24-hour pH monitoring in the treatment of gastroesophageal reflux

The 24 hour pH monitoring is superior to other methods in assessing chemical activity and quantitative characteristics of gastroesophageal reflux (GER). This technique supported by the pull-through esophageal manometry, reveals and classifies the patients for either medical or surgical treatment. The comparison of the diagrams recorded before and after surgical repair, is a reliable guide in evaluating the efficacy of the anti-reflux procedure.     

通过食管测压判定舒丽启能对内镜阴性的胃食管反流病食管动力学的影响

目的:通过食管测压判定舒丽启能对内镜阴性的胃食管反流病食管动力学的影响。方法:选择27例已确诊的内镜阴性的胃食管反流病患者,口服舒丽启能一个月,治疗前后进行食管测压。结果:治疗前后LESP,LES松弛率,蠕动性收缩所占比率均有显著差异。结论:舒丽启能可以作为内镜阴性的胃食管反流病的药物治疗手段之一。     

通过食管测压判定舒丽启能对内镜阴性的胃食管反流病食管动力学的影响

目的:通过食管测压判定舒丽启能对内镜阴性的胃食管反流病食管动力学的影响;方法:选择27例已确诊的内镜阴性的胃食管反流病患者,口服舒丽启能一个月,治疗前后进行食管测压;结果:治疗前后LESP,LES松弛率,蠕动性收缩所占比率均有显著差异;结论:舒丽启能可以作为内镜阴性的胃食管反流病的药物治疗手段之一。     

胃食管反流病患者体表胃电节律的变化规律

目的 观察胃食管反流病(GERD)患者的体表胃电节律变化规律及其与患者症状间的关系.方法 采用PC Polygraph HR 双电极胃电记录仪记录25例GERD患者(GERD组)和12例健康人(对照组)的餐前和餐后胃电正常节律的百分比、胃动过缓的百分比、胃动过速的百分比、主频率(DF)、餐后与餐前主功率之比(PR)、DF不稳定系数(DFIC),以及不同症状积分的GERD患者正常节律的百分比、DF、DFIC.结果 GERD组患者餐前、餐后胃电正常节律的百分比、DF低于对照组,胃动过缓的百分比、胃动过速的百分比、DFIC均高于对照组,差异有统计学意义.GERD组患者餐前胃电正常节律的百分比、DF低于餐后,而胃动过缓的百分比、DFIC 高于餐后,差异有统计学意义.不同症状积分的 GERD 组患者餐前、餐后胃电节律参数与对照组相比差异均有统计学意义,但各积分组间胃电节律参数差异无统计学意义.结论 GERD 患者存在胃电生理活动的异常,这种异常可能是 GERD 的发病机制之一.     

胃食管反流病患者体表胃电节律的变化规律

目的观察胃食管反流病（GERD）患者的体表胃电节律变化规律及其与患者症状间的关系。方法采用PCPolyg。印hHR双电极胃电记录仪记录25例GERD患者（GERD组）和12例健康人（对照组）的餐前和餐后胃电正常节律的百分比、胃动过缓的百分比、胃动过速的百分比、主频率（DF）、餐后与餐前主功率之比（PR）、DF不稳定系数（DFIC），以及不同症状积分的GERD患者正常节律的百分比、DF、DFIC。结果GERD组患者餐前、餐后胃电正常节律的百分比、DF低于对照组，胃动过缓的百分比、胃动过速的百分比、DFIC均高于对照组，差异有统计学意义。GERD组患者餐前胃电正常节律的百分比、DF低于餐后，而胃动过缓的百分比、DFIC高于餐后，差异有统计学意义。不同症状积分的GERD组患者餐前、餐后胃电节律参数与对照组相比差异均有统计学意义，但各积分组间胃电节律参数差异无统计学意义。结论GERD患者存在胃电生理活动的异常，这种异常可能是GERD的发病机制之一。     

