胃食管反流病的症状评分及内镜下表现的对照研究

目的探讨用胃食管反流病（GERD）的症状评分及内镜下表现的对照研究来预测和评估是否有GERD及其程度。方法对500例有胃食管反流症状的患者按症状频率、病期与程度为评分标准进行症状评分，内镜检查是否有反流性食管炎（RE）并分级。比较症状评分与内镜分级的相关性，分析症状评分对GERD的评估价值。200例无症状体检者作为阴性对照。结果GERD症状评分与RE内镜分级呈正相关（r=0．560，P〈0．01）。RE组患者的症状评分高于非糜烂性反流病（NERD）组，RE组症状评分≥8分者有81．70％，NERD组为59．35％（P〈0．05）；RE患者烧心的程度及发作频率、反酸的发作频率与病期重于NERD。GERD组与无反流症状组内镜检查结果比较亦有统计学意义（P〈0．01）。结论症状评分是诊断GERD的一个良好的筛选项目。     

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。     

胃食管反流病临床诊断技术的评价与进展

胃食管反流病(GERD)根据内镜结果分为反流性食管炎 (RE)和非糜烂性胃食管反流病(NERD)。现就其检查的诊断价值及进展作一简述。     

胃食管反流病食管黏膜损伤程度的影响因素

目的探讨胃食管反流病（gastroesophageal reflux disease，GERD）患者中，影响食管黏膜损伤严重程度的因素。方法将消化专科门诊具有典型反流症状，并经24h食管pH监测异常或（和）胃镜检查证实的GERD患者，分为非糜烂性反流病组、轻度糜烂性食管炎组和重度糜烂性食管炎组。比较3组患者一般情况和食管pH监测指标。用logistic回归分析年龄、性别、食管裂孔疝、烟酒嗜好、幽门螺杆菌感染和食管酸暴露程度对食管损伤严重程度的影响。结果共有156例患者纳入本次研究，其中非糜烂性反流病组83例，轻度糜烂性食管炎组51例，重度糜烂性食管炎组22例。重度糜烂性食管炎组患者的平均年龄和合并食管裂孔疝比例显著高于轻度糜烂性食管炎组和非糜烂性反流病组（P〈0．05）。食管pH监测指标中卧位长反流次数在严重的食管黏膜损伤患者中显著增加（P〈0.05）。食管裂孔疝是食管黏膜损伤程度的独立相关因素（OR=15．032，95％CI：3．767-22．723，P〈0．01）。结论GERD患者中高龄、男性、合并食管裂孔疝和卧位反流增加的患者中严重的食管黏膜损伤更加常见，食管裂孔疝在食管黏膜损伤的进展过程中起着重要作用。     

脂肪性肝病与胃食管反流病的相关性研究

目的评估脂肪性肝病(FLD)与胃食管反流病GERD之间的关系。方法选取2 000例受试者,采用较简便的胃食管反流病问卷(GerdQ)作为初筛GERD诊断标准,对入选者均进行腹部超声波等检查,分析FLD与GERD关系。结果对2 000例患者利用GerdQ评估GERD诊断情况,有176例(8.8%)诊断为GERD,女68人(38.64%),男108人(61.36%);脂肪肝患者760例,患病率38.0%,在脂肪肝组中,男女性GERD症状的GerdQ阳性率分别为13.77%和12.24%,两者无明显差异(P>0.05)。脂肪肝人群发生GERD症状的患病率与对照组存在统计学差异(P<0.05)。结论脂肪肝与GERD显著相关,控制脂肪肝发展可以降低GERD发病率。     

胃食管反流病的诊断方法研究进展

胃食管反流病（GERD）是由胃内容物反流引起不适症状和（或）并发症的一种疾病,其主要症状为反流和烧心。近年来随着对GERD研究的深入,GERD的临床诊断方法也在不断发展,此文就GERD 诊断方法的新进展作一综述。     

