食管感觉与胃食管反流病

近年来,一些研究认为食管感觉敏感性改变可能在胃食管反流病发生中发挥着重要的作用.此文就食管高敏感表现,食管感觉的神经机制,食管感觉相关的神经递质及食管感觉与GERD等的研究进展作一综述.     

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,     

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。     

28例老年胃食管反流病与食管运动功能关系的探讨

胃食管反流病（ｇａｓｔｒｏｅｓｏｐｈａｇｅａｌｒｅ－ｆｌｕｘｄｉｓｅａｓｅ，ＧＥＲＤ）在西方国家十分常见，人群患病率达７％～１５％，我国北京、上海两地区的预测患病率为４．４７％。我们对２８例老年ＧＥＲＤ患者进行分析，以了解其发病特点，探讨与食管运动功...     

胃食管反流病

随着胃食管反流病(GERD)患病率的增加，GERD相关并发症亦有所增加，包括Barrett食管和食管腺癌。过去1年提出的有关GERD病理生理学的新观点有助于我们更好地理解反流性疾病发病和黏膜损伤症状之间的关系，并提供针对病人个体化病理生理缺陷的治疗。     

消化内科门诊胃食管反流病诊断问卷诊断胃食管反流病的状况及症状特征分析

目的利用胃食管反流病诊断问卷（Reflux disease questionnaire,RDQ）分析消化专家门诊胃食管反流病（GERD）患病情况及患者症状特征。方法对就诊于我院消化专家门诊的1636例患者进行RDQ问卷调查,得分≥12分者诊断为GERD。根据RDQ内容对GERD患者症状特点进行分析。结果1636例消化专家门诊的患者中,GERD的发生率为10．8％。男女发病无差异（11．0％VS10．5％,P〉0．05）。60岁以上年龄组GERD的患病率最高（14．6％）,而15～30岁年龄组患病率最低（7．7％）。各年龄组内患病率性别间比较差异无显著性。GERD症状中,烧心与反酸为最常见的症状。症状频率积分比严重程度积分更重要（P〈0．05）。结论消化门诊就诊患者GERD患病率较高。GERD患病无性别差异。老年人的GERD患病率高于其他年龄组。烧心和反酸为GERD最常见的症状。症状发生频率比严重程度对GERD的诊断更有意义。     

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。     

下食管括约肌运动和功能与胃食管反流病

目的　观察胃食管反流病 (GERD)患者与对照组餐前、餐后食管pH情况 ,下食管括约肌(LES )运动模式的变化以及酸反流事件与一过性下食管括约肌松弛 (TLESR )、低LES压力 (LESP)的关系。方法　两组受试者均接受连续性 4h食管压力测定 (分别为空腹和餐后 1、2、3h)和食管pH监测 (GERD组检测 4h ,对照组检测 2 4h)。结果　GERD组酸反流事件明显高于对照组 (P <0 0 5 )。两组间TLESR发生率差异无显著性 (P >0 0 5 ) ,但与空腹比较 ,两组餐后 1h和 2hTLESR发生率明显增多 ;GERD组伴有酸反流的TLESR明显高于对照组 (P <0 0 0 1)。 4 3% (2 9/ 6 8)的酸反流事件发生在TLESR期间。 31% (2 1/ 6 8)的酸反流事件出现于低LESP状态中。结论　GERD是多因素参与的病理过程。LES运动形式变化和功能不全是GERD的重要背景因素。     

胃食管反流病Q评分与电子胃镜在胃食管反流病诊断中的应用比较

[目的]探讨胃食管反流病（GERD）Q评分在GERD诊断中的临床应用价值.[方法]将因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为GERDQ评分组和胃镜组,每组60例,分别接受GERDQ问卷评分、电子胃镜,比较分析各种方法对GERD的检出情况.[结果]GERDQ评分组与胃镜组比较差异无统计学意义（P＞0.05）,但GERDQ评分组检出率较胃镜组高.[结论]GERDQ量表是诊断GERD简单、易行、有效且零成本的方法,值得推广.     

胃食管反流病食管运动功能研究新进展

胃食管反流病(Gastroesophageal Reflux Disease,GERD)是指过多胃、十二指肠内容物反流入食管引起的烧心等症状,并可导致食管炎和口咽、喉、气道等食管以外组织的损害。本文主要对一过性下食管括约肌松弛(Transient Lower Esopageal SphincterRelaxation TLESR)、下食管括约肌(LowerEsopageal Sphincter,LES)高压及食管体部运动功能方面的研究新进展作一简要综述。     

胃食管反流病发病机制若干进展

胃食管反流病(GERD)是常见的上消化道动力障碍性疾病。其发病与抗反流防御机制下降、反流物攻击增强、遗传因素、幽门螺杆菌、神经因素、社会心理因素等有关。     

Gastroesophageal reflux disease:From pathophysiology to treatment

This review focuses on the pathophysiology of gastroesophageal reflux disease (GERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of GERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for GERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with GERD.     

