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。     

酸反流与胆汁反流在胃食管反流病中的作用

目的探讨酸反流与胆汁反流在胃食管反流病(GERD)中的作用及相互关系.方法46例GERD患者(反流性食管炎组30例,胃镜阴性组16例)及26例健康对照者在完成食管测压后,应用便携式食管pH监测仪及Bilitec2000胆汁反流监测仪,同时进行24h食管内酸及胆汁反流的动态连续监测.结果GERD患者酸反流及胆汁反流各指标均明显高于健康对照者,且与食管炎严重程度一致.pH＜4总时间百分比与胆红素光吸收值(Abs)＞0.14,总时间百分比存在线性相关关系(r=0.34,P＜0.01).酸反流和胆汁反流共存的双重反流在GERD患者中最为常见,且较单纯反流更易引起严重食管炎.结论GERD患者中较为常见的双重反流对食管粘膜的损伤作用强于单纯酸或胆汁的不完全反流,酸反流与胆汁反流间可能有正性协同作用;联合应用胃镜检查及食管内酸和胆汁反流监测将为GERD的诊治提供可靠的客观依据.     

胆汁反流检测在胃食管反流病中的意义

目的 研究食管胆汁反流的发生情况,探讨其与酸、碱反流的关系及其对胃食管反流病（ＧＥＲＤ）的诊断意义。方法 应用便携式２４小时ｐＨ监测仪及胆汁监测仪同步检测反流性食管炎（ＲＥ）、胃切除术后者及健康志愿者共３４例的食管内２４小时ｐＨ变化及胆汁反流情况。结果 ＲＥ组食管酸暴露时间比对照组及胃手术后组均显著增加。各组间ｐＨ〉８总时间百分比结果相似,均较低。食管胆汁反流用胆红素吸收值≥０．１４的时间百分比表     

原发性胆汁反流性胃炎与胃食管反流病的关系

目的:探讨原发性胆汁反流性胃炎(primary bile reflux gastritis,PBRG)与胃食管反流病(gastroesophageal reflux disease,GERD)之间的相关性.方法:选取我院确诊为PBRG的患者1060例为观察组,无痛胃镜下未查见有PBRG的体检者1060例为对照组,比较两组GERD的发生率;依据内镜下PBRG的诊断标准,将260例PBRG伴有GERD的患者分为轻度、中度及重度3组,对比各组食管黏膜损伤的程度以及GERD症状积分的分布.结果:PBRG组GERD的发生率高于对照组(24.5%vs9.8%,P<0.05).食管黏膜损伤程度加深的发生率随着PBRG程度的加重而增加.PBRG的程度与GERD症状分级无相关性.结论:PBRG与反流性食管炎(refluxe sophagitis,RE)形成存在正性相关,PBRG并非是引起GERD症状的主要原因.     

胆汁反流检测在胃食管反流病诊断中的意义

目的研究食管胆汁反流的发生情况,探讨其与酸、碱反流的关系及其对胃食管反流病（ＧＥＲＤ）的诊断意义。方法应用便携式２４小时ｐＨ监测仪及胆汁监测仪同步检测反流性食管炎（ＲＥ）、胃切除术后者及健康志愿者共３４例的食管内２４小时ｐＨ变化及胆汁反流情况。结果ＲＥ组食管酸暴露时间比对照组及胃手术后组均显著增加。各组间ｐＨ＞８总时间百分比结果相似,均较低。食管胆汁反流用胆红素吸收值≥０．１４的时间百分比表示,以胃手术后组为最高,ＲＥ其次,二组均较对照组明显为高。食管胆汁反流与酸暴露时间之间密切相关（ｒ＝０．７５,Ｐ＜０．０５）。６３．６％的ＲＥ患者同时存在酸及胆汁反流。结论食管胆汁反流并不少见,可与酸反流同时存在,其在ＧＥＲＤ的发生过程中起一定作用。同步动态检测食管内ｐＨ值及胆汁对ＧＥＲＤ的诊断有重要意义。     

