胃食管反流老年患者180例

胃食管反流(GER)是反流性食管炎和Barrett食管的发病基础〔1～3〕。笔者在上消化道钡餐检查时,按设计方法重点进行胃食管交界处的X线观察,分析老年人GER的临床特点。1对象与方法1.1对象以一年内申请上消化道钡餐检查者作为观察对     

滑动型食管裂孔疝患者食管24h pH、LES以及食管运动功能的研究

目的：探讨滑动型食管裂孔疝（HH）伴反流性食管炎（RE）和单纯反流性食管炎患者的食管动力学改变。方法：胃镜或上消化道钡餐确诊GERD患者62例，分为RE组32例和HH组30例，在X线透视下观察食管形态学、蠕动以及反流与廓清方式，同时监测食管24h pH和下食管括约肌（LES）压力及其松弛度，以及干、湿咽时食管蠕动的情况。结果：30例HH患者X线透视下均有食管粘膜增粗，头高脚低位下伴有食管钡剂反流现象，反流以抽吸型为主（80％），廓清以被动廓清为主，（36．67％）。LES静息压力为显著低于对照组（P＜0．05）；24h食管pH监测中总的卧位和立位反流时间百分比均显著低于对照组（P＜0．01），LES的长度各组间无明显差异。松弛率为33．33％，食管体部蠕动频率、波幅均较对照组低，间期明显延长。顺行性蠕动百分比较对照组明显降低（P＜0．05）。结论：HH可能是长期RE的结果，RE在HH发病中起重要的作用。     

胃食管反流检查方法对胃食管反流病的诊断价值

评估不同的诊断方法在胃食管反流病诊断中的价值。对135全角典型胃食管反流症状,并经内镜证实有下段食管炎的患者X线钡餐确定反流,核素显像测定反流,24小时食管内pH监测,LESP测定及Losec实验性治疗。结果显示：X线钡餐检查27例,9例阳性,阳性率为30．3％,核素显像9例,7例阳性,阳性率77．7％;食管内24小时pH监测72例,53例阳性,阳性率73．61％;LESP测定25例,10例阳性,阳性率40％;56例行Losec试验性治疗,有效54例,阳性率96．4％。本研究结果表明：在所有的检查方法中,Losec试验性治疗阳性率最高,且不需特殊设备及操作技能,可作为临床上诊断本病的有效方法。食管内24小时pH 和核素显像测定胃食管反流阳性率近似,但后者设备昂贵,仅适用于有胃食管反流疾病的儿童,食管内24小时pH监测敏感性高,不失为诊断胃食管反流疾病的可靠指标。     

胃食管反流病:从病理生理到诊断和治疗对策

胃食管反流病（Gastroesophagealrefluxdisease,GERD）是由于冒、十二指肠内容物反流入食管引起及酸、反贪、烧心等症状或组织损害，部分患者伴有食管以外的表现．在西方国家，人群中有10％一20％有胃食管反流（GER）症状．北京、匕海对5000名18～70岁普通人群的流行病学调查表明（1997消化病周会，北京），反流症状评分＞6（0～18）达8．86％，经随机抽样，结合精查（内镜和食管pH监测），预测这两地区的胃食管反流病和反流性食管炎的患病率分别为4．74％和2．52％．胃食管反流症状的发生在有呼吸道症状者是无呼吸道症状者的2倍．临床…     

胃食管反流与肺部疾病

许多研究已证实胃食管反流（GER）与肺部疾病密切相关，呼吸系统症状可为GER的唯一临床表现，24h食管PH监测是诊断GER的金标准，已发现部分病例与近端食管反流有关，故采用双极食管PH电极分别置于食管近端和远端进行监测以避免漏诊，抗反流治疗能缓解呼吸道症状，减少解羟药物的使用，GER是肺部疾病的常见原因，临床应予重视。     

儿童胃食管反流84例

本文收集我院近3a来有完整的X线影像和内镜检查发现的儿童GER84例，试行临床分析如下．1对象和方法1．1对象儿童GER4例中，男42例，女42例，年龄分布4岁6例，7岁18例，9岁14例，14岁46例.病程最短7d,最长6a，普遍为3mo～4mo．临床以消化道症状为主，呕吐51例，上腹痛和（或）不适感44例，其他如胸骨后或剑突下突发性、渐进性疼痛5例，反复咽喉部异物感或烧灼感6例，营养不良6例，反复咳嗽和哮喘13例，间歇性抬肩或深吸气为首先症状12例，脑电图异常放电8例．1．2方法受检病例均有胃食管反流的临床表现，新生儿期及受检前3d服用过胃肠动力…     

