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。     

24h食管pH监测在胃食管反流病的临床应用

目的　应用 2 4h食管 pH监测仪 ,检测食管下段 pH值 ,旨在为胃食管反流病 (GERD)提供灵敏性和特异性较高、先进而方便、快捷的诊断方法。方法　正常对照组 2 0例 ,消化性溃疡 5 4例及GERD组 85例 ,均采用Digi trapperMKⅢ 2 4hpH监测仪记录下食管括约肌 (LES)上 5cm处 pH。 结果　GERD组 2 4h食管pH监测有关指标均分别显著高于对照组和消化性溃疡组 (P <0 0 1) ,后二者间比较差异无显著性 (P >0 0 5 ) ;GERD组中有 2 4例内镜无异常的异常反流患者 ,其 2 4h食管 pH监测与 6 1例反流性食管炎比较 ,无显著性差异 (P >0 0 5 )。结论　GERD的症状分析和内镜诊断均有其局限性 ,2 4h食管 pH监测是GERD诊断的确切标准。     

反流性食管炎患者胃底压力改变对下食管括约肌运动功能的影响

反流性食管炎 (ＲＥ)是由多种因素促成的上消化道动力障碍性疾病。一过性下食管括约肌松弛 (ＴＬＥＳＲ)是正常人和多数ＲＥ患者胃、食管反流发生的主要机制[1] 。胃底膨胀、胃排空迟缓会增加ＴＬＥＳＲ的频率 ,是ＲＥ发生因素之一。我们对胃底膨胀对下食管括约肌 (ＬＥＳ)运动功能的影响进行了探讨。材料和方法一、研究对象正常组为 8例健康志愿者 ,男 6例 ,女 2例 ,年龄为 2 4～40岁 ,均无ＲＥ症状 ,无任何疾病 ,2周内无服药史 ,胃镜检查正常。ＲＥ组 13例 ,男 10例 ,女 3例 ,年龄为 2 9～ 6 5岁 ,均有嗳气、反酸、烧心、胸痛等ＲＥ症状 ,…     

pH电极位置对反流性食管炎酸监测的影响

目的探讨pH电极位置对反流性食管炎酸度监测的影响.方法60例反流性食管炎随机分为对照(C)组和试验(T)组.C组30例用测压法将pH电极置于下食管括约肌(LES)上缘5cm处;T组30例用pH梯度法将电极放于胃食管连接处(GEJ)上方5cm处.连续24hpH监测.结果C与T组前鼻孔至GEJ平均距离(46.2±4.1cm与46.5±4.5cm)无明显差异(P=0.8).两组GEJ平均距离(46.3±4.3cm)比C组前鼻孔至LES上缘平均距离(43.3±3.1cm)低3.0cm(P=0.0003).食管酸监测的pH＜4总百分时间和总计分在T组(8.5和45.5)和T组中GEJ＞LES上缘±3cm范围者(10.0和99.3),较C组(4.8和26.3)均有明显增高(P均＜0.01),而T组中GEJ≤LES上缘±3cm范围者(7.1和39.4)则无明显差异(P均＞0.05)结论因GEJ常比LES上缘偏低,故以GEJ安放电极(尤其是GEJ＞LES上缘±3cm范围者)对反流性食管炎行pH监测时,这可能会扩大酸监测结果.     

胃食管反流症24 h酸碱监测及食管下括约肌静息压变化

胃食管反流病(GERD)是由于食管下括约肌(LES)功能障碍引起胃内容物(包括十二指肠内容物)反流导致的一系列慢性症状和食管黏膜损害[1].该病发生率较高,病情易反复.笔者通过对236例具有GERD症状的患者进行了24 h食管酸碱监测及LES静息压(LESP)测定分析,探讨其发病规律,以期为临床治疗用药提供理论依据.现报告如下.     