Oecludin在胃食管反流病患者食管上皮细胞中的表达

目的研究胃食管反流病患者食管上皮细胞Oecludin表达的变化。方法选取62例胃食管反流病患者,其中反流性食管炎（RE）30例（RE组）、非糜烂性胃食管反流病（NERD）32例（NERD组）,采用免疫组化技术对其食管下段上皮的Oecludin分布表达进行检测,并以10例正常食管上皮作为对照组。结果对照组Oecludin均正常表达。NERD组4例正常表达,28例不同程度异常表达,为细胞膜不完整表达、细胞质表达及表达缺失。RE组均异常表达;RE组和NERD组与对照组0ccludin异常表达阳性率比较差异有统计学意义（p〈0．01）,而RE组与NERD组异常表达阳性率比较差异无统计学意义（P〉0．05）。结论胃食管反流病患者食管上皮Oecludin数量减少、分布异常,影响黏膜上皮屏障的完整性,可能是胃食管反流病的发病机制之一,而RE与NERD患者Oecludin异常表达无明显差异。     

Occludin在胃食管反流病患者食管上皮细胞中的表达

目的 研究胃食管反流病患者食管上皮细胞Occhdin表达的变化.方法 选取62例胃食管反流病患者,其中反流性食管炎(RE)30例(RE组)、非糜烂性胃食管反流病(NERD)32例(NERD组),采用免疫组化技术对其食管下段上皮的Occludin分布表达进行检测,并以10例正常食管上皮作为对照组.结果 对照组Occhdin均正常表达.NERD组4例正常表达,28例不同程度异常表达,为细胞膜不完整表达、细胞质表达及表达缺失.RE组均异常表达;RE组和NERD组与对照组Occludin异常表达阳性率比较差异有统计学意义(P＜0.01),而RE组与NERD组异常表达阳性率比较差异无统计学意义(P＞0.05).结论 胃食管反流病患者食管上皮Occhdin数量减少、分布异常,影响黏膜上皮屏障的完整性,可能是胃食管反流病的发病机制之一,而RE与NERD患者Occludin异常表达无明显差异.     

24小时食管pH监测电极的三种定位方法比较及其影响因素

目的 探讨食管测压法(M)、pH梯度定位法(P)及X线透视定位法(X)定位24 h食管pH监测电极的差别及其影响因素.方法 50例患者经M测定下食管括约肌距鼻外缘的长度,记录P定位的pH电极位置距鼻外缘的长度,在X线透视下观察电极位置与胃底贲门交界的距离.以差值绝对值≤2 cm为符合标准,分析三种定位方法的差异,并分析影响差别的相关因素.结果 经M、P、X定位的电极定位点距鼻外缘的长度分别为(37.9±2.9)、(40.8±4.4)和(40.7±5.3)cm,P与M以及X与M比较差异均有统计学意义(P＜0.01).P与M符合率62.0%(31/50);P与X符合率84.0%(42/50);X与M符合率58.0%(29/50).P较M偏向胃侧(2.9±3.9)cm.影响P与M差别的主要因素为年龄、身高和下食管括约肌的长度(P＜0.01或＜0.05).影响X和M的因素为身高和下食管括约肌长度(P＜0.05或＜0.01).结论 与M比较,P确定的位置倾向于偏向胃侧,在身材较高、下食管括约肌长度较长的受试者中易出现差异.X的变异不易确定,亦受身高的影响.     