胃食管反流病诊断技术的进展

胃食管反流病（GERD）的患病率近年来在我国有上升趋势。目前诊断GERD的手段较多，如典型症状（烧心和反酸）、质子泵抑制剂（PPT）试验和上消化道内镜检查等，尤其是GERD的诊断技术，包括最初的X线钡餐以及食管放射性核素检查和24h食管pH监测，到新近出现的食管多通道腔内阻抗监测和无线pH监测等，为胃食管反流提供了客观的证据。     

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。     

抗胃食管反流治疗对缓解支气管哮喘急性发作的临床疗效观察

目的明确抗胃食管酸反流治疗对哮喘症状的协同治疗作用。方法将54例支气管哮喘患者依有无胃食管酸反流症状分为有GER表现组和无GER表现组，对比两组治疗疗效的差异性。结果两组治疗有效率分别为100％和69．23％，经统计学方法处理差异有显著性（P〈0．05）。结论支气管哮喘可合并有胃食管酸反流，经抗胃食管酸反流治疗可提高支气管哮喘的治疗效果。     

食管pH值监测观察酸相关疾病103例

目的 探讨24小时食管pH值监测在诊断上消化道疾病中（尤其胃食管反流病）的临床意义。方法 对2001年4月-2004年5月于我院进行食管pH值监测的103例临床患者，根据有无症状分为两组，无症状组20例为对照组，有症状组83例，其中反流性食管炎（RE）并慢性胃炎的患者30例，占36．1％，然后依次为十二指肠溃疡19例（22．9％）、非糜烂性食管炎13例（15．6％）、单纯反流性食管炎11例（13．3％）及胃溃疡10例（12．0％）。结果 RE并十二指肠溃疡组在各项指标中均高于其他各组（P〈0．05）。结论 RE多合并其他上消化道疾病（尤其酸相关疾病）发生．罹患十二指肠溃疡可能是RE发生和加重的原因之一。     

An updated review on gastro-esophageal reflux in pediatrics

Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall ‘not much has changed’ in the diagnosis and management of GER and GERD in infants and children.     

基于罗马Ⅳ分类的食管反流高敏感研究进展

存在反流症状但内镜检查正常患者具有很大的异质性,在罗马Ⅲ分类中将存在异常酸暴露、症状与生理反流相关及抗酸治疗有效的患者均划入胃食管反流病(gastro-esophageal reflux disease,GERD)的诊断范畴中,其中酸暴露正常但症状与反流相关的患者被认为对反流过于敏感,被称为高敏感食管(hypersensitive esophagus),并未明确归类。     

Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial

Palliation of inoperable esophageal cancer with covered stents aims to relieve progressive dysphagia and improve health-related quality of life (HRQoL). Introducing a stent across the esophagogastric junction in lower third tumors may predispose to unchecked gastro-esophageal reflux (GER). Esophageal stents incorporating an anti-reflux valve have been introduced to address this problem. We prospectively compared an anti-reflux stent with a standard stent in the palliation of inoperable lower third esophageal tumors. Forty-nine consecutive patients with malignant dysphagia were randomized to receive a standard (n = 25, group 1) or an anti-reflux stent (n = 24, group 2). HRQoL was assessed before stenting, at 1 week and at 2 months, utilizing European Organization for Research and Treatment of Cancer questionnaires QLQ-C30, QLQ-OES24 and reflux questionnaires. Esophageal pH testing was performed within 1 week of the stent insertion. Detailed statistical analysis was employed to assess general QoL, symptoms and pH scores in both groups. Both groups reported significantly improved QoL, health and dysphagia scores at 1 week and 2 months after stenting. Group 2 patients reported significantly (P < 0.05) better DeMeester symptom, general reflux scores, and normal pH profile at 1 week. At 2 months DeMeester symptom scores were significantly (P < 0.05) better in group 2 compared with group 1. Standard and anti-reflux stents afford comparable relief from dysphagia and improved quality of life in patients with inoperable lower third esophageal cancer. Anti-reflux stents, however, controlled symptomatic and physiologically relevant reflux and should therefore be considered as optimal palliation in this cohort.     

Symptoms experienced during 24-h pH monitoring and their relationship to outcome after laparoscopic total fundoplication