胃食管反流病的非酸反流和治疗

胃食管反流病(GERD)的发生与酸反流和非酸反流有关。此文从非酸反流的定义、成分、非酸反流损伤机制、非酸反流与正常人、非酸反流与GERD症状、非酸反流与食管外症状、非酸反流治疗和治疗后非酸反流的频率变化方面进行阐述。     

十二指肠胃食管反流研究进展

胃和 (或 )十二指肠内容物反流入食管产生症状或并发症时 ,称为胃食管反流病 (ＧＥＲＤ)。十二指肠内容物经幽门反流入胃内称为十二指肠胃反流 (ＤＧＲ) ,如进一步反流入食管则形成十二指肠胃食管反流(ＤＧＥＲ) ,若反流量大、频率高、持续时间长 ,则可能引起病理性损害。现就十二指肠胃食管反流的病因和致病机制、临床意义、检测方法及防治措施作以下综述。　　十二指肠胃食管反流的病因和致病机制若发生十二指肠胃食管反流则首先要有十二指肠胃反流 ,许多结构或功能紊乱均可引起十二指肠胃反流 ,如胃部分切除术后、胃十二指肠运动异常、胆…     

酸和胆汁反流与胃食管反流症状的关系

目的 分析酸反流及胆汁反流在引起胃食管反流症状中的作用。方法 对56例有典型反流症状的患者进行24小时食管内pH值及BiHtee胆汁同步监测。患者通过症状按键标记典型反流症状，对每一症状事件按症状发生前2分钟内食管最低pH值和最高胆红素光吸收值，分别计算症状与酸反流或胆汁反流事件的相关性，得出每一例患者的酸反流相关症状指数(Sla)及胆汁反流相关症状指数(SIb)。结果 56例患者中共发生典型症状事件357次。其中大部分症状(37．25％)与酸反流有关，仅7．56％的症状与单纯胆汁反流有关。反流性食管炎组(RE)亚组的243次症状事件中，105次(43．21％)事件与酸反流相关，而21次(8．64％)与胆汁反流有关。两种症状相关指数均值比较差异有显著性。结论 胃食管反流症状事件与酸反流的相关性明显高于胆汁反流，胆汁反流在引起典型食管症状方面似乎不起主要作用。     

胃食管反流病患者食管下段鳞状上皮细胞间隙的改变

目的观察胃食管反流病患者食管下段鳞状上皮细胞间隙的改变。方法11例胃食管反流病患者(非糜烂性反流病6例和糜烂性食管炎5例)及5名健康对照者行胃镜、24h食管pH值监测检查。于齿状线上方2cm处取活检,透射电镜下观察。结果健康对照组、非糜烂性反流病组和糜烂性食管炎组食管下段鳞状上皮平均细胞间隙分别为(0．374±0．073)μm、(1．308±0．079)μm和(1．332±0．144)μm,健康对照组和非糜烂性反流病组及糜烂性食管炎组相比差异有统计学意义(P＜0．05),非糜烂性反流病组和糜烂性食管炎组相比差异无统计学意义(P＞0．05)。结论非糜烂性反流病及糜烂性食管炎患者透射电镜下均存在食管上皮细胞间隙的增宽。     

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,     

Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors

AIM： To determine the prevalence and characteristics of bile reflux in gastroesophageal reflux disease （GERD） patients with persistent symptoms who are nonresponsive to medical therapy. METHODS： Sixty-five patients （40 male, 25 female; mean age, 50±7.8 years） who continued to report symptoms after 8 wk of high-dose proton pump inhibitor （PPI） therapy, as well as 18 patients with Barrett＇s esophagus, were studied. All patients filled out symptom questionnaires and underwent endoscopy, manometry and combined pH-metry and bilimetry. RESULTS： There were 4 groups of patients： 22 （26.5%） without esophagitis, 24 （28.9%） grade A-B esophagitis, 19 （22.8%） grade C-D and 18 （21.6%） Barrett＇s esophagus. Heartburn was present in 71 patients （85.5%） and regurgitation in 55 （66.2%）, with 44 （53%） reporting simultaneous heartburn and regurgitation. The prevalence of pathologic acid reflux in the groups without esophagitis and with grades A-B and C-D esophagitis was 45.4%, 66.6% and 73.6%, respectively. The prevalence of pathologic bilirubin exposure in these 3 groups was 53.3%, 75% and 78.9%, respectively. The overall prevalence of bile reflux in non-responsive patients was 68.7%. Pathologic acid and bile reflux was observed in 22.7% and 58.1% of non-esophagitic patients and esophagitic patients, respectively.CONCLUSION： The high percentage of patients poorly responsive to PPI therapy may result from poor control of duodenogastroesophageal reflux. Many patients without esophagitis have simultaneous acid and bile reflux, which increases with increasing esophagitis grade.     

