胃食管反流病的研究进展

胃食管反流病 (GERD)是指胃、十二指肠内容物反流至食管导致的一系列慢性症状和 或食管粘膜损害。在西方发病率非常高 ,美国一项流行病学调查显示 4 4%的成年人每月至少出现一次烧心症状 ,14 %每周至少一次 ,7%成年人每天均有烧心症状。我国北京、上海两地流行病学调查结果提示 :烧心、反酸等症状发病率为 8 97% ,食管 2 4小时pH监测证实有异常反流的GERD发病率为 5 77% ,反流性食管炎发病率为 1 92 %。虽低于西方国家 ,但远高于我们的估计。1　GERD的分类非糜烂性胃食管反流病 (NERD)、反流性食管炎、Barrett食管以往常被认为是G…     

反流性食管炎患者食管测压及pH监测值

为探讨反流性食管炎发病机制及其与胃食管反流的关系。 采用食管测压法和24h食管pH监测对68例反流性食管炎患者和30例健康志愿者进行了食管功能检测。结果显示食管炎患者食管下括约肌压力(LESP)减低(P＜0.05)、食管蠕动波幅(PA)减低(P＜0.01) 、食管蠕动波传导速度(PV)减慢(P＜0.05) ;24h食管pH＜4的百分比 、酸反流次数和＞5 min的酸反流次数明显增加(均P＜0.01), Ⅰ期与Ⅱ期食管炎相比食管动力参数无差异, 而在24h食管 pH监测方面显示Ⅱ期食管炎患者在酸反流次数及＞min反流次数、最长反流时间、pH＜4时间百分比方面均较Ⅰ期食管炎患者有明显增加。提示反流性食管炎发病机制与胃食管反流明显相关。     

帕罗西汀辅助治疗伴有抑郁或焦虑的非糜烂性胃食管反流病46例疗效观察

目的观察帕罗西汀辅助治疗伴有抑郁或焦虑的非糜烂性胃食管反流病（NERD）的疗效。方法NERD应用耐信量表结合胃镜进行诊断,抑郁和焦虑采用汉密尔顿抑郁量表评价,172例患者随机分为2组,对照组予奥美拉唑20mg,每天2次,莫沙必利5mg,每天3次;治疗组在对照组基础上加用帕罗西汀20mg,每天早上服一次,治疗4周后进行疗效比较。结果治疗组总有效率97.7%,优于对照组73.9%（p〈0.05）。结论帕罗西丁辅助奥美拉唑、莫沙必利治疗伴有抑郁或焦虑的NERD有良好疗效,值得推广应用。     

2.97 慢性胃炎及胃部分切除术后患者胃内24h胆汁监测

目的研究不同类型慢性胃炎及胃部分切除术后患者胃内胆汁反流情况.方法共51例患者入选,其中慢性胃炎患者45例,胃部分切除术后患者6例, 慢性胃炎患者中浅表性胃炎17例,糜烂性胃炎21例,萎缩性胃炎7例;用Bilitec 2000便携式胆汁监测仪(瑞典Medtronic Synectics公司)分别对51例受试者行胃内24h胆汁持续监测. 获得胆汁反流指标,以胆红素吸收值＞0.14作为异常指标.分析指标包括吸收值＞0.14 的总时间百分比;胆汁反流次数;胆汁反流持续超过5min次数;最长反流持续时间.结果不同类型慢性胃炎及胃部分切除术后组之间各项胆汁监测指标相差显著.组与组间两两比较,慢性糜烂性胃炎组与胃部分切除术后组各项监测指标均明显高于慢性浅表性胃炎组(P＜0.01);慢性萎缩性胃炎组与慢性浅表性胃炎组相比较,除最长反流时间二者相差不显著外,其余3项胆汁反流(以胆红素吸收值,即abs＞0.14为标准)指标后者均高于前者(P＜0.01或0.05);胃部分切除术后组与各慢性胃炎组比较,前者胆汁反流总时间百分比均明显高于后者(P＜0.01);慢性糜烂性胃炎组和慢性萎缩性胃炎组之间比较,各项胆汁反流指标无明显差异.根据各组患者胆汁反流总时间百分比均数绘制的线图,可以观察到由慢性浅表性胃炎到萎缩性胃炎、糜烂性胃炎及胃部分节除术后,胃内胆汁反流总时间百分比成逐渐上升趋势.结论不同类型胃炎的胃内胆汁反流程度不同,胃粘膜损伤程度与胆汁反流程度成正相关,胃部分切除术后胃粘膜损伤最严重,胆汁反流亦最重.     

