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.     

泮托拉唑钠＋莫沙必利治疗胃食管反流病疗效观察

目的观察泮托拉唑钠＋莫沙必利治疗胃食管反流病（GERD）的疗效,探讨反复发作性胸痛与GERD的关系。方法对110例胸痛反复发作患者行24h食管pH监测,均诊断为GERD。将其随机均分为两组,观察组予泮托拉唑钠＋莫沙必利治疗,对照组单用莫沙必利治疗,疗程均为8周。治疗前后行24h食管pH监测,比较两组各检测指标变化及临床疗效。结果观察组总有效率为94．5％,对照组为60．0％,两组比较P〈0．05。与对照组比较,观察组治疗后酸反流次数、反流时间I〉5min次数、最长反流时间、pH〈4的时间、酸反流指数、立位pH〈4所占百分比均明显降低（P均〈0．05）。结论GER是原因不明胸痛的主要原因之一,24h食管pH监测对明确胸痛病因有重要价值,泮托拉唑钠＋莫沙必利治疗GERD有明显疗效。     

胃食管反流病患者酸反流与食管运动功能障碍的关系

背景：异常酸反流和食管运动功能障碍与胃食管反流病（GERD）密切相关。目的：研究GERD患者的食管运动和酸反流与食管黏膜损害的关系，以及两者之间的相关性。方法：选取有反酸、烧心、胸痛等典型胃食管反流症状的患者72例行上消化道内镜检查、食管测压和24hpH监测。根据pH〈4总时间百分比〈4．5％且DeMeester计分〈14．7的标准。将食管炎患者分为生理性酸反流组（pH^-组）和病理性酸反流组（pH^＋组）。结果：内镜下食管炎组24hpH监测各项指标较无食管炎组显著增高（P〈0．05），病理性酸反流的发生率显著高于无食管炎组（P〈0．01）。两组食管测压各项指标无显著差异，食管炎组pH^＋者的食管下括约肌压力（LESP）较pH^-者显著降低，食管体部蠕动波传导速度减慢，湿咽成功率减少（P〈0．05）。结论：GERD患者食管炎的发生与酸反流密切相关，有病理性酸反流的GERD患者易见食管运动功能障碍。     

酸反流与胆汁反流在胃食管反流病中的作用

目的探讨酸反流与胆汁反流在胃食管反流病(GERD)中的作用及相互关系.方法46例GERD患者(反流性食管炎组30例,胃镜阴性组16例)及26例健康对照者在完成食管测压后,应用便携式食管pH监测仪及Bilitec2000胆汁反流监测仪,同时进行24h食管内酸及胆汁反流的动态连续监测.结果GERD患者酸反流及胆汁反流各指标均明显高于健康对照者,且与食管炎严重程度一致.pH＜4总时间百分比与胆红素光吸收值(Abs)＞0.14,总时间百分比存在线性相关关系(r=0.34,P＜0.01).酸反流和胆汁反流共存的双重反流在GERD患者中最为常见,且较单纯反流更易引起严重食管炎.结论GERD患者中较为常见的双重反流对食管粘膜的损伤作用强于单纯酸或胆汁的不完全反流,酸反流与胆汁反流间可能有正性协同作用;联合应用胃镜检查及食管内酸和胆汁反流监测将为GERD的诊治提供可靠的客观依据.     

食管pH和胆汁监测用于十二指肠胃食管反流的诊断及对治疗的评价

目的探讨十二指肠胃食管反流(DGER)的诊断方法和胆汁反流在胃食管反流病(GERD)中的临床意义.方法用便携式pH监测仪及胆红素监测仪(Bilitec 2000)对20例健康人及52例有烧心、反酸等症状的患者行24 h食管腔内pH和胆红素同步监测,以光吸收值≥0.14作为发生胆汁反流的阈值,计算24 h反流总时间%等指标.并对15例酸和胆汁混合反流者用铝碳酸镁加西沙必利治疗4周,然后复查两项监测.结果20例健康人中未发现病理性酸反流,52例患者中有47例(包括食管炎12例)存在病理性酸反流,诊为GERD.胆汁反流总时间%在健康人组及反流症状组分别为(0.47±0.71)%及(2.67±3.23)%(P＜0.05),在食管炎及非食管炎者分别为(5.41±4.93)%及(1.68±1.76)%(P＜0.05).47例GERD中15例(32%)为酸及胆汁混合反流,另32例为单纯酸反流,前者有食管炎8例而后者仅为4例(P＜0.05).15例混合反流经治疗后酸和胆汁反流总时间%均明显降低,8例食管炎中有7例炎症消退,1例减轻.结论Bilitec 2000是评价DGER的有用工具,32%的GERD存在酸和胆汁混合反流;胆汁反流在GERD食管黏膜损害中起重要作用.     