反流性食管炎患者食管运动功能的研究

１材料和方法１．１材料２８例反流性食管炎为住院及门诊患者，男１７例，女１１例，年龄２５岁～５８岁．诊断标准：①具有反流性食管炎烧心等典型症状，抑酸治疗，症状可缓解．②所有患者皆作电子内镜检查，镜下有不同程度食管炎症，同时排除了胃十二指肠溃疡及糜烂性胃炎③无典型症状者，２４ｈ食管ｐＨ监测提示有病理性酸反流、④经有关检查排除肝胆胰疾病⑤排除责门失弛缓症及肠易激综合征等胃肠运动障碍性疾病．排除糖尿病，结缔组织等疾病引起的继发运动功能障碍．无腹部外伤手术史正常对照组１０例，选择标准为２ａ内无任何胃肠道肝…     

24 h食管pH监测在小儿临床的应用

目的：探讨24h食管pH监测在小儿临床的应用及其意义。方法：对43例患儿进行24h食管pH监测，其中反复呕吐症状为主者29例和以反复呼吸道症状或哮喘发作为主者11例。并对12例诊断为病理性胃食管反流患儿经治疗后进行复查。以11例无消化道症状并排除消化系统疾病和肺支气管疾病儿童作为对照。监测指标有食管pH＜4．0的次数、反流时间≥5min的次数 、最长反流时间、反流时间、立位和卧位pH值＜4的时间占总监测时间的百分比以及Biox-0choa评分。结果：32例存在胃食管反流（GER），占74．4％。各项反应指标的监测结果与对照组的比较和治疗前后反流指标的变化均有显著性差异。结论：通过24h食管pH监测判定反流类型，不仅提高了病理性GER的诊断率，而且不不同临床类型的反流治疗方案的确定提供了根据，尤其是反复呕吐、反复呼吸道病变及新生儿呕吐的病因诊断和疗效观察中具有重要意义。     

体质量指数与食管裂孔疝及反流性食管炎关系的研究

目的探讨体质量指数（BMI）与食管裂孔疝（HH）及反流性食管炎（RE）的关系。方法具有典型反酸、烧心等症状的227例胃食管反流病（GERD）患者,根据BMI（单位：kg／m^2）将患者分为3组,正常组（18．5≤BMI〈24）、超重组（24≤BMI〈28）、肥胖组（BMI≥28）。胃镜诊断RE、非糜烂性反流病（NERD）及HH。pH监测DeMeester积分≥15提示存在病理性酸反流。Logistic回归分析BMI与HH及RE的关系。结果RE检出率为30．0％（68／227）,HH检出率为5．7％（13／227）;HH中76．9％（10／13）存在RE。RE及HH检出率随BMI增加而升高（P均〈0．05）,且正常组、超重组和肥胖组中B级及以上RE所占比例也随BMI增加而升高（6．4％、16．9％、31．6％,P=0．003）;pH监测DeMeester积分在上述3组分别为15．9、19．8和36．9,3组间差异有统计学意义（P〈0．05）,超重组患者下午、夜间及24h食管内平均pH值均明显低于正常组（P均〈0．01）。多因素分析显示,肥胖是HH的危险因素,OR值为7．058（95％可信区间1．294～38．488,P=0．024）。男性、超重、肥胖及HH是RE的危险因素,OR值分别为2．537（95％可信区间1．350～4．766,P=0．004）、1．921（95％可信区间1．005-3．670,P=0．048）、3．305（95％可信区间1．123～9．724,P=0．030）及6．879（95％可信区间1．695～27．913,P=0．007）。结论BMI与HH、RE及其严重程度显著相关,肥胖是HH及RE的共同危险因素,HH可促进RE的发生。     

老年人反流性食管炎的诊断和治疗要点

反流性食管炎（RE）属胃食管反流性疾病（GERD）。随着内镜检查的广泛开展及便携式24h食管pH监测的临床应用，发现健康人群即可有生理性胃食管反流，但常无任何临床症状。西方国家人群中有10％～20％有胃食管反流症状。近年来，我国发病率也有逐年上升的趋势，尤其是老年人患病率较高。解放军总医院老年消化科对3048例老年人进行直接胃镜检查，RE的检出率为5．6％。郑松柏等报道老年人RE的胃镜检出率则高达8．9%，显著高于非老年组。应引起临床医生的高度重视。     

胃肠激素与反流性食管炎

反流性食管炎确切的发病机制目前尚不明确,近年研究表明胃肠激素及气体信使分子对食管运动有调节作用,在反流性食管炎的发生、发展中起着重要作用．胃肠激素(血管活性肠肽、胆囊收缩素、胃泌素、P物质、蛙皮素、生长抑素、阿片肽、降钙素相关基因肽、胃动素、一氧化氮、一氧化碳)与反流性食管炎发病密切相关,本文对此作一综述．     

