26例诊断为GRED,对确诊的26例经12周抗反流治疗,反流症状及呼吸道症状完全缓解的15例,8例明显减轻。3例无明显变化。结论GER是非典型的GERD中呼吸道症状发生的重要因素;以呼吸道症状为主的GERD中以非糜烂性反流病（non-erosive reflux disease,NERD）为主;24h食管pH监测结合症状相关性分析是诊断非典型GERD的重要手段;抗反流治疗对此类患者呼吸道症状的改善有较好的效果。     

巧克力诱导胃酸分泌前后对胃-食管返流病X线检出率的影响的初步研究

目的评价巧克力诱导胃酸分泌增加对胃-食管返流病的影响。方法通过对A组50名健康者和B组50胃-食管返流病（GERD）患者接受胃酸分泌试验（诱导前）和巧克力诱导胃酸分泌情况（诱导后）,对胃-食管返流的影响作用分析。结果两组的受试者巧克力诱导后胃酸分泌较诱导前明显增高,两组相比有显著性差异（P〈0.01）。诱导后A组GER阳性率与诱导前两组相比差异无显著性（P〉0.05）。B组GER阳性率与诱导前两组相比差异有显著意义（P〈0.01）。结论巧克力诱导胃酸分泌过多时,基础胃酸分泌量增加,但对健康者GER的影响无显著关系,对GERD的患者GER影响较大。     

改变生活方式在治疗胃食管反流病中的作用

胃食管反流病(GERD)是指过多的胃、十二指肠内容物反流到食管引起反酸、胃灼痛等症状和食管黏膜的损害,以及口咽、喉、气管等食管以外组织的损害。此病发病率有增高趋势,严重影响患者的生活质量,并花费了大量医疗资源,改变生活方式是GERD的基础治疗。改变生活方式在治疗GERD的地位越来越重要,现专门针对生活方式的改善作相关综述。     

实验性胃功能障碍与胃食管返流关系的猪仔模型研究

目的：探讨实验性猪仔胃功能障碍性因素与胃食管返流的关系。方法：新生猪仔40只，随机分成5组，膈食管韧带切开，食管裂孔开大，胃壁部分浆肌层破坏，幽门十二指肠上段部分缝合闭锁造成不全梗阻等4组猪仔模型及对照组，术前，术后行胃肠钡餐透视，食管测压，猪仔生长至12-16周时处死，行大体解剖观察及病理学观察。结果：对照组无返流发生；实验组出现不同程度的返流。结论：胃排空障碍，胃-幽门-十二指肠蠕动不协调导致胃内压增高是造成胃食管返流的重要原因；小型食管裂孔疝伴有胃食管返流随着时间的延长有自愈的可能性；调整胃-幽门-十二指肠的协调蠕动是消除胃食管返流的关键。     

以哮喘为主51例胃食管反流病患者临床分析

目的：胃食管反流与哮喘是十分常见的疾病,哮喘患儿中50%～80%与胃食管反流密切相关,本文试探讨儿童胃食管返流（Gestro esophageal Reflux,GER）与哮喘的关系。方法：对我院51例有咳嗽、哮喘等呼吸道症状,胸部X线检查及鼻部检查正常,怀疑有胃食管反流病的患儿进行24 h食管p H监测,记录患儿反流与呼吸道症状同时进行抗反流治疗并以51例无呼吸道症状的GER患儿作为对照。结果：以哮喘为主要表现的GER患儿食管24 hp H监测的各项指标与对照组比较有显著差异。抗反流治疗对哮喘治疗有效。结论：胃食管反流并哮喘症状的患儿返流比普通GER严重,对有GER并哮喘症状的患儿,实施抗返流治疗可显著改善症状。提示哮喘症状与胃食管反流密切相关。     

老年社区获得性肺炎与胃食管反流

目的本研究旨在通过对老年肺炎患者24h食管pH监测,探讨胃食管反流(gastroesophageal reflus,GER)在老年肺炎发病机制中的作用.方法选择31例老年社区获得性肺炎患者及30例非肺炎患者进行24h食管pH监测,计算酸反流得分,以12.70作为酸反流得分的正常界限.结果 31例老年肺炎患者平均酸反流得分34.91,对照组平均酸反流得分5.95,与对照组比较,有显著性差异(P＜0.01).肺炎患者25例存在胃食管反流,占80.6%(25/31),其中仅5例有胃食管反流症状,占20.0%(5/25).结论胃食管反流可能是老年肺炎的重要发病机制之一.老年肺炎患者胃食管反流多无典型症状.     

早产儿胃食管反流的诊断及体位疗法

目的探讨24h食管pH值监测和胃B超检查测定胃排空率对早产儿胃食管反流(GER)的诊断价值及体位对GER的影响。方法用24hpH自动记录仪测定40例早产儿食管下段pH值,B超检测胃排空率,观察其与GER参数的相关性。结果40例早产儿中90％出现GER,其中80％为"寂静型"。日龄<14d组及日龄≥14d组,各项反流指标无显著差异。头部抬高30°仰卧位组各项反流指标显著低于平卧位组。GER参数与喂奶后90min胃排空率呈负相关。结论24h食管下段pH监测可早期确诊早产儿GER,B超测定胃排空率可用于早产儿GER的筛查。早产儿取头部抬高30°仰卧位,可减少GER的发生。     

食管贲门癌合并肺功能异常病人的围手术期处理

目的探讨食管贲门癌合并肺功能异常病人围手术期治疗经验.方法总结了268例术前行肺功能检查的食管贲门癌病人临床资料.结果肺功能异常142例,发生肺部并发症的27.5%(39/142),死亡4例:肺功能正常者126例,发生肺部并发症的15.1%(19/126),死亡1例.两组肺部并发症的差异有显著性意义(P＜0.05).结论食管贲门癌病人术前常规作肺功能检查,以评估肺功能正常与否十分重要.肺功能异常者术后易发生或加重肺部并发症,加强围手术期治疗,改善呼吸功能,可有效地提高对手术的耐受性,减少肺部并发症的发生.     