背俞指针疗法对胃食管反流病患者任督二脉穴位皮温与酸反流的影响及其相关性

[目的]观察背俞指针疗法对胃食管反流病（GERD）患者任督二脉穴位皮温与酸反流的影响,探讨二者的相关性.[方法]120例GERD者分为治疗组与对照组,每组60例.治疗组行背俞指针疗法治疗,对照组予枸橼酸莫沙必利分散联合兰索拉唑肠溶片口服治疗,观察2组患者治疗前后酸反流总时间百分率、长时间酸反流次数、最长酸反流时间这3个反映酸反流指标的变化情况;同时检测治疗前、治疗第7天、治疗第14天任督二脉穴位皮温的变化.[结果]治疗后,2组24 h食管酸反流总时间百分率、长时间酸反流次数、最长酸反流时间均显著下降（P＜0.01）;但组间比较差异无统计学意义（P＞0.05）.治疗组治疗第7、14天任督二脉的穴位皮温均较治疗前明显上升（P＜0.05）;而对照组穴位皮温均较治疗前明显下降（P＜0.05）.[结论]背俞指针疗法对GERD患者酸反流有改善作用,可改善任督二脉经气交会失衡,任督二脉经气交会的改善有助于减少酸反流.本研究初步证明“任督二脉交会失衡是GERD发病的经络病机”.     

无效食管运动与胃食管反流病关系的探讨

目的 探讨无效食管运动(IEM)与胃食管反流病(GERD)的关系.方法 对90例GERD全部进行胃镜检查并做食管压力测定和24h食管动态pH监测,其中反流性食管炎(RE)组62例,非糜烂性反流病(NERD)组28例.研究IEM与食管酸暴露及RE的关系.结果 RE组中确诊IEM 30例(48.4％)明显高于NERD组6例(21.4％)(P＜0.05).36例IEM患者33例(91.7％)食管酸暴露阳性,高于食管动力正常患者( 28/49,57.2％)(P＜0.01);远端食管pH ＜4总反流时间、卧位反流时间百分比、＞5 min长反流周期数、最长反流时间、DeMeester评分IEM者明显高于食管动力正常者(P＜0.01),反流周期数前者明显高于后者(P＜0.05).结论 IEM在GERD中较常见,其食管动力障碍中绝大多数为IEM,IEM与食管远端酸暴露及RE密切相关.     

食管内酸、胆盐监测及内镜检查对胃食管反流病的诊治意义

目的探索胃食管反流病(GERD)的合理治疗方案.方法应用24 h食管内胆红素与pH监测,对110例有GERD症状的患者检测24 h食管内胆汁反流情况及pH动态变化,结合内镜检查来综合分析.结果根据24 h食管内酸和胆红素监测的结果,以内镜检查有无黏膜病变而分成两组.内镜检查阳性组25例(22.7%)均有酸(碱)病理性反流;内镜检查阴性组85例(77.3%),其中73例有酸(碱)病理性反流,另12例(10.9%)反流在生理范围内.内镜检查阳性组与阴性组有反流者相比,差异无显著性(P＞0.05),但内镜检查阳性组和阴性组有反流者与内镜阴性且反流在生理范围者相比均差异有显著性(P＜0.05).结论根据24 h食管内监测及内镜检查结果,显示89%GERD均有酸(碱)病理性反流,酸(碱)反流是导致临床症状和食管黏膜损伤的主要攻击因子,削弱或消除反流是GERD治疗的关键.GERD易复发,需长期维持治疗,应特别注意药效、不良反应和经济学问题.     