GerdQ量表在胃食管反流病诊断中的应用

目的探讨胃食管反流病量表(GerdQ)应用于诊断胃食管反流病(GERD)的价值。 方法对2013年6月至2014年10月在新疆维吾尔自治区人民医院就诊收住并存在反流相关症状的疑似胃食管反流病的1 000例患者进行问卷调查,按照烧心、反流、上腹痛、恶心、睡眠障碍、是否服用OTC药物等6项症状的发作频率进行评分。采用上消化道内镜检查及食管24 h pH监测作为GERD诊断的标准,并与GerdQ分值进行比较,最后计算出诊断GERD的临界值,进而分析GerdQ量表在GERD中的诊断价值。 结果GERD组的GerdQ积分主要集中于7～12分,非GERD组主要集中于6分以下,差异有统计学意义(P<0.05)。以GerdQ分值8为临界值,Youden指数最大(0.51),ROC曲线下的面积0.765,其敏感度为81.32%,特异性为70.21%,阳性预测值83.24%,阴性预测值61.53%。 结论GerdQ量表简单、易行,可作为临床上筛查诊断GERD的有效方法。     

胃食管反流病的诊断进展

胃食管反流病（GERD）是指胃内容物反流入食管,引起不适症状和（或）并发症的一种疾病,临床可分为非糜烂性反流病（NERD）,反流性食管炎（RE）和Barrett食管（BE）三种类型。GERD是消化科门诊最常见疾病之一,在欧美的发病率达到10％～20％,年发病率约为0．38％～0．45％,在我国的发病率也呈逐年上升的趋势。     

非糜烂性胃食管反流病的研究及中西医治疗进展

非糜烂性胃食管反流病（non—erosive reflux disease,NERD）是胃食管反流病（gastroesophageal reflux disease,GERD）的一种类型,又称内镜下阴性GERD。GERD还包括反流性食管炎（reflux esophagitis,RE）和Barrett食管（Barrett esopha-gus,BE）两种类型。其中RE可见食管远端黏膜破损,BE是指食管远端鳞状上皮被柱状上皮所取代,它们共称为胃食管反流相关性疾病[1]。     

24h食管pH-阻抗联合监测评估以慢性咳嗽为表现的GERD患者的反流特征

背景：腔内阻抗技术与24h食管pH监测联用,可检出各种类型的胃食管反流事件,明确反流物的性质及其酸碱性。目的：应用24h食管pH-阻抗联合监测初步探讨以慢性咳嗽为表现的胃食管反流病（GERD）患者的反流特征。方法：连续纳入胸部X线检查无明显异常、无典型胃食管反流症状的不明原因慢性咳嗽患者73例,其中内镜检查无异常发现且DH-阻抗联合监测结果符合GERD诊断者定义为慢性咳嗽GERD组,21例健康志愿者作为正常对照组,比较两组pH-阻抗联合监测结果。结果：单纯根据pH监测结果,17例患者诊断为GERD。根据pH-阻抗联合监测结果,则有26例患者诊断为GERD。慢性咳嗽GERD组以气一液混合反流为主（46.3％）,正常对照组以气体反流为主（68．9％）,两组均以弱酸反流为主（59．9％和59．1％）。两组间DeMeester计分以及气体反流、酸反流、近端反流次数等差异有统计学意义（P〈0．05）。结论：以慢性咳嗽为表现的GERD患者以气．液混合反流和弱酸反流为主,无论是立位还是卧位时均存在明显的异常反流且近端反流较正常人多见。24h食管DH-阻抗联合监测对疑似GERD的慢性咳嗽患者有重要诊断价值。     

Defective Mucosal Movement at the Gastroesophageal Junction in Patients with Gastroesophageal Reflux Disease

Background

Little is known about the role of muscularis mucosa at the gastroesophageal junction (GEJ).