32例食管癌围手术期猝死原因分析

目的:分析食管癌围手术期猝死的临床特点,以期减少其发生率。方法:对32例食管癌围手术期猝死病例的临床资料进行回顾性分析研究。结果:导致食管癌围手术期猝死最常见的原因是心脏性猝死23例(占71%);其次为肺动脉栓塞猝死6例(占18%);再其次为胃食管反流导致窒息猝死2例(占6%)和鼾症猝死1例(占3%)。结论:食管癌围手术期猝死事件以心脏性猝死和肺动脉栓塞猝死占比例最大,是防治重点。     

食管癌和贲门癌术后24h食管pH监测分析

目的观察食管癌和贲门癌切除术后患者胃食管反流情况,探讨不同手术吻合方式对胃食管反流的影响。方法 80例食管癌和贲门癌患者随机分为两组:A组40例,采取平卧位睡眠;B组40例,采取上身抬高30°～40°仰卧睡眠。监测患者24 h食管pH值。同时比较A组采用不同吻合术式患者24 h pH监测结果。结果 A组患者反流次数、时间>5 min反流次数、单次最长反流时间、pH<4的总时间、pH<4的百分数、DeMeester评分均明显高于B组,差异有统计学意义(P<0.05)。A组套入式吻合组和端侧吻合组患者反流次数、时间>5 min反流次数、单次最长反流时间、pH<4的总时间、pH<4的百分数、DeMeester评分比较,差异均无统计学意义(P>0.05)。结论食管癌和贲门癌患者术后均存在胃食管反流,上身抬高可明显减少胃食管反流,套入式吻合与端侧吻合方法均不能减少胃食管反流,术式的改进仍需进一步研究。     

胃食管反流合并难治性咳嗽患者食管动力特点分析

目的 应用食管高分辨率测压,探讨胃食管反流病（GER）合并难治性咳嗽患者食管动力特点。方法 选取2016年1月—2018年3月郑州大学第一附属医院确诊为GER并行食管高分辨率测压（HRM）的患者71例,根据其是否合并难治性咳嗽分为GER合并难治性咳嗽组（22例）和GER组（49例）。采用HRM测量食管上括约肌静息压（UESP）、食管下括约肌静息压（LESP）、远端收缩积分（DCI）、远端潜伏期（DL）及4 s综合松弛压（4?s IRP）,分析两组患者食管动力特点的差异。结果 两组患者在性别、年龄、体重指数、吸烟史、饮酒史等方面差异无统计学意义（P?>0.05）;GER合并难治性咳嗽组存在无效食管动力（IEM）的患者比例高于GER组（P?<0.05）;GER合并难治性咳嗽组DCI更低（P?<0.05）;两组患者UESP、LESP、DL、4?s IRP比较,差异均无统计学意义（P?>0.05）。结论 GER合并难治性咳嗽患者IEM比例高,DCI低于单纯GER患者,HRM可客观评价食管动力,为临床诊治提供指导。     

Gastroesophageal reflux: clinical presentations, diagnosis and management.

Symptomatic gastroesophageal reflux occurs daily in an estimated 7% of adults and weekly or monthly in 29%. Untreated it can lead to esophageal erosions, ulceration and stricture formation. The pathogenesis is often multifactorial: defects in the function of the lower esophageal sphincter, esophageal clearance mechanisms and gastric emptying combine to produce frequent lengthy periods during which the lower esophagus is bathed in regurgitated acid. In most patients reflux disease is easily recognized as recurrent heartburn, regurgitation or dysphagia, or a combination. When acute chest pain or respiratory illness is the primary presenting complaint the patient needs particularly careful investigation to determine whether the symptoms are due to a primary cardiac or respiratory condition, are secondary to gastroesophageal reflux alone or represent a combination of disorders. Endoscopy with biopsy and long-term pH monitoring are the most reliable ways of determining whether reflux disease is present. Additional investigations, such as exercise testing, cardiac catheterization or inhalation challenge, may be needed in patients with cardiac or respiratory symptoms. Treatment should follow a stepped-care approach and in most patients should begin with changes in lifestyle, including dietary manipulation, reducing alcohol and cigarette consumption, and raising the head of the bed, together with appropriate use of antacids or alginate-antacid combinations. H2-receptor antagonists and agents to improve both gastric emptying and the tone of the lower esophageal sphincter may be added in sequence. Most patients will respond well to this regimen. Surgery should be considered only for those with intractable symptoms or with complications (e.g., stricture formation, bleeding, development of dysplastic epithelium in those with Barrett's esophagus, or secondary pulmonary disease that does not respond to medical management). It is successful in 85% of well-selected patients and has few complications.     

Diagnosis and Treatment of Chronic Cough due to Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is one of most common causes of chronic cough.Medical history offers few clues as to the cause of cough induced by this disease.24-h esophageal ph monitoring is considered as the most sensitive and specific test for the diagnosis.When it is unavailable or unsuitable,upper gastrointestinal endoscopy and barium esophagography can be used as an alternative examination.Combined multichannel intraluminal impedance and pH testing is promising because of its ability to detect nonacid reflux as well as acid reflux.Empiric therapy trial is a simple and cheap way to identify suspected patients.Drug therapy is effective in most of the patients,in which proton pump inhibitors is the most powerful.Antireflux surgery is the last choice,used only when intensive drug therapy fails.The definitive diagnosis of cough due to gastroesophageal reflux disease can be established only after cough improves or completely disappears with antireflux therapy.