老年人胃食管反流病

胃食管反流病是指反流至食管的胃或十二指肠内容物（主要是胃酸或／和胆汁）过多,或在食管内停留时间过长,腐蚀食管黏膜,致使胃食管反流病发生。根据内镜下表现的不同,胃食管反流病可分为非糜烂性和糜烂性胃食管反流病（后者又称反流性食管炎）,据有关资料报告,     

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目的探讨非糜烂性胃食管反流病不同于反流性食管炎的发病机制。方法选择1996～2004年北京大学人民医院因反酸、胃灼热感等反流症状确诊为胃食管反流病患者57例,按照内镜下食管黏膜有无破损分为非糜烂性胃食管反流病组和反流性食管炎组,比较两组的一般情况、反流症状、是否合并H.pylori(Hp)感染,以及食管动力测定和食管胃24hpH监测结果。结果两组患者年龄、性别、烟酒嗜好等一般情况及合并Hp感染情况比较差异无显著性。非糜烂性胃食管反流病组不典型反流症状(胸骨后痛)的发生率明显高于反流性食管炎组。两组患者都存在病理性酸反流,但两组患者之间酸和(或)碱反流比较无差异。非糜烂性胃食管反流病患者的食管体部各段蠕动波峰值明显高于反流性食管炎患者。非糜烂性胃食管反流病患者卧位胃酸分泌高于反流性食管炎患者。结论非糜烂性胃食管反流病的不典型反流症状发生率更高。在两组发病机制异同上,反流的强弱并非主要因素,重要的是食管防御机制的差别。     

食管阻抗测定新参数在胃食管反流病中的应用

食管pH-阻抗监测可以反映食管反流物的性质、酸度及方向、症状与反流的关系等, 为胃食管反流病的诊治提供综合评估。常规食管pH-阻抗监测参数包括酸暴露时间、反流次数、酸暴露百分比及反流-症状相关性等。近年来提出的食管阻抗新参数包括基线阻抗、反流后吞咽诱发的蠕动波、平均夜间基线阻抗及黏膜阻抗等, 为胃食管反流病诊断及疗效的预测提供了重要的证据。本文将对这些新的阻抗监测参数在胃食管反流病中的应用价值做一综述。     

正常人和胃食管反流患者的昼夜食管pH和动力变化

正常人和胃食管反流患者的昼夜食管ｐＨ和动力变化王智凤，柯美云，蓝宇作者单位：１００７３０中国协和医科大学，中国医学科学院，北京协和医院消化内科胃食管反流病（ＧＥＲＤ）是常见的上胃肠动力障碍性疾病。下食管括约肌（ＬＥＳ）在胃食管反流病发病中起着重要的作...     

胃内酸袋与胃食管反流病的研究进展

胃食管反流病是一种胃内容物反流引起不适症状和(或)并发症的一种疾病,其发病与食管下括约肌(inferior esophageal sphincter,LES)一过性松弛、食管酸清除功能障碍以及食管抗反流屏障下降等机制有关。研究表明,胃内酸袋的存在亦为导致胃食管反流病发生的机制之一。本文就胃内酸袋与胃食管反流病的关系作一综述。     

胃食管反流病的治疗进展

胃食管反流病是常见的上消化道动力障碍性疾病，发病率呈现逐年上升趋势，目前胃食管反流病的治疗主要有改变生活方式、应用质子泵抑制剂以及中药治疗。对于药物治疗无效的胃食管反流病，内镜治疗如内镜下射频消融、注射治疗以及抗反流手术及外科手术治疗均可改善患者症状，减少胃食管反流病的并发症发生，对于胃食管反流病患者的治疗，应根据具体情况，选择恰当的治疗方法。     

胃食管反流病与牙周炎的关系

胃食管反流病是指胃十二指肠内容物反流入食管、口腔、咽喉或肺引起的相关表现.近期研究报道胃食管反流病与牙周炎之间可能存在着一定的相关性.牙周炎是常见的口腔疾病之一.本文就胃食管反流病的口腔表现、胃食管反流病与牙周炎关系的研究进展作一综述.     