Aim

To evaluate the movement of the mucosa/muscularis-mucosa/submucosa (MMS) at the GEJ in normal subjects and in patients with gastroesophageal reflux disease (GERD).

Methods

Gastroesophageal junctions of 20 non-GERD subjects and 10 patients with GERD were evaluated during 5 mL swallows using two methods: in high-resolution endoluminal ultrasound and manometry, the change in the GEJ luminal pressures and cross-sectional area of esophageal wall layers were measured; in abdominal ultrasound, the MMS movement at the GEJ was analyzed.

Results

Endoluminal ultrasound: In the non-GERD subjects, the gastric MMS moved rostrally into the distal esophagus at 2.17 s after the bolus first reached the GEJ. In GERD patients, the gastric MMS did not move rostrally into the distal esophagus. The maximum change in cross-sectional area of gastroesophageal MMS in non-GERD subjects and in GERD patients was 289 % and 183 %, respectively. Abdominal ultrasound: In non-GERD subjects, the gastric MMS starts to move rostrally significantly earlier and to a greater distance than muscularis propria (MP) after the initiation of the swallow (1.75 vs. 3.00 s) and (13.97 vs. 8.91 mm). In GERD patients, there is no significant difference in the movement of gastric MMS compared to MP (6.74 vs. 6.09 mm). The independent movement of the gastric MMS in GERD subjects was significantly less than in non-GERD subjects.

Conclusion

In non-GERD subjects, the gastric MMS moves rostrally into the distal esophagus during deglutitive inhibition and forms a barrier. This movement of the MMS is defective in patients with GERD.     

Is the Proton Pump Inhibitor Test Helpful in Patients with Laryngeal Symptoms?

Background and Objectives

The association of gastroesophageal reflux disease (GERD) and laryngeal symptoms is not clear. We aimed to examine the symptomatic and endoscopic relations between GERD and laryngeal symptoms and also to evaluate the response to a 2-week proton pump inhibitor (PPI) trial.

Methods

Seventy-two patients experiencing persistent laryngeal symptoms ≥2/week were enrolled. The laryngeal symptoms using the 1-week laryngeal symptom score (LSS) and the typical reflux symptoms including heartburn and acid regurgitation were assessed. Transnasal-esophagogastroduodenoscopy (TN-EGD) and ambulatory 24-h esophageal pH monitoring were performed. The patients were classified into a GERD group and a non-GERD group. The GERD group was defined as the cases of the presence of typical reflux symptoms and/or reflux esophagitis and/or pathologic acid exposure. Patients were treated with 30 mg of lansoprazole bid for 14 days.

Results

Thirty-nine patients (54 %) were diagnosed with GERD on the basis of typical reflux symptoms, EGD, and/or pH testing. There was no significant association between the LSS and the presence of typical reflux symptoms. Also, the presence of laryngitis was not significantly related to reflux esophagitis. The 2-week PPI trial showed no significant difference in the improvement in laryngeal symptoms between the GERD and non-GERD groups.

Conclusions

There was no significant symptomatic and endoscopic association between GERD and laryngeal symptoms. Therefore, GERD does not appear to be the sole cause of these symptoms. Additionally, a 2-week PPI trial is not long enough to be a diagnostic tool in patients with laryngeal symptoms.     

Refractory gastroesophageal reflux disease: advances and treatment

‘Refractory gastroesophageal reflux disease’ is one of the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive proton pump inhibitor therapy. The term should be replaced with ‘refractory symptoms.’ We must acknowledge that in many patients symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to diagnostic testing. In majority of patients these tests are normal. The role of non-acid reflux in this group is uncertain and patients should not undergo surgical fundoplication based on this parameter. In patients unresponsive to acid suppressive therapy GERD is most commonly not causal and a search for non-GERD causes must ensue.     