体位与胃食管反流关系的初步探讨

体位与胃食管反流关系的初步探讨许军英，张锦坤（同济医科大学协和医院消化病研究室）本研究对１２例具有典型胃食管反流症状内镜检查有下段食管炎的病人行食管内ＰＨ监测、食管内及胃内压力的测定，比较直立位和卧位餐后反流的发生频率及发生机理。发现，直立位与卧位时...     

食管运动功能障碍与食管黏膜损伤的关系

目的　了解食管运动功能对胃食管反流病患者食管黏膜损伤的影响。方法　 12例正常人 ,10 0例有胃食管反流病典型症状患者 ,根据内镜检查结果 ,按洛杉矶内镜下食管炎的分级标准分三组 :NERD组 2 7例 ,LA -A、B组 30例 ,LA -C、D组 4 3例 ,所有患者均接受食管测压检查。测定下食管括约肌静息压 (LESP) ,以湿咽成功率、食管远端收缩波幅和食管蠕动的传导速度作为食管体部运动功能的指标。结果　食管黏膜损伤的严重程度与LESP低压明显相关 ,LA -C、D组的LESP明显低于正常组 (P<0 0 5 ) ,而其他两组与正常组比较差异无显著性。食管…     

食管源性胸痛

胸痛是胸部及邻近组织炎症 ,缺血、外伤、肿痛、机械压迫、理化刺激等因素引起患者的一种主观感觉 ,主要病因有胸壁病变 ,肺胸膜病变 ,心血管病变 ,腹腔病变 ,其中心血管病变和食管疾病引起的胸痛在临床上非常相似 ,其性质、部位 ,放射等特点相同 ,均可以被硝酸甘油所缓解。因此 ,二者的鉴别诊断非常困难。研究发现 ,在临床表现为心绞痛的患者中有 1 10无冠心病证据 ,这部分患者称为“非心源性胸痛 (NCCP)” ,在非心源性胸痛患者中有 5 0 %为食管疾病所引起 ,称为“食管源性胸痛”。1　胃食管反流和反流性食管炎胃食管反流 (GER)和反流性…     

正常人餐后不同体位对胃食管反流的影响

目的　胃食管反流 (GER)在右侧卧位比左侧卧位增加。食管酸暴露与贲门的酸度有关。但体位对贲门口酸度的影响尚无研究。我们的目的是研究右侧卧位增加食管酸暴露的基本机制。方法　在不同日的情况下 ,10名健康者进食高脂肪餐后取左侧和右侧位同时检测 4h的食管和食管下段括约肌(L ES)张力 ,食管、胃贲门和胃体的 PH值。结果　右侧卧位同左侧卧位的记录相比 ,食管的酸暴露延长 (7.0 %与 2 .0 % ,P<0 .0 3) ;反流的几率更高 (3.8与0 .9/h,P <0 .0 3) ;短暂性 L ES松弛 (TL ESRS)更频繁 (6 .5与 3.2 /h,P <0 .0 3) ;与反流相关的 TL …     

胃功能三项指标及其联合分析对胃食管反流病的诊断价值研究

目的 研究胃功能三项指标及其联合分析对胃食管反流病的诊断和预警价值.方法 选取2019年7月至2019年10月在火箭军特色医学中心收治的具有胃食管反流症状且经临床诊断确诊的患者60例为实验A组,具有胃食管反流症状但经临床诊断检查排除确诊的患者65例为实验B组,同时选取健康体检者60例为对照组.比较3组血清PGI、PGII、G-17水平.建立ROC曲线分别评估PGI、PGII、G-17三项指标及其联合分析对胃食管反流病的诊断价值及预警价值.结果 两个实验组PGI、PGII、G-17水平均高于对照组,差异均具有统计学意义;两个实验组PGI、PGII、G-17水平差异无统计学意义.ROC曲线分析显示,PGI、PGII和G-17指标对于胃食管反流病具有诊断及预警价值.指标联合分析显示,PGI和PGII联合、PGI和G-17联合、PGII和G-17联合以及三项指标联合对于胃食管反流病亦具有较好的诊断及预警价值.结论 将PGI和G-17指标联合分析,对于胃食管反流病的诊断和预警具有较好的效果,可以在胃食管反流病筛查中推广应用,为临床诊断提供参考.     