Autofluorescence imaging endoscopy can distinguish non-erosive reflux disease from functional heartburn: A pilot study

AIM: To investigate whether autofluorescence imaging(Af I) endoscopy can distinguish non-erosive reflux disease(NERD) from functional heartburn(fh).METHODS: In this prospective observational trial, 127 patients presenting with typical reflux symptoms for 6 mo were screened. All the participants underwent endoscopy, during which white light imaging(WLI) was followed by Af I. finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during Af I endoscopy. Ambulatory 24-h multichannel intraluminal impedance and ph monitoring was also performed. After standard proton-pump inhibitor(PPI) tests, subjects were divided into an NERD group and an fh group and the diagnostic performance of Af I endoscopy to differentiate NERD from fh was evaluated.RESULTS: Of 84 endoscopy-negative patients, 36(42.9%) had a normal ph/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. finally 10 patients were diagnosed with fh and the others with NERD. Altogether, 68(81.0%) of the 84 patients were positive on Af I endoscopy. In the NERD group, there were 67(90.5%) patients with abnormal esophageal findings on Af I endoscopy while only 1(10%) patient was positive on Af I endoscopy in the fh group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5%(95%CI: 81.5%-96.1%) and 90.0%(95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of Af I in differentiating between NERD and fh were 90.5%(95%CI: 84.2%-96.8%), 98.5%(95%CI: 92.1%-99.9%) and 56.3%(95%CI: 30.0%-80.2%), respectively.CONCLUSION: Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and fh.     

应用食管气囊扩张法建立胃食管反流病动物模型研究

目的探讨应用微创方法建立胃食管反流病动物模型的可行性。方法对10只新西兰兔实施食管气囊扩张术,气囊中部定位于胃食管交界处,压力为10Psi（1Psi=6．89kPa）,维持10min,扩张2次,每次间隔3min,以建立胃食管反流病动物模型。实验动物在扩张前1周及扩张后1周行食管测压及食管下段pH值检测,对扩张前后的食管压力及胃食管反流进行比较。对气囊扩张后实验兔的食管进行病理检查并与正常食管进行比较。结果气囊扩张前后食管下括约肌的压力分别为（11．2±1．56）mmHg与（7．89±2．99）mmHg,两者差异有统计学意义（t=3．67,P=0．006）。扩张前后的反流率分别为（1．07±0．93）％与（9．36±7．79）％,两者差异有统计学意义（t=3．10,P=0．015）。病理结果示扩张后食管有明显的病理改变。术后6只动物出现明显的反流,造模的成功率为60％。结论食管气囊扩张法是一种新的、简单可靠和微创的建立胃食管反流病动物模型的方法。     

Gastroesophageal reflux disease:From heartburn to cancer

About 10%-15% of patients with gastroesophageal reflux disease develop Barrett’s esophagus. This is considered a premalignant condition because it can progress from metaplasia to high-grade dysplasia, and eventually to adenocarcinoma. Recently, major advances have been made in the endoscopic treatment of Barrett’s esophagus, therefore limiting the role of surgery in the treatment of this disease.     

Gastroesophageal reflux disease: Important considerations for the older patients

Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Although elderly patients with GERD have fewer symptoms, their disease is more often severe. They have more esophageal and extraesophageal complications that may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett's esophagus and adenocarcinoma of the esophagus. Extraesophageal complications include atypical chest pain that can simulate angina pectoris; ear, nose, and throat manifestations such as globus sensation, laryngitis, and dental problems; pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may be warranted in the elderly patient, because of the higher incidence of severe complications. Although the evaluation and management of GERD are generally the same in elderly patients as for all adults, there are specific issues of causation, evaluation and treatment that must be considered when dealing with the elderly.     

Endoscopic aspects in diagnosis of gastroesophageal reflux disease and motility disorders: Bravo,capsule, and functional lumen imaging probe

Catheter-based testing remains the current standard of practice for the diagnosis of gastroesophageal reflux disease and esophageal motility abnormalities. Ambulatory pH testing and esophageal manometry have been in use for the past 40 years, but with the development of high-resolution manometry and multichannel intraluminal impedance testing, catheter-based testing has undergone significant recent technological improvement. Nonetheless, these tests continue to have limitations. In the case of ambulatory reflux testing, patient discomfort and limited activity remain significant problems. For esophageal manometry, methodological issues limit its ability to evaluate the function of the esophagogastric junction in normal and diseased states. In recent years, several new diagnostic tools have been developed to address the shortcomings of catheter-based testing. The wireless pH probe has been available for clinical use for more than 10 years, is better tolerated than catheter-based testing, and provides longer monitoring periods. Esophageal capsule endoscopy has undergone clinical evaluation for gastroesophageal reflux disease and Barrett esophagus with mixed results. Functional lumen imaging probe testing is a new technology that is still undergoing clinical evaluation but holds promise as a complimentary method for evaluating esophageal physiology, in particular esophagogastric junction function.     

肝纤维化的MR功能成像研究

长期以来,临床多以肝活检组织病理学检查作为诊断肝纤维化的金标准,但其有一定的创伤性及盲目性。MR功能成像研究如MR灌注成像、MR弥散成像、MR波谱分析、磁化传递对比、磁共振弹性成像在肝纤维化、肝硬化的诊断、治疗及预后的评价方面发挥着重要的作用,它们各具优缺点,应进行合理的选用及相互对照验证。     

胃食管反流病与功能性肠病关系的研究

目的探讨胃食管反流病与功能性肠病的关系。方法随机选取2004年北京大学人民医院消化科门诊有上腹症状的病人168例,填写反流性疾病诊断问卷(耐信量表),以Sc≥12为症状性胃食管反流标准,将病人分为两组,Sc≥12组及Sc<12组,记录病人身高、体重、计算体重指数、吸烟史、饮酒史、手术史、用药史,按照功能性肠病罗马Ⅱ诊断标准筛选功能性肠病病人,包括肠易激综合征(IBS)、功能性便秘、功能性腹胀、功能性腹泻等病人。结果按照罗马Ⅱ标准,两组患IBS及患功能性便秘差异无显著统计学意义,但两组发生功能性腹泻的差异有显著统计学意义,经logistic回归分析,发现体重指数与发生和胃食管反流病程相伴的下消化道功能异常有一定关系。结论胃食管反流可以合并不同程度下消化道功能异常,但具体机制尚有待进一步研究。