Applying Data Mining Techniques in the Development of a Diagnostics Questionnaire for GERD

Gastroesophageal reflux disease (GERD) is a common condition, managed mostly in primary care practice. Heartburn and acid regurgitation are considered primary symptoms, and are usually highly specific. However, the symptom spectrum is much wider and in many cases it is difficult to determine whether the patient has GERD or dyspepsia from another origin. The aim of this study is to develop a symptom score and rule for the diagnosis of GERD, using data mining techniques, to provide a clinical diagnostic tool for primary care practitioners in the evaluation and management of upper gastrointestinal symptoms. A diagnostic symptom questionnaire consisting of 15 items and based on the current literature was designed to measure the presence and severity of reflux and dyspepsia symptoms using a 5-point Likert-type scale. A total of 132 subjects with uninvestigated upper abdominal symptoms were prospectively recruited for symptom evaluation. All patients were interviewed and examined, underwent upper gastrointestinal endoscopy, and completed the questionnaire. Based on endoscopic findings as well as the medical interview, the subjects were classified as having reflux disease (GERD) or non-reflux disease (non-GERD). Data mining models and algorithms (neural networks, decision trees, and logistic regression) were used to build a short and simple new discriminative questionnaire. The most relevant variables discriminating GERD from non-GERD patients were heartburn, regurgitation, clinical response to antacids, sour taste, and aggravation of symptoms after a heavy meal. The sensitivity and specificity of the new symptom score were 70%-75% and 63%-78%, respectively. The area under the ROC curve for logistic regression and neural networks were 0.783 and 0.787, respectively. We present a new validated discriminative GERD questionnaire using data mining techniques. The questionnaire is useful, friendly, and short, and therefore can be easily applied in clinical practice for choosing the appropriate diagnostic workup for patients with upper gastrointestinal complaints.     

胃食管反流病与哮喘关系初探

目的探讨胃食管反流与哮喘的关系。方法对15例以哮喘为主要表现的GERD患者进行了食管24hpH值监测及胃镜检查,并分析食管pH值与症状的关系,并以22例无呼吸系统症状的GERD患者作为对照。结果以哮喘为主要表现的GERD患者食管24hpH监测的各项指标与无呼吸系统症状的GERD患者存在显著差异(P<0.001,0.05),胃镜结果无显著差异,提示症状与酸反流密切相关。结论以哮喘为主要表现的GERD患者酸反流比普通GERD患者重,并且哮喘为患者的唯一临床表现,而无食管症状,因此临床上极易误诊。     

Barrett＇s esophagus： Prevalence and risk factors in patients with chronic GERD in Upper Egypt

AIM： To determine the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with chronic gastroesophageal reflux disease （GERD） in EI Minya and Assuit, Upper Egypt. METHODS： One thousand consecutive patients with chronic GERD symptoms were included in the study over 2 years. They were subjected to history taking including a questionnaire for GERD symptoms, clinical examination and upper digestive tract endoscopy. Endoscopic signs suggestive of columnar-lined esophagus （CLE） were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BF was diagnosed by pathological examination when specialized intestinal metaplasia was detected histologically in suspected CLE. pH was monitored in 40 patients. RESULTS： BE was present in 7.3% of patients with chronic GERD symptoms, with a mean age of 48.3 ± 8.2 years, which was significantly higher than patients with GERD without BE （37.4 ± 13.6 years）. Adenocarcinoma was detected in eight cases （0.8%）, six of them in BE patients. There was no significant difference between patients with BE and GERD regarding sex, smoking, alcohol consumption or symptoms of GERD. Patients with BE had significantly longer esophageal acid exposure time in the supine position, measured by pH monitoring. CONCLUSION： The prevalence of BE in patients with GERD who were referred for endoscopy was 7.3%. BE seems to be associated with older age and more in patients with nocturnal gastroesophageal reflux.     