2.15食管运动功能障碍与食管黏膜损伤的关系

目的了解食管运动功能对胃食管反流病患者食管黏膜损伤的影响. 方法12例正常人,100例有胃食管反流病典型症状患者,根据内镜检查结果,按洛杉矶内镜下食管炎的分级标准分三组:NERD组27例,LA-A、B组30例,LA-C、D组43例,所有患者均接受食管测压检查.测定下食管括约肌静息压(LESP),以湿咽成功率、食管远端收缩波幅和食管蠕动的传导速度作为食管体部运动功能的指标.     

Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.     

Screening and Identifying Erosive Esophagitis in Children with Non-cardiac Chest Pain

Non-cardiac chest pain is a common disorder that leads to costly evaluations to distinguish it from cardiac pain. The present study aimed to clarify the clinical characteristics of erosive esophagitis in children with non-cardiac chest pain. Ninety nine patients (mean age, 9.55 ± 2.95 years, 49 girls) with non-cardiac chest pain were enrolled. Patients were classified into two groups: erosive esophagitis and non-erosive esophagitis-related non-cardiac chest pain by esophagogastroduodenoscopy. Children in the erosive esophagitis-related non-cardiac chest pain group were significantly older (10.95 ± 2.54 years vs. 8.52 ± 2.83 years). Multivariate logistic regression analysis identified the following predictors of gastroesophageal reflux: chest pain related to sleep (odds ratio = 18.05, 95% confidence interval: 3.18–102.49); unfavorable dietary habits (odds ratio = 7.11, 95% confidence interval: 1.53–32.87); chest pain related to food (odds ratio = 5.09, 95% confidence interval: 1.37–18.86); epigastric pain (odds ratio = 3.73, 95% confidence interval: 1.12–12.33); and nausea, vomiting, and/or regurgitation (odds ratio = 4.35, 95% confidence interval: 1.22–15.54). Gastroesophageal reflux disease should be considered first in children with non-cardiac chest pain. Children with gastroesophageal reflux disease should receive medical treatment and lifestyle modifications.     

The added value of magnifying endoscopy in diagnosing patients with certain gastroesophageal reflux disease

Purpose

In most cases gastroesophageal reflux disease proceeds without macroscopic erosions in the esophagus. We aimed to clarify if abnormalities detectable in magnifying endoscopy may offer additional diagnostic criteria for gastroesophageal reflux disease and to what histopathologic structures do they correspond.

改善行为方式对胃食管反流病的治疗作用

目的探究行为方式的改善对胃食管反流病的治疗作用。方法入选102例胃食管反流病患者随机分为两组,其中对照组（51例）予以常规药物治疗,研究组（51例）在药物治疗的基础上加用行为方式的干预。治疗8周后,分析比较两组患者的相关临床资料。结果治疗8周后,研究组患者在反酸、胸骨后疼痛、烧心、食管反流、嗳气、吞咽不适等症状方面有显著的改善（P〈0.05）,内镜下分级情况也有显著的改善,并且与对照组相比较,效果更明显（P〈0.05）。对照组的总有效率为78.53%,研究组的总有效率为94.12%,两组之间具有统计学差异（P〈0.05）。结论行为方式的改善对胃食管反流病具有显著的治疗效果,既经济又简单易行。     

Pancreatic acinar cells—a normal finding at the gastroesophageal junction? Data from a prospective Central European multicenter study

Pancreatic acinar cells are a well-recognized finding at the gastroesophageal junction, but their histogenesis and biological significance are unclear. From the prospective Central European multicenter histoGERD trial, we recruited 1,071 individuals undergoing gastroscopy for various non-selected reasons. Biopsy material was systematically sampled from the gastroesophageal junction and from the stomach. The study aimed to assess the prevalence of pancreatic acinar cells and to relate their presence to various histologic and clinical features. Overall, pancreatic acinar cells were observed in 184 (17.2 %) participants. Individuals diagnosed with pancreatic acinar cells were slightly younger than those without (median 50 vs. 53 years; p?=?0.009). There was no association with patients’ symptoms and/or complaints or with an endoscopic diagnosis of esophagitis or Barrett’s esophagus. Regarding histology, pancreatic acinar cells were not associated with features of the squamous epithelium indicating reflux disease, such as basal cell hyperplasia, papillary elongation, dilation of intercellular spaces, and inflammatory cell number, but were associated with the presence of cardiac mucosa (p?<?0.001), oxyntocardiac mucosa (p?<?0.001), and intestinal metaplasia (p?=?0.038), respectively. No association with Helicobacter pylori infection or diagnosis of gastritis was noted. In conclusion, pancreatic acinar cells are a common finding at the gastroesophageal junction, and no association with either reflux disease (histologically or endoscopically) or diagnosis of gastritis was observed. These data suggest a congenital rather than an acquired (metaplastic) origin of pancreatic acinar cells at the gastroesophageal junction. This questions the term “pancreatic acinar metaplasia” which is currently widely used for their diagnosis.     