胃食管反流病误诊为咽喉疾病48例临床分析

目的探讨胃食管反流病误诊原因,提出防范误诊措施。方法对48例胃食管反流病误诊资料进行回顾性分析。结果48例患者主要表现为咽痛、清咽、咽部阻塞感、咽不适感等胃肠外症状。喉镜检查均见咽喉部黏膜充血、水肿、咽后壁有淋巴小结增生。经胃镜检查、诊断性治疗诊断胃食管反流病。给予质子泵抑制剂及促胃动力药。结论部分胃食管反流病以咽喉症状为主要表现,易误诊为咽喉疾病,应仔细鉴别胃食管反流病,行胃镜检查或24h食管PH值测定及其他寻找胃食管反流证据的检查、给予质子泵抑制剂诊断性治疗,有助于正确诊断。     

呼出气一氧化氮及食管pH监测对支气管哮喘和胃食管反流病的诊断与鉴别价值

目的探讨呼出气一氧化氮（FeNO）对诊断和鉴别支气管哮喘及合并胃食管反流病的价值及其与24h食管pH测定的关系。方法选取2010年3月至2011年2月在我科住院的支气管哮喘患者16例、胃食管反流病患者20例及支气管哮喘合并胃食管反流病患者16例,分别测定FeNO、白细胞分类计数及百分比、24h食管pH测定中pH〈4的时间百分比,pH〈4的总次数,pH〈4大于5min以上的次数及DeMeester评分,分别比较三组FeNO水平的差异及与上述测定指标的关系。结果FeNO、嗜酸性粒细胞（EOS）、嗜酸性粒细胞百分比（EOS％）在三组组间存在总体差异,组间两两比较发现,哮喘组和哮喘合并胃食管反流病组比胃食管反流病组FeNO、EOS、EOS％均显著增高（P〈0．05—0．01）;哮喘组比哮喘合并胃食管反流病组FeNO显著增高（P〈0．05）,而EOS、EOS％无明显差异;哮喘组FeNO水平与EOS和EOS％有显著相关性（P〈0．05）;但胃食管反流病（GERD）组及哮喘合并胃食管反流病组FeNO水平与EOS没有明显的相关性;胃食管反流病组和哮喘合并胃食管反流病组FeNO水平与pH〈4的时间百分比、pH〈4的总次数、pH〈4发作大于5min的次数及DeMeester评分值均有非常显著的相关性（P均〈0．01）;哮喘组FeNO水平与24h食管pH监测结果没有相关性。结论FeNO是一项检测气道炎症的敏感指标,尤其能反映嗜酸性粒细胞气道炎症;在哮喘合并胃食管反流病患者中,吸入酸性胃内容物可能以双重作用影响FeNO的变化,提示在哮喘合并胃食管反流病患者中,FeNO的增加可能部分反映了胃酸反流的严重程度;FeNO对于哮喘和哮喘合并胃食管反流病患者具有较好的诊断价值,同时为鉴别哮喘和哮喘合并胃食管反流病患者与胃食管反流病提供了可靠的依据。     

胃食管反流性咳嗽的发病机制及诊疗

胃食管反流性咳嗽为胃食管反流病的一种特殊类型,是慢性咳嗽常见病因之一.与典型胃食管反流病相比,胃食管反流性咳嗽在发病机制、诊疗方面有其特点.胃食管反流性咳嗽的发病机制可能是高位反流、低位反流和气道高敏感性等多因素共同作用的结果,诊断需结合临床表现和辅助检查建立,多通道食管腔内阻抗联合pH监测可以区分酸与非酸性反流,是有前景的诊断技术,抗反流药物治疗是目前胃食管反流性咳嗽的主要治疗方法.     

The effects of inhaled albuterol and oral theophylline on gastroesophageal reflux in patients with gastroesophageal reflux disease and obstructive lung disease.