伴特发性肺纤维化的胃食管反流病患者夜间酸暴露特点

背景:胃食管反流是特发性肺纤维化(IPF)发生的危险因素之一,夜间反流在胃食管反流病(GERD)食管外表现中起重要作用。目的:研究伴IPF的GERD患者夜间食管酸暴露的特点。方法:选取2006年12月～2008年1月北京朝阳医院收治的16例IPF-GERD患者、32例GERD患者和16例健康志愿者(非GERD)。各组患者行24 h食管pH监测,对夜间8 h内(10pm-6am)的酸暴露程度,包括pH4的时间百分比、酸清除时间、反流次数、长反流(5 min)次数、最长反流时间等指标进行分析。结果:14例(87.5%)IPF-GERD患者存在夜间酸暴露,其程度高于非GERD组(P0.05),而与GERD患者无明显差异(P0.05)。IPF-GERD组患者前半夜pH4的时间百分比显著高于后半夜(12.2%±3.9%对1.1%±0.5%,P0.05),GERD组两者无明显差异(10.8%±2.7%对5.1%±1.8%,P0.05)。结论:大部分IPF-GERD患者存在夜间酸暴露,其主要发生于前半夜。     

非心源性胸痛的评估和处理

非心源性胸痛（NCCP）是指复发性心绞痛样胸痛,并除外心源性因素,是常见且具有挑战性的临床问题,需经过适当的评估,鉴别症状产生的原因。胃食管反流病（GERD）、食管动力异常和功能性胸痛是NCCP的三大主要病因,其中以GERD最为常见,应首先进行评估。质子泵抑制剂（PPI）试验、上消化道内镜检查、24 h食管pH-阻抗监测是评估GERD相关胸痛的常用方法,食管高分辨率测压是鉴别食管动力异常的主要工具,而诊断功能性胸痛需要心脏检查、PPI试验、上消化道内镜检查和活检病理、食管pH-阻抗监测和食管测压结果均阴性。NCCP的治疗应根据症状产生的机制选择个体化方案,PPI和平滑肌松弛剂分别是GERD和食管动力异常相关胸痛的常用药物,也可选择内镜和外科手术治疗,神经调节剂（主要为抗抑郁药）则是功能性胸痛的治疗基石。     

Clinically distinct characteristics in patients younger than 40 years old with non-cardiac chest pain

Background and Aim: Little is known about non‐cardiac chest pain (NCCP) in young patients. We aimed to examine the proportion of gastroesophageal reflux disease (GERD) in young patients with NCCP compared to the average‐aged NCCP patients and to evaluate their symptomatic characteristics and the clinical efficacy of a 2‐week proton pump inhibitor (PPI) trial. Methods: Ninety‐six patients with NCCP ≥ 1/week were classified into the young‐aged (≤ 40 years, n = 38) and the average‐aged groups (> 40 years, n = 58). Typical reflux symptoms were assessed. The patients were defined into a GERD group and non‐GERD group according to reflux esophagitis on esophagogastroduodenoscopy and/or pathologic acid exposure on 24‐h esophageal pH monitoring. Then the patients were treated with 30 mg of lansoprazole bid for 14 days. Results: Nine patients (23%) in the young‐aged group and 22 patients (38%) in average‐aged group were diagnosed with GERD‐related NCCP (P = 0.144). The proportion of typical reflux symptoms was higher in the GERD group compared with the non‐GERD group in both age groups. A PPI test improved symptoms in the GERD group irrespective of age, but this improvement was not observed in non‐GERD group. Conclusions: In young NCCP patients, the prevalence of GERD was relatively low compared to average‐aged NCCP, but the difference was insignificant. The PPI test was very effective in diagnosing GERD in the NCCP patients in both age groups. Therefore, in young NCCP patients, if there is a negative response to a 2‐week PPI trial, the possibility of extra‐esophageal disease origin needs to be considered.     

胃食管反流病相关非心源性胸痛患者食道患病率调查研究

ObjectiveTo investigate the prevalence and clinical characteristics of esophagus in patients with non-cardiac chest pain (NCCP). MethodsPatients who diagnosed with NCCP from January 2018 to April 2019 in Xinjiang Uygur Autonomous Region People's Hospital were selected as the study subjects. Detailed medical history, physical examination, upper gastrointestinal endoscopy, high resolution esophageal manometry and 24 h dynamic esophageal pH monitoring were performed on all subjects. ResultsThe total number of subjects was 85, of which male 45(52.94%), with an average age of 41.2±12.4 years;female was 40 (47.06%), with an average age of 43.3±10.9 years. The most common symptoms in NCCP patients were acid reflux 43.53%, dysphagia 31.76%, heartburn 24.71%. Endoscopic abnormalities of upper gastrointestinal tract accounted for 31.76%, esophageal manometry abnormalities accounted for 67.06%, and dynamic pH monitoring abnormalities accounted for 34.76%. The prevalence of GERD was 42.36% determined by upper gastrointestinal endoscopy combined with 24 h pH monitoring. According to manometric results, ineffective esophageal motility in 23.53% of NCCP patients was the most common cause of NCCP. ConclusionBy analyzing the causes of esophagogenous NCCP, it is helpful for clinicians to exclude other high-risk factors leading to chest pain and to provide appropriate treatment for their diagnosis and treatment     