Studying the Overlap Between IBS and GERD: A Systematic Review of the Literature

Evidence points to a significant overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). In this study, we evaluate this overlap by conducting a systematic review of the literature. Six electronic databases from 1966 through January 2005 were screened by multiple search terms to identify all epidmiological evidence linking IBS and GERD. In addition, AGA meeting abstracts for 2003 and 2004 were also screened. All studies were validated by the authors and data extracted according to predefined criteria. As a separate search strategy, studies evaluating the prevalence of IBS and GERD in the general population were sought. These articles were obtained to compare the prevalence of IBS and GERD in the community to the degree of overlap. The search identified 997 original titles with 15 publications that fulfilled our eligibility criteria. Among the 15 studies, 7 determined the GERD maximum mean prevalence in patients already diagnosed with IBS to be 39.3% and the weighted mean 30.3%. The other 7 studies examined the prevalence of IBS in patients already diagnosed with GERD. The maximum mean prevalence of IBS in subjects with known GERD was 48.8% and the weighted mean 60.5%. Based on the prevalence of IBS (12.1%) and GERD (19.4%) in the community, the rate of IBS in the non-GERD community was calculated to be only 5.1%. There is a strong overlap between GERD and IBS that exceeds the individual presence of each condition. In the absence of GERD, IBS is relatively uncommon.     

Increased prevalence of irritable bowel syndrome in patients with gastroesophageal reflux

GOALS: To determine the prevalence of irritable bowel syndrome (IBS) in subjects with gastroesophageal reflux disease (GERD) compared with non-GERD controls. STUDY: Two hundred subjects were identified from a list of Cedars-Sinai Medical Foundation patients and gastroenterology motility practice subjects with and without a potential diagnosis of GERD. All subjects were then evaluated independently by two blinded physicians who were asked to identify subjects with GERD based on taking a history (gold standard). A follow-up questionnaire was later mailed to patients. This questionnaire included Rome I criteria for IBS. The prevalence of IBS was compared between GERD and non-GERD subjects. Finally, to further strengthen the method, a retrospective review of all subjects' charts was conducted to identify patients who had had 24-hour pH tests, and the prevalence of IBS was determined in this subgroup. RESULTS: Of the 200 subjects, 90 (45%) patients returned the questionnaire. After excluding subjects with IBD and incomplete questionnaires, there were 84 subjects (35 with GERD) included in the analysis. Of the 35 GERD subjects, 25 (71%) were Rome I criteria positive for IBS, whereas only 17 of the 49 (35%) non-GERD subjects had IBS (odds ratio = 54.7, CI = 1.7-13.5, p < 0.01). In 11 of the GERD subjects a 24-hour pH study was available and confirmed GERD. Of these 11 subjects, 7 (64%) met Rome I criteria for IBS. CONCLUSION: There is a higher prevalence of IBS in subjects with GERD compared with subjects without GERD.     

伴特发性肺纤维化的胃食管反流病患者夜间酸暴露特点

背景:胃食管反流是特发性肺纤维化(IPF)发生的危险因素之一,夜间反流在胃食管反流病(GERD)食管外表现中起重要作用。目的:研究伴IPF的GERD患者夜间食管酸暴露的特点。方法:选取2006年12月～2008年1月北京朝阳医院收治的16例IPF-GERD患者、32例GERD患者和16例健康志愿者(非GERD)。各组患者行24 h食管pH监测,对夜间8 h内(10pm-6am)的酸暴露程度,包括pH4的时间百分比、酸清除时间、反流次数、长反流(5 min)次数、最长反流时间等指标进行分析。结果:14例(87.5%)IPF-GERD患者存在夜间酸暴露,其程度高于非GERD组(P0.05),而与GERD患者无明显差异(P0.05)。IPF-GERD组患者前半夜pH4的时间百分比显著高于后半夜(12.2%±3.9%对1.1%±0.5%,P0.05),GERD组两者无明显差异(10.8%±2.7%对5.1%±1.8%,P0.05)。结论:大部分IPF-GERD患者存在夜间酸暴露,其主要发生于前半夜。