Patients with gastroesophageal reflux disease may have pulmonary symptoms due to repeated aspiration of gastric contents or reflex bronchospasm during a reflux event. Oral bronchodilators are known to worsen gastroesophageal reflux and may lead to vicious cycle when gastroesophageal reflux causes bronchospasm. The effect of inhaled bronchodilators on gastroesophageal reflux is unknown. We compared the severity of gastroesophageal reflux in patients with documented gastroesophageal reflux disease and obstructive lung disease while they were taking inhaled albuterol or oral theophylline. Nine patients with gastroesophageal reflux disease had 24-hour esophageal pH studies on two separate days approximately 1 week apart. On one study day, the patients received 0.5 mg of albuterol in 2.5 mL of normal saline vias hand-held nebulizer, four times a day. On the other day, the patients received sustained-release theophylline, 200 mg twice a day, or in a dosage taken previously to achieve a serum theophylline level of 55 to 110 mumol/L. The patients had 40% reduction in the total time the pH was less than 4.0 with albuterol than with theophylline (9.7% vs 16.1%). Seven patients had less gastroesophageal reflux while taking albuterol, and two patients had essentially no change. Patients with gastroesophageal reflux disease, who require bronchodilator therapy for obstructive lung disease, have less reflux with inhaled albuterol.     

胃食管反流病与胰岛素抵抗的研究进展

胃食管反流病（GERD）是胃、十二指肠内容物反流至食管内引起一系列症状及并发症的疾病。胰岛素抵抗是以高胰岛素水平为特征的葡萄糖调节障碍。有研究表明，GERD与胰岛素抵抗有关。胰岛素抵抗可能通过高血糖、肥胖等表现来引起胃食管反流病，而GERD，特别是糜烂性食管炎可通过炎症介质相关的机制来影响胰岛素敏感性从而引起胰岛素抵抗。本篇综述讨论关于胃食管反流病与胰岛素抵抗之间的相关性。     

Prevalence and demographic determinants of gastroesophageal reflux disease (GERD) in the Turkish general population: A population-based cross-sectional study

Background/aims: We aimed to establish the prevalence and demographic determinants of gastroesophageal reflux disease in the Turkish general population using the Turkish version of the gastroesophageal reflux disease questionnaire. Material and Methods: A total of 8143 volunteers (mean age: 38.5 (13.3) years; 52.3% males) were included in this cross-sectional questionnaire study conducted via face-to-face administration of the questionnaire forms including items on sociodemographic features, past history of gastric disorders, gastroesophageal reflux disease, the influence of reflux symptoms on patients' lives, physician visits, diagnostic tests, and reflux medications. Results: A past history of gastric symptoms was reported in half of the population. More female participants (p<0.001) had a past history of gastric symptoms that yielded a previous diagnosis of gastroesophageal reflux disease in 19.1% of the population. The likelihood of gastroesophageal reflux disease was low in the majority (75.3%) of the subjects evaluated. Gastroesophageal reflux disease with an inconveniencing or disrupting impact on the patient's life was present in 17.9% and 6.8% of the population. Total gastroesophageal reflux disease-questionnaire scores and reflux prevalence were higher in older age groups (p<0.001). Females were more likely to have gastroesophageal reflux disease prevalence based on reflux symptoms. The impact of gastroesophageal reflux disease on sleep and psychological/emotional well-being was more pronounced in older and female patients, whereas the impact on eating/drinking behaviors and physical-social activities was more marked among females independent of their age (p<0.001). Reflux prevalence was higher in subjects from East Anatolia, Central Anatolia, Mediterranean, and Black Sea regions of Turkey (p<0.001 for each). Conclusions: Prevalence and demographic determinants of gastroesophageal reflux disease are compatible with the profile of the disease in the other Western populations, with a predilection for females and older individuals.     