Role of clinical presentation in diagnosing reflux-related non-cardiac chest pain

INTRODUCTION: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health-care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux, such as heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD but in patients with NCCP the clinical diagnosis of reflux is difficult, and invasive methods or the omeprazole test are required for its detection. The aim of the present study was to evaluate the role of clinical presentation when diagnosing GERD among patients with NCCP. METHODS: Patients with NCCP underwent upper endoscopy, Bernstein and omeprazole tests. The patients were divided into two groups based on GER- or non-GER-related chest pain, and clinical presentation was compared between these two groups. Gastroesophageal reflux disease was considered positive when at least two methods were positive. RESULTS: From 78 NCCP patients (41 male; mean age 50.4 +/- 2.3 years), the chest pain was related to GERD in 35 patients (44.8%). The two groups were the same based on sex and age. The chest pain severity, site, radiation and relation to food, exercise, and sleep were equal in the two groups, except for two symptoms: pain that was relieved by antacid (P < 0.031) and presence of classical reflux symptoms (P < 0.009), seen in the GERD patients. With regard to recent patient history, heartburn and regurgitation symptoms were seen more frequently in GERD patients (P < 0.036 and P < 0.002, respectively). DISCUSSION: Clinical presentation is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux- and non-reflux-related NCCP, the symptoms of heartburn or regurgitation in the present or recent patient history are diagnostic for GERD-related chest pain.     

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.     

Evaluation of symptom index in identifying gastroesophageal reflux disease-related noncardiac chest pain

BACKGROUND: Symptom index (SI), which represents the percentage of perceived gastroesophageal reflux-related symptoms that correlate with esophageal acid reflux events (pH <4), has been suggested as a measure to improve diagnosis of gastroesophageal reflux (GER)-related noncardiac chest pain (NCCP). Because no study has evaluated the value of the symptom index in NCCP patients, data to support this claim have yet to be elucidated. AIM: To evaluate the value of SI in identifying gastroesophageal reflux disease (GERD)-related NCCP patients. METHODS: Patients enrolled in this study were referred by a cardiologist after a comprehensive work-up excluded a cardiac cause for their chest pain. All patients underwent upper endoscopy to determine esophageal inflammation and 24-hour esophageal pH monitoring to assess esophageal acid exposure. Patients were instructed to record all chest pain episodes during the pH test. Patients with a positive SI (> or =50%) underwent the proton pump inhibitors (PPI) test, which is a therapeutic trial using a short course of high dose PPI. RESULTS: A total of 94 patients with NCCP were included in this study. Forty-seven (50%) had either a positive upper endoscopy or an abnormal pH test and were considered GERD-Positive. Forty-seven patients (50%) had both tests negative and were considered GERD-Negative. Total number of reflux episodes and percent total, supine and upright time pH less than 4, were significantly higher in the GERD-Positive group as compared with the GERD-Negative group (P < 0.0001, P < 0.0001, P = 0.0045, and P < 0.0001 respectively). Only 9 (19.1%) patients in the GERD-Positive group and 5 (10.6%) patients in the GERD-Negative group had a positive SI (p = ns). Eight (89%) out of the 9 patients who had a positive SI in the GERD-Positive group and 2 (40%) out of 5 patients in the GERD-Negative group responded to the PPI test. CONCLUSION: Positive SI is relatively uncommon in NCCP patients, regardless if GERD is present or absent. Hence, symptom index provides very little improvement in diagnosing GERD-related NCCP.     