Ambulatory esophageal pressure and pH monitoring in patients with high-grade reflux esophagitis

Using conventional manometry and 24-hr ambulatory pressure and pH monitoring, we investigated esophageal motility and the esophageal motor response to reflux in 11 patients with reflux esophagitis Savary-Miller grade III and IV, and an age- and sex-matched group of 11 healthy controls. The patients had a significantly increased esophageal acid exposure. Conventional manometry showed a significantly decreased LES pressure and distal peristaltic amplitude in patients. The 24-hr monitoring yielded a significant decrease in peristaltic contraction duration and peristaltic propagation velocity in the patient group. Distal peristaltic amplitude was not decreased. Analysis of the contractions occurring in the 2-min period after each reflux episode showed a reduced number of contractions during the upright period, caused by a significantly decreased number of peristaltic contractions. During the supine period, there was a trend towards an increased number of contractions. It is concluded that esophageal motor activity and the response to reflux are impaired in patients with high-grade reflux esophagitis. However, the abnormalities found are only minor and are unlikely to play an important role in the pathogenesis of reflux esophagitis.     

Ambulatory 24-hour esophageal pH monitoring

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH<4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH<4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean ±2sd of the relative differences between the two test results for all 53 subjects. Total percent time with pH<4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.Supported, in part, by Public Health Services Grant AM 34200-01A1 from NIADDIK.     

24-Hour esophageal pH monitoring before and after medical therapy for reflux esophagitis

Medical treatment of gastroesophageal reflux disease often results in improvement of symptoms. The purpose of this study was to determine if improvement in symptoms and endoscopic appearance after treatment was associated with a reduction in reflux, as measured with 24-hr pH recordings. Twenty patients with severe chronic reflux esophagitis participated in an eight-week double-blind trial of medical therapy with metoclopramide and cimetidine versus placebo and cimetidine. Significant symptom score improvement was noted in 11 patients. Eleven patients also had improvement in the endoscopic appearance of the esophageal mucosa, and eight of these patients had significant symptom improvement. Initial 24-hr pH recordings were abnormal in all patients, evidenced by an esophageal pH<4 during 20% of the study period. Improvement in 24-hr results was noted in only five patients—three with clinical and endoscopic improvement, and two with no improvement. In conclusion, there was no relationship between clinical improvement and the results of 24-hr pH recordings. Successful symptom relief and endoscopie healing of esophagitis during medical treatment may occur despite persistent reflux of gastric contents.This study was supported by grant RR00334 from the General Clinical Research Center Branch of the Division of Research Resources, National Institutes of Health.     

Simultaneous two-level esophageal 24-hour pH monitoring in patients with mild and severe esophagitis

Simultaneous ambulatory esophageal pH monitoring was performed in 10 patients (group 1) with normal distal acid exposure and in 40 patients (group 2) with pathological distal reflux. The probes were placed 5 and 10 cm above the lower esophageal sphincter to quantify variations of pH values that can be due to a displacement of pH sensor. In group 1 the median percent time with pH<4 for total and upright monitoring periods and composite score were significantly lower at the proximal than the distal level. In group 2 all pH data were significantly lower at the proximal than the distal level. The patients with pathological reflux were subdivided into two subgroups based on endoscopic findings (mild and severe esophagitis). The patients with severe esophagitis showed a proximal acid reduction higher than in patients with mild esophagitis. Nine patients with mild esophagitis showed normal values at 10 cm, but all patients with severe esophagitis had abnormal proximal acid exposure.     