光学显微镜食管下段细胞间隙的测量对胃食管反流病诊断的意义

目的 通过光学显微镜(光镜)对胃食管反流病(GERD)患者食管下段细胞间隙的测量,探讨光镜下细胞问隙的变化对GERD的诊断意义.方法 158例受试者行内镜检查,分为正常对照组(25例)、非糜烂件反流病(NERD)组(58例)和糜烂性食管炎(EE)组(75例),在齿状线以上2～3 cm取活榆行光镜检查,并随机选取43例(其中正常对照组4例,EE组28例,NERD组11例)在相同部位取活检同时进行电镜检查.光镜/电镜下观察切片并采集图像,采用图像分析系统对每例切片测量100个细胞问隙,并进行统计学分析.结果 正常对照组、NERD组及EE组光镜下测量的平均细胞问隙(LMIS)分别为(0.61±0.10)μm、(1.12±0.61)μm和(1.30±0.19)μm,3组两两相比差异均有统计学意义(P<0.05);EE组不同洛杉矶分级的各亚组间相比,细胞间隙增宽程度的差异无统计学意义(P>0.05);NERD患者食管24 h pH监测阳性者(40例)与阴性者(17例)LMIS的差异无统计学意义(P>0.05);光镜下LMIS的截断(cut-off)值为0.85 μm,如果以临床症状加内镜和食管24 h pH监测综合作为诊断GERD的金标准,LMIS诊断GERD的敏感性为95.5%,特异性为100.0%;同时做光镜和电镜测量的受试者共43例,经相火性分析和一致性检验,光镜测量和电镜测量的细胞间隙宽度显著相关(r=0.737,P=0.000),且一致性好.结论 GERD患者食管下段组织的细胞间隙可通过光镜进行定晕测量,其结果与电镜测量结果的一致性好.光镜下细胞间隙增宽可以作为GERD诊断的敏感、特异且较为客观的指标之一.     

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.     

胃食管反流病发病机制研究进展

胃食管反流病(GERD)是一种临床常见病,迄今为止其发病机制尚未阐明。此文就近年来GERD发病机制的研究进展作一综述,有助于采取更合理的治疗。     

Asthma and gastroesophageal reflux disease： Effect of long-term pantoprazole therapy

AIM: To define the prevalence of gastroesophageal reflux disease (GERD) in mild persistent asthma and to value the effect of pantoprazole therapy on asthmatic symptoms. METHODS: Seven of thirty-four asthmatic patients without GERD served as the non-GERD control group. Twenty-seven of thirty-four asthmatic patients had GERD (7/27 also had erosive esophagitis, sixteen of them presented GERD symptoms. An upper gastrointestinal endoscopy was performed in all the subjects to obtain five biopsy specimens from the lower 5 cm of the esophagus. Patients were considered to have GERD when they had a dilation of intercellular space (DIS)>0.74 urn at transmission electron microscopy. Patients with GERD were treated with pantoprazole, 80 mg/day. Forced expiratory volume in one second (FEV1) was performed at entry and after 6 mo of treatment. Asthmatic symptoms were recorded. The required frequency of inhaling rapid acting β2-agonists was self-recorded in the patients' diaries. RESULTS: Seven symptomatic patients presented erosive esophagitis. Among the 18 asymptomatic patients, 11 presented DIS, while all symptomatic patients showed ultrastructural esophageal damage. Seven asymptomatic patients did not present DIS. At entry the mean of FEV1 was 1.91 L in symptomatic GERD patients and 1.88 L in asymptomatic GERD patients. After the treatment, 25 patients had a complete recovery of DIS and reflux symptoms. Twenty-three patients presented a regression of asthmatic symptoms with normalization of FEV1. Four patients reported a significant improvement of symptoms and their FEV1 was over 80%. CONCLUSION: GERD is a highly prevalent condition in asthma patients. Treatment with pantoprazole (80 mg/day) determines their improvement and complete regression.     

