不同类型胃食管反流病发病机制的差异

目的:比较不同类型胃食管反流病(GERD),即反流性食管炎(RE)、非糜烂性反流病(NERD)和Barrett食管(BE)发病机制的差异.方法:113例GERD患者,根据内镜下表现及病理情况分为RE、NERD、BE三组,比较三组患者内镜下表现、食管测压和24 h pH监测指标、合并食管裂孔疝(HH)情况的差异.结果:RE组较NERD组与BE组下食管括约肌压力减低,但无统计学差异.食管体部各段的收缩波幅比较,RE组减低最明显,NERD组减低最少,两组比较P<0.05;无效食管运功比较,RE组较另两组明显增多( P<0.05).RE、NERD、BE组24 h食管pH监测的DeMeester计分分别为90.2、55.2、48.8;RE组以重度酸暴露多见(43%),反流总时间阳性率较高;NERD组以轻度酸暴露多见(45.8%),反流频率阳性率较高;BE组以长反流时间阳性率较高.HH在RE、NERD、BE组中的检出率分别为50%、14.6%、25.7%( P = 0.003).结论:下食管括约肌及食管体部运动功能受损程度、酸反流情况的差异可能是造成三种不同类型GERD食管黏膜损伤表现不同的主要原因.     

胃食管反流病与胃酸胆汁联合反流的关系

目的探讨胃食管反流病(gastroesophagealrefluxdisease,GERD)与胃酸胆汁联合反流的关系。方法2002-09～2004-09河南大学淮河医院及新乡医学院第二附属医院住院及门诊GERD患者82例,其中非糜烂性反流病(nonerosiverefluxdisease,NERD)22例,反流性食管炎(refluxesophagitis,RE)31例,Barrett食管(Barrett esophagus,BE)29例及健康对照组20例。应用便携式24hpH监测仪和胆汁反流监测仪对三组患者及对照组进行24h食管内pH和胆汁动态联合监测。结果RE、BE患者胃酸和胆汁联合反流比NERD患者和对照组更加频繁。结论胃酸和胆汁的联合反流在RE和BE的发病机制中起着更加重要的作用,同步监测食管pH值及胆汁变化对RE、BE的诊断和治疗具有重要的意义。     

反流性食管炎与非糜烂性反流病食管酸暴露的特点比较

目的　比较反流性食管炎 (RE)与非糜烂性反流病 (NERD)各亚组食管酸暴露特点。方法　具有典型反酸 烧心等症状的 12 8例患者 ,经胃镜等系统检查诊断为胃食管反流病 (GERD)。便携式 pH监测仪行胃食管 2 4hpH监测 ,DeMeester积分≥ 15分为存在病理性酸反流。 结果　 12 8例患者中 ,37例 (2 8 9% )存在RE ,91例 (71 1% )为NERD。pH监测阳性在RE组和NERD组中分别为 2 5例 (6 7 6 % )和 4 6例 (5 0 5 % ) ,差异无统计学意义 ;两组DeMeester积分均值差异亦无统计学意义 (5 3 4 5± 6 2 0 4比 4 0 0 4± 6 1 80 ,P >0 0 5 )。RE组长反流次数显著高于NERD组 (8 16±10 2 7比 3 96± 6 87,P =0 0 0 4 )。以症状指数 >5 0 %为阳性 ,NERD阳性组 (pH值监测异常 )症状指数阳性率显著高于NERD阴性组 (pH值监测正常 ) (43 5 %比 15 6 % ,P <0 0 0 1)。NERD阴性组中具有阳性症状指数的患者 7例 (15 6 % ) ,阴性症状指数者 38例。前者总反流次数及立位反流时间百分比显著高于后者。RE患者中 ,12例 pH监测阴性者食管及胃内pH的中位值显著高于 pH监测阳性者。结论　RE患者长反流发生率高于NERD患者 ;症状的发生与酸反流相关 ;NERD患者根据酸反流与症状关系可分为不同的亚组。RE阴性组可能存在混合反流或胆汁反流     