Reliability and validity of the gastrointestinal symptom rating scale in patients with gastroesophageal reflux disease

The objective of this study was to evaluate the reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) in US patients with gastroesophageal reflux disease (GERD). Five hundred and sixteen adults with predominant heartburn symptoms of GERD were recruited from gastroenterologist and family physician practices and treated with 6 weeks of 150mg ranitidine twice daily to identify poorly responsive symptomatic GERD. The GSRS, the Medical Outcomes Study Short Form-36 (SF-36) Health Survey and the Psychological General Well-being (PGWB) scale were administered at baseline and after 6 weeks of treatment. Reported ratings of GERD-related symptoms from physician and patient diaries were measured. The GSRS contains five scales: reflux syndrome, abdominal pain, constipation syndrome, diarrhoea syndrome and indigestion syndrome. The internal consistency reliabilities for the GSRS scales ranged from 0.61 to 0.83 and the intraclass correlation coefficients ranged from 0.42 to 0.60. The GSRS scale scores were correlated with the SF-36 and PGWB scales and with the number and severity of heartburn symptoms. Patients with two or three clinician-rated GERD-related symptoms reported worse GSRS scale scores compared with patients with fewer symptoms (p < 0.0001). Statistically significant differences in the mean GSRS scale scores were observed between treatment responders and non-responders (p < 0.0001) and patients showing a response to treatment had larger mean changes in their GSRS scales than patients not showing a response to treatment (p < 0.0001). The standardized response means ranged from 0.42 to 1.43 for the GSRS scale scores. It was concluded that the GSRS is a brief, fairly comprehensive assessment of common gastrointestinal symptoms. The GSRS has good reliability and construct validity and the GSRS scales discriminate by GERD symptom severity and are responsive to treatment. The GSRS is a useful patient-rated symptom scale for evaluating the outcomes of treatment for GERD.     

The evaluation and treatment of adults with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is defined as symptoms or tissue damage that results from the abnormal reflux of gastric contents into the esophagus. A systematic review of population-based studies estimates that heartburn or regurgitation symptoms occur in 21% to 59% of the population during a given year. The frequency of GERD in specific populations is provided in Table 1. Although only 1 in 5 patients with upper intestinal symptoms that occur at least weekly seeks medical attention, nearly 1% of all visits to a family physician's office are for GERD or related conditions. GERD significantly affects the quality of patients' lives. In a survey of patients presenting for upper endoscopy with symptoms of at least 3 months' duration, those with a diagnosis of GERD reported low scores at baseline for general well-being. Fortunately, follow-up data reported 4 weeks after treatment note improvement in gastrointestinal symptoms, general well-being, general health, vitality, and depression.     

Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations

Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24-hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were 6019 for event recording and 9605 for Holter monitoring. The average costs were 51 per symptomatic patient detected by event recorder monitoring and 130 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.     

As-needed treatment with gastric acid inhibitors in gastroesophageal reflux disease

Although proton pump inhibitors and H2-receptor antagonists are usually prescribed for continuous use by patients with gastro-oesophageal reflux disease, at least 50% of such patients do not take their medication daily and some take it only sporadically. On-demand treatment with proton pump inhibitors or H2-receptor antagonists is safe and cost-effective. Indications are: (a) incidental reflux episodes of short duration, (b) periodic reflux lasting several weeks or months, (c) chronic reflux not requiring continuous treatment. On-demand treatment is unsuitable for patients with reflux disease who either require daily medication or in whom the maximal dosage is insufficient. There are three types of on-demand treatment. Type 1: use of medication only in case of incidental symptoms. Type 2: continuous medication for 2-4 weeks when symptoms appear. Type 3: continuous use because of chronic symptoms, but the interval between doses is determined by the patient on the basis of his symptoms. All antacids can in principle be used for on-demand treatment; for type 3 treatment, antacids with a rapid onset of action are preferred. A favourable response to the two weeks of initial therapy is a good predictor for successful on-demand treatment.     

Technical aspects,indications and results of 24-hour esophageal pH-monitoring

Twenty four-hour esophageal pH-monitoring is considered as the gold standard for the diagnosis of gastroesophageal reflux disease. The aims of this review are to describe technical aspects, interprative modalities and normal values of esophageal pH data to determine the indications of esophageal pH-monitoring with special interest of the most established indications.     