胃食管反流病问卷对胃食管反流病的诊断价值

目的 评价胃食管反流病问卷(GerdQ)在胃食管反流病(GERD)患者中的诊断价值,初步探讨中国GERD人群的症状特点.同时探索一种适合中国人群的质子泵抑制剂(PPI)试验的诊断标准.方法 在全国五家医院进行多中心研究.所有入组患者填写GerdQ问卷表.以胃镜检查、24 h食管pH监测和PPI试验其中任何一项阳性作为GERD的诊断标准,评价GerdQ的诊断价值.以拟定PPI试验诊断标准与胃镜和食管pH监测的诊断相比较,并优化PPI试验的诊断标准.结果 拟定PPI试验诊断的敏感度为0.6627,特异度为0.4872.经统计分析,以PPI治疗1周最后3 d烧心、反流症状总评分较治疗前相比下降3分为优化PPI试验诊断标准,诊断的敏感度为0.3787,特异度为0.8077,阳性预测值为0.8101,阴性预测值为0.3750,Youden指数最大为0.1864.经人群矫正,GerdQ取临界值为10分时,Youden指数达到最大0.1080,诊断的敏感度为0.6690,特异度为0.4390.50岁以上女性患者随着评分的增高,问卷诊断价值下降.结论 GerdQ具有肯定的诊断价值.但在临床工作中,对特殊人群中症状突出而PPI诊断性治疗反应不佳的患者,GERD的诊断应慎重.PPI试验的评分以治疗1周最后3 d为佳.     

光学显微镜测量胃食管反流病患者食管下段细胞间隙的临床价值

目的 通过光学显微镜（光镜）对糜烂性食管炎（ERD）、非糜烂性食管炎（NERD）、Barrett食管（BE）患者及正常对照组食管下段鳞状上皮细胞间隙宽度的测量,探讨胃食管反流病（GERD）患者各亚型尤其是BE食管下段细胞间隙的光镜下改变及其对临床诊断的意义.方法 顺次收集具有GERD症状且内镜和24 h食管pH监测证实为ERD 21例、NERD 21例;胃镜诊断为BE,并在病变处活检且经病理证实BE 13例;对照组为内镜检查及24 h食管pH监测均为阴性者,共20例.ERD组、NERD组及对照组在食管齿状线上2 cm取活检,经常规方法制成HE切片,在油镜下（×1000）观察细胞间隙增宽情况,并采集图像采用图像分析系统对鳞状上皮层基底上层细胞间隙宽度进行定量测量.每例样本测量10个细胞,每个细胞连续测量10个细胞间隙,即每例患者测量100个细胞间隙,求其均值后进行统计学分析.结果 光镜下正常对照组、BE、ERD及NERD组平均细胞间隙分别为0.59、0.99、1.29及1. 06μm.GERD各亚型的细胞间隙均较正常对照组显著增宽,ERD组平均、最大及最小细胞间隙均较NERD组和BE组显著增宽,差异有显著性意义（P=0.000）;NERD组和BE组平均、最大及最小细胞间隙差异无显著性意义（P＞0.05）.光镜下细胞间隙增宽诊断GERD的截断（cut-off）值为0.85 μm,联合临床症状、内镜表现及细胞间隙增宽大于此cut-off值,则光镜下细胞间隙增宽诊断ERD、NERD、BE的敏感度为89.1%,特异度为100.0%.结论 GERD各亚型食管下段均可见细胞间隙增宽的改变,光镜测量GERD患者食管下段鳞状上皮细胞间隙可作为ERD、NERD及BE诊断的一项辅助检查.