反流性食管炎、Barrett食管和食管腺癌的研究

背景:胃食管反流病(GERD)是一种常见疾病,包括非糜烂性反流病(NERD)、反流性食管炎(RE)和Barrett食管(BE),近年其发病率逐渐增高。目的:探讨RE、BE与各种因素的关系。方法:应用反流性疾病问卷筛选具有胃食管反流症状的患者,行胃镜检查检测RE、BE和食管腺癌的检出率,分析吸烟、饮酒、饮食、年龄、性别和民族与RE、BE的关系。结果:共纳入1834例具有胃食管反流症状的患者,其中RE患者234例(12.8%);BE患者213例(11.6%),包括特殊肠化生型BE 47例;食管腺癌5例(0.3%)。蒙古族RE、BE的检出率显著高于汉族和其他民族。饮酒者中RE和BE的比例明显升高。BE患者中-重度异型增生和食管腺癌的检出率升高。结论:蒙古族人群RE和BE的检出率较高,饮酒与食管反流致损伤的关系密切,BE为食管腺癌的癌前病变。     

唾液胃蛋白酶含量与老年胃食管反流病的关系

目的探讨唾液中胃蛋白酶与胃食管反流病(GERD)的关系。方法 60例GERD患者依照病情不同分为反流性食管炎(RE)组、非糜烂性食管反流病(NERD)组及Barrett食管(BE)组,采用中国消化内镜学会标准(1998烟台)分级内镜下表现积分对患者临床症状进行评价,应用乳胶增强免疫比浊法分析患者唾液中胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及总胃蛋白酶原水平。结果 RE组胃蛋白酶原Ⅰ水平显著高于NERD组和BE组,总胃蛋白酶原水平显著高于BE组(均P<0.05);3组症状评分差异无统计学意义(P>0.05);3组均有较佳的阴性预测值和敏感性;RE、NERD、BE组临床症状评分与唾液内胃蛋白酶原Ⅰ浓度均呈正相关(r=0.573,0.463,0.452;P<0.05)。结论老年GERD患者唾液中胃蛋白酶水平与症状评分呈正相关,临床中可考虑通过检测患者唾液中胃蛋白酶水平分析老年GERD患者病情。     

反流性食管炎和非糜烂性反流病患者症状谱、生活质量和精神心理状态调查

背景：胃食管反流病（GERD）包括非糜烂性反流病（NERD）、反流性食管炎（RE）和Barrett食管（BE），其发病机制可能有所不同。目的：分析比较NERD和RE患者的人口学特征和临床特点，为探讨其发病机制和有效治疗提供依据。方法：对连续入组的278例GERD患者进行问卷调查，内容包括一般人口学资料、胃食管反流以及相关症状评分、食管外症状、重叠症状、生活质量评价和精神心理状态评价。结果：NERD和RE分别占GERD的60．8％和37．1％；与RE组相比，NERD患者以女性多见（P〈0．05），平均年龄较轻（R〈0．05）。胃食管反流症状评分在两组患者间无显著差异，但RE组烧心频率较NERD组高（P〈0．05），而NERD组胸骨后疼痛更突出，反食症状较轻。两组患者的食管外症状、重叠症状发生率无显著差异。NERD组患者生活质量下降更明显。NERD组患者合并精神心理异常的比例显著高于RE组（P〈0．05），且抑郁评分高。结论：本组资料中大部分GERD患者为NERD，NERD和RE的反流以及相关症状谱无显著差异。但NERD患者常合并精神心理异常、生活质量下降，提示精神心理因素在NERD的发病中可能起重要作用。     

合并食管外症状的难治性胃食管反流病的临床研究

选取51例难治性GERD患者,分析合并食管外症状和典型反流症状的难治性GERD患者的高分辨率食管测压和24 h pH-阻抗监测数据。结果显示合并食管外症状组弱酸反流事件发生率(41.0%,16/39)高于典型反流症状组(9/12),差异有统计学意义(χ^2=4.238,P=0.040);而两组酸反流、长反流、非酸反流和食管动力之间差异均无统计学意义(P均>0.05)。弱酸反流可能是合并食管外症状难治性GERD的重要发病机制。     

