小肠细菌过度生长和肠易激综合征关系的探讨

目的　探讨小肠细菌过度生长与肠易激综合征发病中的关系。方法　用乳果糖氢呼气试验测定 49例腹泻及便秘型肠易激综合征病人口 -回盲瓣通过时间 ,并了解其阳性发生率 ;对其中 10例阳性者给普瑞博思治疗1周 ,进行治疗前后比较。结果　在肠易激综合征病人中腹泻及便秘型口 -回盲瓣通过时间较对照组延长 (P <0 0 5 ) ,阳性发生率无差别 (P >0 0 5 ) ,治疗后口 -回盲瓣通过时间改善明显 (P <0 0 5 ) ,症状改善。结论　小肠功能紊乱可导致小肠细菌过度生长 ,并可能是肠易激综合征发病因素之一。     

胃食管反流病和肠易激综合征的异同

胃食管反流病（GERD）和肠易激综合征（IBS）的临床表现有很高的症状重叠现象，其发生机制可能与其有共同的危险因素、相同的病理生理学和遗传易感性等有关。治疗GERD和IBS时，应针对其病理机制给予综合治疗，这样才能提高疗效，改善生活质量。     

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,     

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.     

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。     

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。     

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。     

胃食管反流病与功能性肠病关系的研究

目的探讨胃食管反流病与功能性肠病的关系。方法随机选取2004年北京大学人民医院消化科门诊有上腹症状的病人168例,填写反流性疾病诊断问卷(耐信量表),以Sc≥12为症状性胃食管反流标准,将病人分为两组,Sc≥12组及Sc<12组,记录病人身高、体重、计算体重指数、吸烟史、饮酒史、手术史、用药史,按照功能性肠病罗马Ⅱ诊断标准筛选功能性肠病病人,包括肠易激综合征(IBS)、功能性便秘、功能性腹胀、功能性腹泻等病人。结果按照罗马Ⅱ标准,两组患IBS及患功能性便秘差异无显著统计学意义,但两组发生功能性腹泻的差异有显著统计学意义,经logistic回归分析,发现体重指数与发生和胃食管反流病程相伴的下消化道功能异常有一定关系。结论胃食管反流可以合并不同程度下消化道功能异常,但具体机制尚有待进一步研究。     

胃食管反流病与功能性消化不良、肠易激综合征症状重叠的研究

目的探讨胃食管反流病（GERD）重叠功能性消化不良（FD）、肠易激综合征（IBS）症状的发生率，分析糜烂性食管炎（EE）和非糜烂性反流病（NERD）亚型患者重叠FD、IBS症状发生率的异同。方法通过胃镜及24h食管pH监测，将147例GERD患者区分为EE47例、病理性酸反流[NERDpH（＋）]42例和生理性酸反流[NERDpH（-）]58例。根据罗马Ⅱ诊断标准对患者重叠FD、IBS症状的情况进行问卷调查。采用《检验比较不同组间重叠症状发生率。结果147例GERD患者中重叠FD症状54例（36．7％），重叠IBS症状19例（12．9％），其中同时重叠FD、IBS症状10例（6．8％）。EE及NERD组重叠FD症状者分别为11例（23．4％）及43例（43．0％），差异有统计学意义（P〈0．05）。EE及NERDpH（＋）组重叠FD症状者分别为n例（23．4％）及13例（31．O％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠FD症状者分别为13例（31．0％）及30例（51．7％），差异有统计学意义（P〈0．05）。EE及NERD组重叠IBS症状者分别为6例（12．8％）及13例（占13．0％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠IBS症状者分别为4例（9．5％）及9例（15．5％），差异无统计学意义（P〉0．05）。结论部分GERD患者重叠FD、IBS症状。无异常食管酸暴露的烧心患者易合并FD症状。     

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。     

Small Intestinal Bacterial Overgrowth in Patients with Interstitial Cystitis and Gastrointestinal Symptoms

Purpose Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity. This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy. Methods Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200–1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement. Results Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%). Conclusions A majority of IC patients and GI symptoms had an abnormal LBT suggesting SIBO. Rifaximin improved symptoms, which was sustained by tegaserod.     

Small Intestine Bacterial Overgrowth and Metabolic Bone Disease

Small intestine bacterial overgrowth is a malabsorption syndrome and, therefore, it may contribute to the occurrence of metabolic bone disease. However, studies that evaluate the magnitude of this problem and the potential underlying mechanisms are still needed. Fourteen patients with bacterial overgrowth and 22 comparable healthy volunteers took part in this study. All patients were affected by conditions known to predispose to bacterial overgrowth. Diagnosis was based on the following criteria: increased breath hydrogen levels in the fasting state and/or increased breath hydrogen excretion after the ingestion of 50 g of glucose solution, improvement after a 10-day course of antibiotic therapy of severity of symptoms and of H₂ excretion parameters. Measurement of bone mineral density by dual-energy x-ray absorptiometry at lumbar spine and femoral level and evaluation of nutritional status were performed. Physical activity, sunlight exposure, and cigarette smoking were also evaluated. Patients showed lumbar and femoral bone mineral density values significantly lower than control group; also the prevalence of bone loss at both lumbar and femoral levels was higher in patient group than in healthy volunteers. Body mass index was significantly lower in patients than in healthy volunteers. Lumbar and femoral bone mineral density were significantly correlated and both correlated with body mass index and with duration of symptoms. No correlation between BMD values and physical activity, sunlight exposure, and cigarette smoking was evident. Our results show that small intestine bacterial overgrowth is an important cofactor in the development of metabolic bone disease. The severity of bone loss is related to poor nutritional status and duration of malabsorption symptoms.     

Small Intestinal Bacterial Overgrowth in Gastroparesis

Objective

To determine symptoms of small intestinal bacterial overgrowth (SIBO) in gastroparesis patients.

Methods

Patients undergoing LBT (lactulose breath test) for evaluation of SIBO were included. LBT was considered positive on the basis of three conventional criteria: (1) hydrogen level increase >20 ppm above baseline by 90 min (H2@90min); (2) dual hydrogen peaks (>10 ppm increase over baseline before second peak >20 ppm (DPHBT); and (3) breath methane increase of >20 ppm above baseline by 90 min. Results of gastric emptying scintigraphy (GES) were recorded. Patients completed the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index.

Results

Of 740 patients who underwent LBT from December 2009 to August 2011, 471 underwent GES, with 201 having delayed GES. Of patients with delayed GES who underwent LBT 87 % were female, 23 % diabetic, 49 % used gastric acid suppressants, 29 % used opiate analgesics, 35 % used pro-motility medications, and 27 % had a history of gastrointestinal surgery. Overall, 79 (39 %) patients with gastroparesis had evidence of SIBO by LBT: 30 (15 %) had positive H2@90min, 53 (26 %) positive DPHBT, and 6 (3 %) positive breath methane test. In gastroparesis patients with positive H2@90min, there was increased severity of bloating (3.80 ± 0.20 vs 3.29 ± 0.12; P = 0.02), early satiety (3.57 ± 0.27 vs 3.05 ± 0.13; P = 0.045), and postprandial fullness (4.20 ± 0.18 vs 3.52 ± 0.12; P < 0.01) compared with negative H2@90min patients. No significant difference in symptom severity was seen between positive and negative DPHBT gastroparesis patients.

Conclusion

In our cohort, 39 % of gastroparesis patients tested positive for SIBO by LBT. Positive H2@90min testing by LBT was associated with increased symptoms of bloating and excessive fullness during and after meals.