非糜烂性反流病的治疗进展

胃食管反流病（GERD）一直是胃肠病学专家研究的热点，近年来逐渐认识到非糜烂性反流病与糜烂性反流病是GERD的两种不同亚型，其临床特征和治疗均存在一定程度的差异，且非糜烂性反流病较糜烂性反流病更难以完全治愈，本文就近年来非糜烂性反流病的治疗进展作一概述。     

Epidemiology of gastroesophageal reflux disease in Tehran, Iran

BACKGROUND AND AIM: Epidemiological studies have indicated an increase in the prevalence of gastroesophageal reflux disease in Western countries; however, there is a lack of information about its prevalence in Iran. The aim of this study was to measure gastroesophageal reflux disease prevalence in a representative sample of the Tehran population in 1999. METHODS: In a cross-sectional study, 700 people, with a male : female ratio of 1:1, were selected by stratified randomization based on the probability of 20% prevalence of gastroesophageal reflux disease and 3% error. They were divided equally into seven age groups. Heartburn and acid regurgitation were considered as the most common symptoms of gastroesophageal reflux disease. The severity and frequency of heartburn and the role of personal habits in the appearance of this symptom were determined. The prevalence of gastroesophageal reflux disease in samples was measured, and its actual prevalence in society was estimated. RESULTS: Of 700 people, 350 were male and 350 were female. The major symptoms of gastroesophageal reflux disease were observed in 278 (39.7%) people. The prevalence of gastroesophageal reflux disease of smokers was twice that of non-smokers. CONCLUSIONS: Gastroesophageal reflux disease is a serious and unresolved problem in Western countries, and its increasing prevalence correlates with an increasing prevalence of adenocarcinoma of distal esophagus. The prevalence of gastroesophageal reflux disease appears to be increasing in Iran also; therefore, it is recommended that major attention be paid to this disease.     

反流性咽喉炎的研究进展

随着对胃食管反流病认识的深入,其对咽喉部的影响越来越受到临床的关注,研究证明它是导致咽喉部疾病的重要致病因素之一。胃食管反流对消化系统影响的研究很多,但其与咽喉反流性疾病的相关研究甚少,很多基层医生对该病还不甚了解。本文主要对反流性咽喉炎的发病机制、临床表现、诊断方法和治疗作一综述。     

Effect of hyoscine N-butylbromide on gastroesophageal reflux in normal subjects and patients with gastroesophageal reflux disease

OBJECTIVES: Recent studies have shown that atropine reduces gastroesophageal reflux in normal subjects and patients with gastroesophageal reflux. The aim of the study has been to assess the effects of an atropine derivative, hyoscine N-butylbromide in normal subjects and patients with gastroesophageal reflux disease by recording esophageal and gastric pH-metry for a 24-h period. METHODS: Ten normal subjects and 10 patients with gastroesophageal reflux disease were evaluated. PH-metry was performed using two glass pH flexible probes with distal incorporated electrodes. The two catheters were introduced nasally under fluoroscopy. One probe was positioned in the gastric body; the other was placed 5 cm above the lower esophageal sphincter which had been evaluated manometrically before the study. Recording lasted without interruption for 48 h. Patients and normal subjects were assigned to receive hyoscine N-butylbromide (10 mg p.o. t.i.d.) for 24 h followed by a placebo for another 24 h or vice versa in a random manner. The pH was analyzed for a total number of acid refluxes and percentage of the period with pH <4 in the esophagus and the mean gastric pH in 24 h, before and after treatment with hyoscine N-butylbromide. RESULTS: The number of reflux episodes was significantly greater with hyoscine N-butylbromide in comparison with a placebo in patients with gastroesophageal reflux disease and normal subjects (p < 0.02). The percentage of time with pH <4, was also significantly greater in patients with gastroesophageal reflux disease and in controls (p < 0.05). The mean 24-h gastric pH after hyoscine N-butylbromide was not different from placebo in gastroesophageal reflux disease and controls. CONCLUSIONS: Hyoscine N-butylbromide, an anticholinergic agent, increases the total number of esophageal acid refluxes in patients with gastroesophageal reflux disease and in controls, therefore it is not recommended in the treatment of gastroesophageal reflux disease.     

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors

OBJECTIVE: The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients. METHODS: The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis. RESULTS: The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were II cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13-46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01-30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01-13.9) were significantly associated with reflux esophagitis. CONCLUSIONS: Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.