Barrett食管、糜烂性食管炎和非糜烂性反流病食管酸暴露及食管动力学分析

目的分析胃食管反流病(GERD)三种亚型Barrett食管(BE)、糜烂性食管炎(EE)和非糜烂性反流病(NERD)患者食管24 h pH监测与高分辨率食管测压结果,探讨不同亚型胃食管反流病食管酸暴露及动力学变化特点。 方法收集2015年12月至2017年12月,新疆维吾尔自治区人民医院接受住院治疗的90例GERD患者的临床资料,其中BE组28例、EE组35例、NERD组27例,通过食管24 h pH监测结果评价患食管酸暴露及反流特点,高分辨率食管测压检查评价食管动力学特点。 结果3组患者年龄及身体质量指数(BMI)等一般资料比较,差异无统计学意义(P>0.05);EE组患者24 h食管pH监测中pH≤4(酸反流)、40.05);3组Demeester评分比较,差异无统计学意义(P>0.05);LES长度3组无明显差异,BE组LES静息压及残余压较EE组和NERD组稍高,但差异无统计学意义(P均>0.05);3组在食管远端收缩积分比较,差异无统计学意义(P>0.05)。 结论食管测酸检查在GERD临床亚型的鉴别方面并无显著差别;Barrett食管、糜烂性食管炎、非糜烂性反流病均存在抗反流屏障功能减退,但不同程度的食管粘膜损伤对食管动力学的影响并无差异。     

问询表诊断老年人胃食管反流病的临床评价

目的探讨问询表调查在我国诊断老年胃食管反流病( GERD)的临床价值. 方法选取有烧心,反酸,胸痛等症状,且连续发作一周以上的老年患者.进行胃镜检查,胃镜阳性者归入反流性食管炎组( RE组),胃镜阴性者进一步行食道测压及 24小时胃食管 pH监测,根据结果分为非糜烂性胃食管反流病组( NERD组)和正常对照组( Normal组).所有患者均填写 Carlsson- Dent自我症状问询表并给予 PPI试验一周,以胃镜及 24小时胃食管 pH监测阳性为 GERD确诊标准,统计问询表诊断胃食管反流病的敏感性、特异性和准确率. 结果共 78例老年患者入选,经检查分为 RE组 21例、 NERD组 31例和正常对照组 26例.三组的问询表得分分别为 5.86± 2.90、 5.00± 3.14和 3.69± 1.57, RE组和 NERD组得分与 Normal组比较有显著差异( P< 0.05); RE组和 NERD组比较无明显差异.以 4分为临界值, Carlsson- Dent问卷诊断胃食管反流病的敏感性为 69.23%、特异性为 38.46%、准确率为 58.97%; PPI抑制试验结合 Carlsson- Dent问卷诊断胃食管反流病的敏感性为 88.46%、特异性为 26.92%、准确率为 67.94%. 结论 Carlsson- Dent问卷可用于筛选老年 GERD,结合 PPI试验可提高诊断的敏感性.     

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.     

Reflux profile of Chinese gastroesophageal reflux disease patients with combined multichannel intraluminal impedance-pH monitoring

Background and Aims:  To investigate the reflux profile of Chinese gastroesophageal reflux disease (GERD) patients with the aid of combined multichannel intraluminal impedance-pH (MII-pH) monitoring technique.
Methods:  Consecutive patients presented with GERD symptoms were enrolled to erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group and functional heartburn (FH) group after upper endoscopy, combined MII-pH monitoring and rabeprazole test. Another 20 healthy controls (HC) were recruited.
Results:  Sixty-four GERD patients (EE:20, NERD:22, FH:22, HC:20) were enrolled. There were more episodes of liquid reflux and proximal reflux in EE and NERD groups than that in FH and HC groups ( P  < 0.05). Patients in FH and HC groups had higher proportion of mixed reflux ( P  = 0.000). The percentage of acid reflux in EE and NERD was much higher, while there was a higher percentage of weakly acidic reflux in FH and HC ( P  = 0.000). No significant difference was found in MII-pH parameters between groups with and without response to rabeprazole test except recumbent percentage time of esophageal pH value below 4 and episodes of proximal reflux.
Conclusion:  Erosive esophagitis and NERD patients had more liquid and proximal reflux episodes than FH patients and healthy controls. Acid and liquid reflux was predominant in the former two groups, while weakly acidic and mixed reflux was predominant in the latter two groups.     