Clinical usefulness of subgrouping of patients with non-cardiac chest pain according to characteristic symptoms in Korea

BACKGROUND: Non-cardiac chest pain (NCCP) is a heterogeneous disorder. There is controversy about the associations between symptoms and causes in NCCP patients. The purpose of the present study was to evaluate the clinical usefulness of subgrouping according to characteristic symptoms in NCCP patients. PATIENTS AND METHODS: Fifty-eight patients were classified into two groups, as patients with typical reflux symptoms (group I, n = 24) and those without typical reflux symptoms (group II, n = 34). They underwent upper endoscopy, manometry, and 24-h esophageal pH monitoring. RESULTS: Twenty-four (41%) of the patients were diagnosed with gastroesophageal reflux disease (GERD) at upper endoscopy or 24-h esophageal pH monitoring. Eleven (19%) were diagnosed with GERD-associated esophageal motility disorder and 13 (22%) were diagnosed with non-GERD-associated esophageal motility disorder. The two groups did not differ significantly in age, sex, weight, smoking history, history of chronic alcoholism, or the severity, duration and frequency of symptoms. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of group I for GERD-related NCCP were significantly higher than those of group II. Group I had a higher proportion of patients with GERD-associated esophageal motility disorder (55%) than non-GERD-associated esophageal motility disorder (23%). CONCLUSION: Typical reflux symptoms can be used to distinguish patients with GERD-related NCCP from patients with NCCP, and subgrouping according to characteristic symptoms may assist the diagnosis of these patients in Korea.     

Noncardiac chest pain

Noncardiac chest pain (NCCP) affects approximately 1 quarter of the adult population in the United States. The pathophysiology of the disorder remains to be fully elucidated. Identified underlying mechanisms for esophageal pain include gastroesophageal reflux disease (GERD), esophageal dysmotility, and visceral hypersensitivity. Aggressive antireflux treatment has been the main therapeutic strategy for GERD-related NCCP. NCCP patients with or without spastic esophageal motor disorders are responsive to pain modulators. The value of botulinum toxin injection, endoscopic treatment for GERD, and antireflux surgery in alleviating NCCP symptoms is limited.     

胃食管反流病食管酸暴露和食管动力学变化特征

目的探讨无效食管动力(IEM)在胃食管反流病(GERD)中的作用,以及体质量对食管酸暴露及食管动力的影响。方法77例GERD典型症状患者全部行食管高分辨率压力测定(HRM)和24 h食管动态pH监测,分析IEM及正常食管动力患者酸暴露情况。结果 77例典型GERD症状患者中病理性酸暴露者38例(49%),在病理性酸暴露组中IEM 9例(24%),正常酸暴露组中IEM 5例(13%)。IEM组LES压力低于食管动力正常组(15.15±3.60 vs 22.15±6.73,P0.01);IEM组总pH4时间(百分比)较正常食管动力组高[(14.78±3.8)%vs(4.30±2.68)%,P0.01];IEM组患者BMI值较高。结论 IEM在GERD中较常见,其食管动力障碍中绝大多数为IEM,IEM与食管远端酸暴露密切相关。     

Esophageal Dysmotility Elicited by Acid Perfusion in Children with Esophagitis

Objective : To determine the importance of acid reflux-induced dysmotility in the genesis of noncardiac chest pain in children. Method : We performed esophageal manometries during intaesophageal perfusion with 0.9% NaCI or 0.1 N HCI in 19 children (age, 14.5 ± 0.5 yr) with gastroesophageal reflux, biopsy-proven esophagitis, and complaints of at least one episode of chest pain per day. Results : Baseline esophageal motilities were normal in all patients. Eight of 19 children (42%) complained of chest pain during intraesophageal acid perfusion. In three of these eight patients, complaints of chest pain during acid perfusion were temporally associated with "conversion" of previously normal motility patterns to manometric tracings, indicating esophageal dysmotility. Compared with findings during saline perfusion, esophageal acid exposure in these three children resulted in significant increases in both the duration (13.6 ± 4.0 vs 3.2 ± 0.2 s,p < 0.05) and amplitude (105.2 ± 7.8 vs 61.2 ± 2.1 mm Hg, p < 0.05) of esophageal contractions during wet swallows. Symptoms of chest pain resolved in all patients after therapy with H2 receptor antagonists, Conclusions : These data represent the first demonstration of acid-induced esophageal dys-motility in children with chest pain and suggest that reflux-induced motor abnormalities contribute to the onset and/or exacerbation of chest pain in pediatric patients with gastroesophageal reflux and esophagitis.