胃食管反流病胃电活动变化的研究

目的　探讨胃食管反流病 (GERD)的胃电活动变化。方法　主诉反流症状的患者 ,经 2 4小时食管酸、碱监测和 (或 )胃镜检查 ,GERD 43例 ,健康对照组 3 9例 ,进行餐前、餐后体表胃电图 (EGG)监测。结果　GERD组的平均正常胃电慢波百分比 ( 63 .40 %± 3 1.63 %)显著低于对照组 ( 80 .89%± 2 5 .42 %) ,餐前胃电节律异常的发生率 ( 5 8.1%)显著高于对照组 ( 17.0 %) ,餐前主频不稳定系数 ( 5 3 .6± 5 0 .8)也显著高于对照组 ( 3 4.2± 3 3 .1) ;GERD组的餐后胃电节律异常的发生率 ( 3 2 .6%)显著高于对照组 ( 12 .8%)。结论　GERD患者存在餐前、餐后胃电活动异常 ,体表EGG检查有助于了解GERD的胃运动功能情况     

兰索拉唑对糜烂性食管炎及非糜烂性胃食管反流病胃电节律影响

目的研究糜烂性食管炎及非糜烂性胃食管反流病患者胃电节律,以及兰索拉唑对其症状及胃电节律的影响。方法采取反流性疾病问卷分析20例糜烂性食管炎（EE组）及20例非糜烂性胃食管反流病（NERD组）4周及8周兰索拉唑30mg／a治疗前后的症状程度,并使用体外胃电图描述方法记录10名健康志愿者（对照组）胃电节律,以及EE组及NERD组患者4周及8周兰索拉唑30mg／d治疗前后的胃电节律。结果EE组和NERD组均存在胃电节律的异常,且与对照组有明显差异（P〈0．05）,并且EE组与NERD组之间无明显差异（P〉0．05）。经过兰索拉唑30mg／d治疗后,EE组及NERD组RDQ评分均较前好转,并且治疗8周后的RDQ评分小于治疗4周时（P〈0．05）,且两组之间无明显差异。治疗4周时EE组的餐前及餐后的正常慢波百分率较治疗前明显升高（P〈0．05）,而NERD组治疗4周时正常慢波百分率较治疗前无明显变化（P〉0．05）。当兰索拉唑30mg／d疗程满8周时两组餐前、餐后的正常慢波百分率均较治疗前明显升高（P〈0．05）,并且与对照组比较无差异（P〉0．05）。结论EE及NERD均存在胃电节律异常,兰索拉唑不仅能缓解EE及NERD的症状,也能使其胃电节律恢复正常。     

胃食管反流病

患者：男,58岁。主诉：反酸烧心5年余。 1．病例特点介绍患者诉近5年来间断出现反酸、烧心、胸骨后不适,近期症状加重．故就诊,     

十二指肠胃食管反流在胃食管反流病中的作用

目的　研究十二指肠胃食管反流 (DGER)在胃食管反流病发病机制中的作用及其对非糜烂性反流病 (NERD)的诊断价值。方法　 95例患者根据内镜检查的结果分为反流性食管炎和NERD组 ,对其均进行 2 4h食管 pH和胆汁联合监测。 结果　反流性食管炎患者DGER的各项指标 :吸光度值 >0 14时间百分比 (% )、总反流次数和反流 >5min的次数分别为 19 0 5± 2 3 4 4、30 5 6±34 0 4和 5 90± 6 37,均显著高于NERD组相应的 7 2 6± 11 0 8、15 6 8± 2 0 92和 2 5 9± 3 5 7(P <0 0 5 ) ,而酸反流差异无显著性 ,随着反流性食管炎的程度加重DGER发生率增高 ;18 2 %的NERD患者存在单纯DGER ,联合胆汁监测可使NERD诊断阳性率由 6 5 9%升高到 84 1%。结论　DGER可以单独发生 ,在引起反流性食管黏膜损伤或症状方面都有作用 ,2 4h食管 pH和胆汁联合监测有助于NERD的诊断。     

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。     

胃食管反流病的临床研究

目的 研究胃食管反流病（GERD）的反流症状与诊断关系，以引起临床医生的重视。方法采用典型症状、波利特试验及内镜检查；结果 检出反流性食管炎89例，非糜烂性食管炎291例，Barrett食管41例。结论 反流症状并有效检查为临床提供良好治疗方案。     

胃食管反流病

随着胃食管反流病(GERD)患病率的增加，GERD相关并发症亦有所增加，包括Barrett食管和食管腺癌。过去1年提出的有关GERD病理生理学的新观点有助于我们更好地理解反流性疾病发病和黏膜损伤症状之间的关系，并提供针对病人个体化病理生理缺陷的治疗。     