全凭静脉麻醉时双相气道正压面罩通气下胃食管反流的监测

目的 监测全凭静脉麻醉(TIVA)下双相气道正压(BiPAP)面罩通气时的胃食管反流情况,评估该通气方法 在伞身麻醉中应用的安全性.方法 选择择期行腹腔镜胆囊切除手术的成年患者40例,美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级,无胃食管反流危险因素,随机分为面罩通气组(Ⅰ组)和气管内插管通气组(Ⅱ组),每组20例.麻醉前经鼻置人胃食管舣探头pH电极,使远端探头位于食管下段(A点),近端探头置于食管中上段(B点).麻醉诱导后,两组分别应用BiPAP面罩通气和间歇正压机械通气(IPPV),连续实时监测同术期食管下段及中上段pH值变化直至患者清醒.以pH值小于4.0作为胃食管反流的诊断标准.结果 麻醉后30 min、气腹后30 min、麻醉结束后pH值监测结果 显示,Ⅰ组食管下段pH 值分别为5.43±0.51、5.24±0.47、5.36±0.53;Ⅱ组食管下段pH值分别为5.37±0.67、5.29±0.68、5.36±0.78.Ⅰ组和Ⅰ组食管下段及食管中上段各时点pH值监测无1例小于4.0,反流发生率均为0,两组比较pH值差异无统汁学意义(P>0.05).结论 在无胃食管反流病史的患者行腹腔镜胆囊切除术时,应用BiPAP而罩通气全身麻醉不增加胃食管反流概率,是较安全的方法 之一.     

幽门螺杆菌在胃食管反流病发病中的作用

目的 探讨幽门螺杆菌（Hp）在胃食管反流病（GERD）发病中的作用,为临床诊治GERD提供参考。方法 选取2016年 2月~2018年12月我院收治的胃食管反流病患者85例,设为GERD组,另选同期我院体检健康者30人为对照组,14C呼气试验法进行Hp检测,比较两组Hp感染阳性率、GERD不同症状程度者Hp感染阳性率以及反流性食管炎（RE）不同程度者Hp感染阳性率。结果 GERD组Hp感染阳性率（54.12%）高于对照组（46.67%）,差异无统计学意义（P＞0.05）;GERD轻度症状组、中度症状组、重度症状组及极重度症状组Hp感染阳性率分别为55.00%、52.00%、54.55%、55.56%,组间比较,差异无统计学意义（P＞0.05）;RE患者LA-A组、LA-B组、LA-C组及LA-D组Hp感染阳性率分别是57.14%、55.56%、47.06%、46.15%,组间比较差异无统计学意义（P＞0.05）。结论 幽门螺杆菌感染在胃食管反流病发生和发展过程中可能无相关性,但对于Hp阳性的GERD患者也应根据实际情况实施根除Hp治疗,以减少恶变几率。     

Gastric cardia inflammation and intestinal metaplasia: associations with reflux esophagitis and Helicobacter pylori.

Gastric cardia inflammation and intestinal metaplasia are the subjects of recent investigation. Some authors have found associations with gastroesophageal reflux disease, whereas others have identified relationships with Helicobacter pylori (HP). We studied 150 consecutive patients who underwent upper endoscopy, had normal gastroesophageal anatomy, and had biopsies of the antrum, cardia, and lower esophagus, to evaluate relationships between reflux esophagitis, cardia inflammation, intestinal metaplasia, and HP gastritis. Forty-two patients had HP infection. Cardia inflammation was significantly related to esophageal squamous inflammation in the non-HP-infected patient group and to antral inflammation and cardia HP infection in the HP-infected patient group. The differences between the patient groups was most apparent in the patients with moderate or marked inflammation. Twenty-seven percent of patients had cardia intestinal metaplasia that was related to cardia inflammation. Cardia inflammation and intestinal metaplasia probably have multiple causes. Pathologists should refrain from applying the term Barrett's esophagus for biopsies procured from the cardia that show intestinal metaplasia in patients with a normal squamocolumnar junction.