Otorhinolaryngeal and phonation aspects of gastroesophageal reflux disease]

Experts dealing with patients of chronic upper and lower airway disorders have drawn a lot of interest in the last decades to gastrooesophageal reflux disease (GORD). Nowadays it is obvious that 'occult GORD' may be an aetiological factor in this group of patients. GORD may has a role in lot of organic laryngeal diseases and functional voice disorders. Symptoms are triggered by gastric content refluxed into the oesophagus, which cause irritation and inflammation. At laryngeal and phoniatric examinations gastrointestinal signs might remain hidden behind chronic cough, hoarseness and globus sensation. Authors summarise the diagnostic and therapeutic possibilities of GORD and its typical laryngeal and phoniatric manifestations. Although the first step is medication of GORD, it might come to surgical intervention of the laryngeal alterations, sometimes followed by voice therapy as well. Authors draw attention to patients after laryngectomy, whose voice rehabilitation therapy is extremely hindered by medical therapy resistant GORD. These patients may benefit of anti-reflux surgery.     

上消化道造影对胃食管反流病的诊断价值

目的 探讨上消化道造影对胃食管反流病(GERD)的诊断价值.方法 回顾性分析2003年1月至2012年12月上消化道造影对GERD的检出率,不同性别及年龄间的差异.总结2012年454例患者反流程度及反流体位,并探讨患者年龄与反流程度、反流症状的关系.结果 2003年1月至2012年12月GERD检出率为13.48％(2 743/20 353),GERD检出率有逐年增加的趋势.男性与女性GERD检出率比较差异无统计学意义[13.73％(1 312/9 554)比13.25％(1 431/10 799),P＞0.05].随着年龄的增加GERD检出率逐渐增高[≤30岁为6.87％(197/2 866),31 ～ 60岁为11.63％(1 096/9 421),≥61岁为17.98％(1 450/8 066)],差异有统计学意义(P＜0.05).2012年454例GERD患者的反流程度为轻度242例,中度110例,重度102例.随着年龄的增加,反流程度加重[≤30岁重度反流占10.26％(4/39),31～ 60岁占17.92％(38/212),≥61岁占29.56％(60/203)],差异有统计学意义(P＜0.05).左前斜位反流占95.37％(433/454).结论 上消化道造影可直观显示钡剂的反流、反流程度及反流体位,方法简单实用,可用于GERD的诊断.上消化道造影时应注意卧位变换体位观察,可提高GERD检出率.     

Health state utilities in gastroesophageal reflux disease patients with heartburn: a study in Germany and Sweden.

The objectives of this study were to assess health state utilities in patients with gastroesophageal reflux disease with heartburn and to analyze if severity and annual frequency of heartburn can predict utilities. A total of 1011 patients in Germany and Sweden participated in telephone interviews, where utilities were assessed using the rating scale (RS), EQ-5D, time trade-off (TTO) and standard gamble (SG) instruments. The average RS, EQ-5D, TTO, and SG utilities were 0.69, 0.70, 0.88, and 0.89, respectively. Linear regression analyses showed that the EQ-5D and RS utilities were negatively and significantly related to the severity and frequency of heartburn. The EQ-5D and RS results indicate that patients with heartburn assign their health states substantial disutility and that it is feasible to estimate regression equations to predict utilities from heartburn-specific variables. In the TTO and SG analyses, the impact of heartburn was in the expected direction but smaller and in general not significant.     

Diet and lifestyle modifications in the management of gastroesophageal reflux disease

Gastroesophageal reflux disease is a chronic condition affecting 44% of the American population at least once a month, with daily occurrences affecting about 7% of the population. It is the most common gastrointestinal-related diagnosis given by physicians during clinic visits in the United States. Treatment of this disease is a step-wise approach that includes diet and lifestyle interventions as well as medications titrated based on symptom severity. This article reviews dietary and lifestyle factors that contribute to the physiology and symptoms of gastroesophageal reflux disease and modification of these factors as an adjunctive therapy.