SUMMARY.  Some patients having a 24-h pH monitoring test prior to laparoscopic fundoplication experience no symptoms at all in spite of having a positive test, and other patients experience only atypical symptoms in spite of having a positive test. This study investigates the postoperative outcome of such patients. All patients underwent esophageal manometry and 24-h esophageal pH monitoring before laparoscopic total fundoplication. Patients were divided into three groups based on their symptom profile recorded during a positive 24-h pH monitoring: those with typical symptoms ( n = 104), those with atypical symptoms ( n = 28) and those who experienced no symptoms at all ( n = 23). The outcomes measured were heartburn score (0–10), dysphagia composite score (0–45) and satisfaction score (0–10) at 12 months after surgery. Outcome analysis reveals the heartburn scores were significantly reduced postoperatively for all groups of patients. At 1 year after surgery, there was no difference among the three groups of patients in terms of heartburn score and dysphagia composite scores, nor the experience of bloating, belching, or their willingness to repeat surgery. Despite one group experiencing no symptoms, and another group atypical symptoms during a positive pH study, the postoperative satisfaction scores for these two groups was good, but significantly less ( P = 0.03, P = 0.02, respectively) than the group of patients with a typical symptom index. In conclusion, patients who experience only atypical symptoms or no symptoms at all during their preoperative positive 24-h pH monitoring may still obtain a good result from antireflux surgery. However, these symptom profiles should alert the surgeon that such patients may have an outcome which is not as good as patients who experience only typical symptoms during a pH study.     

Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of followup were observed. A progression to erosive gastroesophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy;72% of these were Los Angeles grade A-B.CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year,despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.     

Esophageal adenocarcinoma developing above an Angelchik prosthesis

The Angelchik device is a horseshoe-shaped prosthesis made of silicone elastomer; it was inserted by the trans-abdominal route to encircle the lower esophagus and was used in the treatment of gastro-esophageal reflux disease. Over 25 000 were inserted worldwide, with acceptable symptom control in between 54% and 95% of patients. However, they were associated with a wide variety of complications, including intractable dysphagia, prosthesis migration and erosion into the stomach, and a significant proportion had to be removed. This article details the cases of three patients in our institution who underwent the insertion of an Angelchik prosthesis and who subsequently developed adenocarcinoma of the esophagus. It is suggested that the Angelchik prosthesis does not effectively prevent acid reflux and thus has no effect in preventing the dysplasia-metaplasia-adenocarcinoma sequence in the lower esophagus.     

Follow-up of a cohort of children and adolescents with gastro-esophageal reflux disease who were free of reflux esophagitis at initial diagnosis

Abstract

Objective. Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions. Material and methods. We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1–17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000–2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions. Results. During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD. Conclusions. Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.     

The cultivable bacterial flora of the esophagus in subjects with esophagitis

Background: The healthy human esophagus is colonized by bacteria similar to that of the oral mucosa. However, little is known about the microbiome of the esophagus in esophagitis or the possible role of bacteria in the inflammatory response.

Aim: To survey bacterial diversity and compare the microbiome of the esophagus in subjects with gastro-esophageal reflux disease (GERD) and eosinophilic esophagitis (EoE).

Material and methods: Seventeen subjects diagnosed with GERD and 10 with EoE underwent endoscopic examination with brush sampling and biopsies from the oral cavity, upper and lower esophagus. The samples were cultivated on agar plates, and bacterial growth was identified to the genus or species level and semi-quantified.

Results: Significantly higher numbers of bacterial groups or species were found in specimens from the lower esophagus in subjects with EoE compared to subjects with GERD (median 4 (range 1–7) vs. 2 (range 0–6), p?Conclusion: Subjects with GERD had significantly less bacterial diversity in both oral and esophageal samples than EoE-subjects. Whether this discrepancy might be explained by an effect on the protective mucosal biofilm by the acidic content of the reflux in subjects with GERD remains unclear.     

The Influence of Helicobacter pylori Eradication on the Gastric Mucosal Content of Epidermal Growth Factor,Transforming Growth Factor-a,and Their Common Receptor

Abstract

Objective. To assess the accuracy of newly developed software for detection of gastro-esophageal reflux episodes in ambulatory 24-h impedance tracings. Material and methods. 24-h esophageal impedance recordings obtained from 60 consecutive patients with reflux symptoms were used in this study. The impedance tracings of the first 10 consecutive patients were analyzed manually by three investigators. Liquid-containing reflux episodes and their proximal extent were scored. A consensus between the three investigators was used as a gold standard. Computer analysis using dedicated software was performed, and the results were compared with the results of the consensus agreement. In addition, in order to assess the accuracy of symptom association analysis 24-h impedance tracings of all 60 patients were analyzed both manually by one investigator and using computer software. The number of reflux episodes and the results of symptom association analysis obtained by the human and computer analysis software were compared. Results. The consensus meeting resulted in a total of 625 reflux episodes. The mean sensitivity and the percentage of true-positives of analysis by individual investigators was 89 ± 1% and 94 ± 1%, respectively. Automated analysis had a sensitivity of 73 ± 4% and a proportion of true-positive reflux episodes of 62 ± 8%. Symptom association analysis performed by the computer and a human observer showed concordant results in 83% of the patients. Conclusions. Although not as good as manual analysis by experts, computer analysis can be a helpful tool to identify reflux episodes and to assess the relationship between reflux episodes and symptoms.     

Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

AIM: To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.METHODS: Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.RESULTS: Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%).CONCLUSION: GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.