Diagnostic value of dilated intercellular space and histopathologic scores in gastroesophageal reflux disease

The aim of this paper is to investigate the diagnostic value of histopathologic score and the dilated intercellular space (DIS) in patients with gastroesophageal reflux disease (GERD) and functional heartburn (FH). Participants with GERD symptoms including reflux esophagitis, non‐erosive reflux disease (NERD), Barrett's esophagus (BE), functional heartburn (FH), along with a control group with atypical GERD‐like symptom (Sym‐C), and asymptomatic healthy volunteers (H‐C) were administered GERD questionnaire, and subjected to endoscopy and biopsies, as well as 24‐hour pH‐impedance monitoring. Biopsies were evaluated using standards from the 2011 Esohisto Project after Hematoxylin‐Eosin staining. DIS was measured quantitatively under light microscopy. Among the total of 565 participants with qualified biopsy specimens, the mean DIS of the reflux esophagitis (RE) group was significantly wider compared with the other five groups. DIS in patients with GERD‐like symptoms was significantly wider compared with the H‐C. No significant differences were observed between NERD and FH. Results from 24‐hour pH‐impedance monitoring indicated that only the DIS of patients with acid reflux or the amount of acid reflux episodes in patients with DIS was significantly wider compared with patients with nonacid reflux or patients without DIS (P < 0.001). With DIS = 0.9 μm as the cutoff value, the sensitivity and specificity were 62.6% and 54.1%, respectively. Using the total histopathologic score > 3 as the diagnostic criterion, the sensitivity and specificity were 71.7% and 47.4%. DIS is closely associated with GERD and acid reflux. The diagnostic value of histological scores in lower esophagus in GERD is very similar to that of the quantitative measurement of DIS.     

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE).RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m². All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P < 0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extra-esophageal symptoms (P < 0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively).CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.     

Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

Background/Aims

Gastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD.

Methods

Patients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-).

Results

A total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p<0.05).

Conclusions

Demographic characteristics and reflux symptom patterns cannot differentiate pH- group from GERD subtypes. Esophageal pH monitoring could be considered for the initial evaluation of GERD in the tertiary referral setting.     

反流性食管炎和非糜烂性反流病患者酸暴露与食管压力监测结果分析

目的通过对胃食管反流病（GERD）患者的酸暴露情况、食管下括约肌（LES）压力、食管体部压力、幽门螺杆菌（Hp）感染结果的比较，探讨反流性食管炎（RE）、非糜烂性反流病（NERD）的不同状况，为临床治疗提供科学依据。方法2001年10月至2005年7月，具有反流症状（烧心、反酸）的患者80例，胃镜检出RE31例，NERD45例，Barrett食管（BE）4例。行食管24hpH动态监测，并以De—Meester积分均值将GERD分为轻、中、重度，检测LES、食管体部即LES上方5cm、7cm、13cm（简记为L5、L7、L12）和食管上括约肌（UES）下方1cm、6cm、8cm（简记为U1、U6、U8）压力指标，并进行Hp感染的检查。结果RE、NERD两组患者食管24hpH酸暴露各指标的差异，无统计学意义（P〉0．05），De-Meester积分均值亦无统计学意义（P〉0．05）；轻、中、重度GERD患者食管24hpH监测指标具有统计学意义（P〈0．01）。RE、NERD两组患者LES压力、食管体部的L5、L7、L12、U6和u8压力监测指标无统计学意义（P〉0．05），只有RE组U1压力低于NERD组，差异有统计学意义（P〈0．05）；轻、中、重度GERD患者LES压力和食管体部的压力监测指标差异无统计学意义（P〉0．05）。RE和NERD组患者Hp感染率分别为16．1％和22．2％，其差异无统计学意义（P〉0．05），OR为1．309，95％C10．364～4．705。结论RE和NERD患者酸暴露、LES压力和食管体部压力等相应指标无明显差异；NERD在发病机制中，酸反流的强弱没有起到决定性作用。     