胃食管反流检查方法对胃食管反流病的诊断价值

评估不同的诊断方法在胃食管反流病诊断中的价值。对135全角典型胃食管反流症状,并经内镜证实有下段食管炎的患者X线钡餐确定反流,核素显像测定反流,24小时食管内pH监测,LESP测定及Losec实验性治疗。结果显示：X线钡餐检查27例,9例阳性,阳性率为30．3％,核素显像9例,7例阳性,阳性率77．7％;食管内24小时pH监测72例,53例阳性,阳性率73．61％;LESP测定25例,10例阳性,阳性率40％;56例行Losec试验性治疗,有效54例,阳性率96．4％。本研究结果表明：在所有的检查方法中,Losec试验性治疗阳性率最高,且不需特殊设备及操作技能,可作为临床上诊断本病的有效方法。食管内24小时pH 和核素显像测定胃食管反流阳性率近似,但后者设备昂贵,仅适用于有胃食管反流疾病的儿童,食管内24小时pH监测敏感性高,不失为诊断胃食管反流疾病的可靠指标。     

胃食管反流病的流行病学研究进展

胃食管反流病（gastroesophageal reflux disease,GERD）是指胃、十二指肠内容物反流入食管引起食管症状和并发症的一类疾病,其主要表现为反酸、烧心或食物反流症状,最终可导致食管糜烂、溃疡、出血、狭窄等食管炎和咽、喉、气道等食管以外的组织损害。     

胃食管反流病Q评分与电子胃镜在胃食管反流病诊断中的应用比较

[目的]探讨胃食管反流病（GERD）Q评分在GERD诊断中的临床应用价值.[方法]将因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为GERDQ评分组和胃镜组,每组60例,分别接受GERDQ问卷评分、电子胃镜,比较分析各种方法对GERD的检出情况.[结果]GERDQ评分组与胃镜组比较差异无统计学意义（P＞0.05）,但GERDQ评分组检出率较胃镜组高.[结论]GERDQ量表是诊断GERD简单、易行、有效且零成本的方法,值得推广.     

Surgical Management of Gastroesophageal Reflux Disease in Obesity

Bariatric surgery is ubiquitous today. In the obese patient with comorbid gastroesophageal reflux disease (GERD), it is increasingly being used as an alternative to fundoplication because it not only has an effect on GERD but also on other comorbid illnesses. Traditional GERD surgery is designed to augment the mechanical barriers against reflux, decrease acid production in the stomach, improve gastric emptying, or divert bile from the stomach. Roux-en-Y gastric bypass addresses these issues in addition to resulting in profound weight loss in patients. Banding may have a positive influence in patients' GERD, though to a lesser extent. The duodenal switch provides excellent control for patients with alkaline reflux. A revision of the 1991 National Institutes of Health guidelines for determining bariatric surgical candidates is overdue, and it may be feasible to consider expanding the body mass index and comorbidity requirements to reflect the benefits offered by these techniques for GERD patients.     

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。     

Seronegative Celiac Disease in Patients with Isolated Refractory Dyspepsia and Gastroesophageal Reflux Disease

Background/AimsTo investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints.MethodsThis was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up.ResultsThe median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the HLA-DQ2 and DQ8 haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487).ConclusionsSeronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.     

探讨胃食管反流病的临床分型

目的:应用24h食管内胆红素与pH监测(食管内双监测)以及食管内镜检查对胃食管反流病(GERD)进行临床分型研究。方法:根据食管胆红素、pH双监测、食管内镜检查的结果同时结合病人症状将GERD分成3型,观察病人在各型中的分布。结果:食管内24h胆红素与pH监测结果显示:Ⅰ、Ⅱ型病人胆红素吸收值≥0.14及pH<4总时间百分比、酸反流次数和胆汁反流次数较对照组和Ⅲ型明显增加(P<0.05),而Ⅰ型和Ⅱ型之间无显著性差异(P>0.05),Ⅲ型和对照组之间无显著性差异(P>0.05)。GERD病人在3个临床分型中呈正态分布。Ⅰ、Ⅱ、Ⅲ型病人分别为23.3％、65.9％、10.8％。结论:临床上对GERD分型有助于进一步探讨和研究临床治疗。     