国产食管pH胶囊与导管式24h食管pH监测的有效性、安全性及耐受性比较

[目的]比较国产食管pH胶囊与导管式24h食管pH监测的有效性、安全性及耐受性。[方法]26例志愿者均先应用导管式24h食管pH监测系统检测食管酸反流,隔1d后再应用国产食管pH胶囊进行食管酸反流检测,48h后送回接收器;监测期间记录工作、饮食、活动、睡眠和不适症状等情况。食管pH胶囊检查结束12d后行胸片检查明确胶囊脱落情况。[结果]与导管式24h食管pH监测方法相比,食管pH胶囊监测方法对食管酸反流检测的敏感性为78.57%,特异性为91.67%,准确性为84.62%;食管pH胶囊监测方法主要不适症状为吞咽疼痛、胸骨后异物感,而导管式24h食管pH监测方法中,咽喉部不适、流涕和恶心较多见。食管pH胶囊监测方法对日常生活、饮食和运动的影响程度较小,生活满意程度较高。当需要重复检查时,更多的志愿者愿意选择应用食管pH胶囊监测方法。12d后食管pH胶囊的脱落率为96.43%。[结论]国产食管pH胶囊与导管式24h食管pH监测2种方法的有效性相当,但食管pH胶囊监测方法较导管式24h食管pH监测耐受性高,安全性好。     

Age- and gender-related differences in 24-hour esophageal pH monitoring of normal subjects

Twenty-four-hour esophageal pH monitoring is currently the most sensitive test for diagnosing gastroesophageal reflux. Little is known, however, about the effect of aging and gender on esophageal acid exposure in asymptomatic individuals. Thirty asymptomatic volunteers underwent 24-hr esophageal pH monitoring. Fifteen were <65 years (eight female, seven male) and 15 were 65 years (seven female, eight male). In this asymptomatic group no significant difference was seen by age, while males were found to have significantly more esophageal acid exposure than females. The need for sex-specific normal 24-hr pH monitoring values is suggested. Thirty percent of these asymptomatic subjects were abnormal by conventional 24-hr pH criteria. The clinical importance of these silent refluxers is unknown.     

Dynamic position versus 24-hour pH testing for detection of esophageal acid reflux disease

Although the 24-hour pH test is currently considered the gold standard for the determination of significant esophageal acid reflux disease, it is a problematic study, requiring multiple manipulations for interpretation. Dynamic position testing has recently been described as an alternative method of detecting significant esophageal acid reflux disease. In this initial comparative study, dynamic position testing was at least as reliable as 24-hour pH testing, required much less time, and provided additional useful information.     

糖尿病患者食管和胃24小时pH动态监测及临床意义

目的 了解糖尿病患者食管酸碱反流情况及胃内ｐＨ变化,探讨其诊断胃、食管分泌及运动障碍的临床意义。方法 采用便携式２４小时ｐＨ动态监义,对３４例２型糖尿病患者进行非卧床食管和胃２４小时ＰＨ动态监测,对食管反流的６项ＰＨ指标综合分析,并与４０例正常人进行比较。结果 糖尿 有一食管酸反流的６项指标及总计分明显高于对照组（Ｐ〈０．００１）。食管碱反流及胃内２４小时各项ＰＨ指标与对照组相比无显著性差异（Ｐ〉     

Reliability of 24-hour home esophageal ph monitoring in diagnosis of gastroesophageal reflux

Twenty-four-hour home esophageal pH monitoring is proposed in order to study gastroesophageal reflux (GER) so that prolonged use of costly hospital equipment and staff can be curtailed and the diagnostic accuracy of the examination improved. Eighty-six patients affected by GER symptoms and 20 healthy volunteers underwent 24-hr home esophageal pH monitoring, x-rays, and endoscopy of the upper gastrointestinal tract to investigate reliability of outpatient recording. Fifteen more patients consecutively underwent out- and inpatient recording to detect possible differences between these methods in the two daily periods. Outpatient monitoring was well tolerated in 94.7% of the patients; 14.3% of them markedly reduced their routine activities. The range of normality of outpatient recording does not differ from that of inpatients. In the 15 patients who consecutively underwent out-and inpatient monitoring, no significant differences were reported. The sensitivity of 24-hr home esophageal pH recording is 0.85, the specificity 1, the accuracy for negative prediction 0.68, and the accuracy for positive prediction 1. The reliability of 24-hr home esophageal pH monitoring is comparable to inpatient recording. It allows hospital cost reduction and is also better tolerated by patients but has not greatly improved the diagnostic accuracy of the gastroesophageal reflux pH monitoring.Supported by the Ministere Pubblica Istruzione, Rome; and Finanziamenti per studi e ricerche 40%, Com. 06, Cat 12-07 imp. 11515, University of Bologna.