胃食管反流病中非酸反流的比例及其与烧心的关系

目的 应用食管联合阻抗-pH监测技术探讨胃食管反流病中非酸反流的比例及其与烧心的相关程度.方法 选取消化专科门诊以烧心为主诉的连续病例,通过上消化道内镜将上述患者分为糜烂性食管炎(EE)组和非糜烂性反流病(NERD)组,并进一步通过24 h食管多通道腔内阻抗-pH监测及雷贝拉唑试验性治疗予以确诊.比较两组的联合阻抗-pH监测指标.结果 EE组36例,NERD组62例.两组患者酸反流次数、酸反流时间百分比差异有统计学意义(P值分别=0.001和0.002).EE组和NERD组中非酸反流次数的百分比分别为37.3%(663/1777)和44.3%(1220/2754),差异有统计学意义(x=21.723,P=0.000).EE组酸反流烧心症状指数阳性、非酸反流烧心症状指数阳性及总反流烧心症状指数阳性的百分比分别为36.1%(13/36)、19.4%(7/36)和55.6%(20/36),NERD组则为27.4%(17/62)、6.4%(4/62)和33.8%(21/62).结论 EE组和NERD组患者中非酸反流次数的比例分别为37.3%及44.3%,非酸反流与烧心关系密切.     

Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms.

BACKGROUND AND AIM: Patients with gastroesophageal reflux disease (GERD) usually suffer from acid reflux and duodenogastroesophageal reflux (DGER) simultaneously. The question of whether DGER has an important effect on the development of GERD remains controversial. The aim of the present study was to investigate the role of DGER in the pathogenesis of GERD and its value for the diagnosis of nonerosive reflux disease (NERD). METHODS: GERD was initially diagnosed using the reflux disease questionnaire. For further diagnosis, results of the upper gastrointestinal endoscopy (excluding a diagnosis of Barrett's esophagus) were considered in conjunction with simultaneous 24 h esophageal pH and bilirubin monitoring. RESULTS: According to endoscopic findings, 95 patients (43 men, 50+/-10 years of age) were divided into two groups: the reflux esophagitis (RE) group (n=51) and the NERD group (n=44). Three DGER parameters, the percentage of time with absorbance greater than 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 min, were evaluated in the study. For the RE group, the values of the DGER parameters (19.05%+/-23.44%, 30.56+/-34.04 and 5.90+/-6.37, respectively) were significantly higher than those of the NERD group (7.26%+/-11.08%, 15.68+/-20.92 and 2.59+/-3.57, respectively, P<0.05 for all) but no significant difference was found in acid reflux. Of NERD patients, 18.5% were diagnosed with simple DGER. The positive diagnosis rate of NERD could be significantly elevated from 65.9% to 84.1% (P<0.05), if bilirubin monitoring was employed in diagnosis. CONCLUSIONS: DGER may occur independently but plays an important role in the development of RE and GERD symptoms. Simultaneous 24 h esophageal pH and bilirubin monitoring is superior to simple pH monitoring in helping identify patients at risk for NERD.     

Acid and Non-Acid Reflux Patterns in Patients with Erosive Esophagitis and Non-Erosive Reflux Disease (NERD): A Study Using Intraluminal Impedance Monitoring

Background Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most common phenotypic presentations of gastroesophageal reflux disease (GERD). Aim To assess acid and non-acid reflux patterns in patients with EE and NERD using combined esophageal pH-impedance monitoring. Methods A total of 26 GERD patients off acid-suppressive medication and ten healthy volunteers (HV) underwent upper endoscopy and 24-h pH-impedance monitoring. Analysis of the pH-impedance signals included total reflux time, number of reflux episodes according to gas–liquid composition, and pH (acid, non-acid). Results EE was identified in 13 patients and NERD in 13 patients. Pathologic acid reflux was found in 92.3 and 69.2% of patients with EE and NERD, respectively (P = 0.15). When compared to HV, EE patients and NERD patients showed a higher incidence of acid (P = 0.002 and P < 0.001, EE vs. HV and NERD vs. HV, respectively) and non-acid reflux episodes (P = 0.03 and P = 0.001, EE vs. HV and NERD vs. HV, respectively). Mean reflux times, as assessed by both pH-metry and impedance monitoring, and incidence of acid and non-acid reflux episodes were similar in EE and NERD patients. In the supine position, however, EE patients showed a higher incidence of acid (P = 0.048) and liquid reflux episodes (P = 0.07). Conclusion Whereas EE patients have more acid reflux episodes in the supine position than NERD patients, patients with EE and NERD have similar non-acid reflux patterns. This observation lends support to the notion that non-acid reflux is less damaging to the esophageal mucosa than acid reflux.