19例胃食管反流病患者根除幽门螺杆菌后食管酸反流的变化

目的：在胃食管反流病(GRED)患者根除幽门螺杆菌(Hp)是否会加重胃食管反流目前存在很大争议。本研究将采用食管内24h pH监测及食管测压检查的方法，定量观察GERD患者根除Hp治疗前后食管酸暴露及食管动力的变化。方法：连续选取我院门诊就诊的Hp阳性GERD患者。Hp感染诊断依据RUT和UBT或UBT和血清学检查。所有入选对象均在内镜检查后1～3d内行食管内24h pH监测和食管测压检查，同时评估反流症状。给予1周三联根除Hp治疗(奥美拉唑20mg，克拉霉素0．25g，阿莫仙1．0g，均bid)。疗程结束3个月后^14C—UBT检查，证实Hp根除者复查食管内24h pH监测和食管测压，同时重新评估反流症状。随访期间不用抑酸剂及促动力剂。结果：共23例Hp阳性GERD患者入选了本研究，其中19例患者完成了根除Hp前后的对比研究。在入选时有6例患者内镜下表现符合反流性食管炎，24h食管内pH监测提示病理性反流者10例。在确定根除Hp3个月后反酸、腹痛症状明显改善，食管24h pH监测各项参数与根除前相比均无显著性差异。LESP根除前10mm Hg(7．7—15．9)，根除后15mm Hg(10—20．6)，前后相比有显著性差异。食管体蠕动无明显改变。结论：本研究在GERD患者根除Hp3个月后反流症状有改善，食管酸暴露情况无明显变化，LESP较根除前增高，提示在GERD患者根除Hp有可能改善胃食管反流症状。     

Study of Respiratory Disorders in Endoscopically Negative and Positive Gastroesophageal Reflux Disease

Background/Aim:

The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in this question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlations between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease.

Patients and Methods:

This study included 515 patients evaluated for gastroesophageal reflux disease (GERD) by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index (BMI), medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies.

Results:

A total number of 515 patients were categorized according to endoscopic findings into two groups; (group1) subjects with normal endoscopic studies (NERD) 118 (22.9%) patients and (group2) subjects with abnormal endoscopic studies (ERD) 397 (77.1%). The proportion of females was significantly higher in ERD group (80.1%) as compared with NERD group (62.7%) (P<0.02). Duration of reflux symptoms found to be significantly prolonged in ERD group (P<0.03). The cases of ERD group were more likely to be overweight (BMI > 25) P<0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients (57.1%) with different pulmonary manifestations. These manifestations were significantly higher among female group (P<0.01) and among obese, above 40 years old (P<0.001, 0.05 respectively). Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis (50.3%), chronic bronchitis (15.8%), bronchial asthma (12.6%) and recurrent pneumonia (3.3%). Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders (P<0.001). There were statistically significant differences in FEV1, FVC and FEV1/FVC (P<0.02, P<0.05 and P<0.05) respectively in ERD group as compared with NERD group.

Conclusion:

The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. There is direct relationship between the severity of airways obstruction as detected by FEV₁ and FEV1/FVC and GER symptoms.     

尼扎替丁治疗老年胃食管反流病

目的观察尼扎替丁治疗老年胃食管反流病的疗效。方法将116例老年胃食管反流病随机分为3组A组40例,B组38例,C组38例,分别应用奥美拉唑20 mg、尼扎替丁150 mg、雷尼替丁150 mg,bid×4周;然后分别改为20 mg、150 mg、150 mg qd至6个月。于治疗4周、3月、6月后观察各组总有效率。结果显示B组4周、3月、6月总有效率分别为81．58％、89．47％、94．47％,与A组相比(分别为85．00％、90．00％、95．00％)无显著性差异(P＞0．05);而与C组相比(分别为65．79％、76．72％、78．95％)有显著性差异(P＜0．05)。症状积分与总有效率结果一致。结论尼扎替丁治疗老年胃食管反流病与奥美拉唑疗效相仿,优于雷尼替丁,且价廉、副作用少。     

惠州地区胃食管反流病与肠易激综合征重叠的特征

目的 探讨惠州地区胃食管反流病（GERD）重叠肠易激综合征（IBS）的症状特征.方法 采用整群、分层、随机抽样的方法,收集到61例GERD症状人群,其中12例（19.7％） GERD重叠IBS患者、49例单纯GERD患者,记录其人口统计学资料以及症状严重程度,对结果进行统计分析.结果 GERD重叠IBS组男女比例为1：1.4,其症状较单纯GERD组严重（P＜0.05）.结论 GERD与IBS的重叠现象多见,患者多为女性,且症状更严重.     

胃食管反流病误诊为咽喉疾病48例临床分析

目的探讨胃食管反流病误诊原因,提出防范误诊措施。方法对48例胃食管反流病误诊资料进行回顾性分析。结果48例患者主要表现为咽痛、清咽、咽部阻塞感、咽不适感等胃肠外症状。喉镜检查均见咽喉部黏膜充血、水肿、咽后壁有淋巴小结增生。经胃镜检查、诊断性治疗诊断胃食管反流病。给予质子泵抑制剂及促胃动力药。结论部分胃食管反流病以咽喉症状为主要表现,易误诊为咽喉疾病,应仔细鉴别胃食管反流病,行胃镜检查或24h食管PH值测定及其他寻找胃食管反流证据的检查、给予质子泵抑制剂诊断性治疗,有助于正确诊断。