慢性结石性胆囊炎与胃食管反流病的系的研究

目的探讨胃食管反流病与结石性胆囊炎的关系。 方法前瞻性研究2017年9月至2019年9月在新疆民心医院通过胃食管反流病调查问卷（GerdQ）或体检胃镜检查被诊断为胃食管反流病（GERD）的488例患者的临床资料（GERD组）,同时通过同样的方法诊断选取为非GERD的590例患者的临床资料（非GERD组）,2组均分别进行腹部彩超、腹部CT检查或将同期腹部彩超结果作为参看,诊断是否伴有胆囊结石,并对其结果进行统计学分析。 结果2组腹部彩超或腹部CT结果示胆囊结石发病率比较,差异无统计学意义（P＞0.05）。 结论胃食管反流病与慢性结石性胆囊炎之间的无明显关系,GERD的严重程度也没有受到胆结石的影响。     

Prevalence of Symptoms of Gastroesopahgeal Reflux in a Cohort of Saudi Arabians: A Study of 1265 Subjects

Background/Aims:

In this study, we aimed to determine the prevalence of gastroesophageal reflux disease (GERD) in the general population of the capital city of Riyadh and to assess its association with other factors including age, smoking, body mass index (BMI), asthma, as well as the presence of other co-morbid diseases.

Materials and Methods:

We used the Gastroesophageal Reflux Disease Questionnaire (GerdQ) for diagnosing GERD, based on a GerdQ score of 8 or more. Riyadh was divided into four quadrants, and from each area, a single shopping mall was chosen randomly to conduct our surveys. Data collected included age, sex, history of smoking, history of asthma or any other medical condition, dietary habits, monthly household income, history and frequency of heartburn, epigastric pain, regurgitation of food, nausea, sleep disturbance from heartburn, the use of common over-the-counter antacids for the control of their symptoms, and their height and weight.

Results:

Over a 4-week period from the 19 December 2012 to 17 January 2013, a total of 1265 individuals were included in the survey. The mean age was 29.97 ± 11.58 years. Females formed 67.81% of the respondents and 62.73% had one or more episodes of heartburn per week. Based on a cutoff GERDQ score of 8, the prevalence of GERD in the surveyed population was 45.4%. GERD was more prevalent in older individuals (mean age 31.9 vs. 30.0 years, P < 0.001) and in those with a higher BMI (27.29 vs. 26.31 kg/m², P = 0.02). There was no difference between males (45.43%) and females (45.13%) (P = 0.92); there was a trend of a higher prevalence in smokers (51.63% vs. 44.41%), but it did not reach statistical significance (P = 0.09).

Conclusion:

Symptoms suggestive of GERD as determined by the translated GerdQ are prevalent among this study population.     

降逆汤治疗反流性食管炎150例

目的:观察降逆汤治疗反流性食管炎(refluxesophagitis,RE)的疗效及复发情况.方法:将150例RE患者随机分为三组:实验1组给予降逆汤治疗;实验2组为降逆汤联合奥美拉唑治疗;对照组给予奥美拉唑治疗.疗程8 wk,治疗后及停药半年后计算症状积分(GERDQ)及胃镜检查,进行疗效评价.结果:8 wk治疗后各...     

中山北部地区脂肪性肝病和胃食管反流病两者关系研究

目的评估中山北部地区脂肪性肝病(FLD)和胃食管反流病GERD之间的关系。方法选取2012年8月—2014年2月来该院就诊的1 000例患者,依据胃食管反流病问卷(Gerd Q)作为初筛GERD的诊断标准,对参与者进行腹部超声波检查,分析FLD与GERD关系,将参与者分为脂肪肝组与对照组,观察脂肪肝人群发生GERD的患病率。结果 1 000例患者利用Gerd Q评估GERD诊断情况,有104例(10.4%)诊断为GERD,女42人(40.3%),男62人(59.6%);脂肪肝患者380例,患病率38.0%,在脂肪肝组中,男女性GERD症状的Gend Q阳性率分別为20.7%和17.3%,两者对比,差异无统计学意义(P>0.05)。脂肪肝人群发生GERD症状的患病率与对照组比较,差异有统计学意义(P<0.05)。结论脂肪肝与GERD显著相关。     

The diagnostic value of GerdQ in subjects with atypical symptoms of gastro-esophageal reflux disease

Background: Symptoms are essential in the clinical diagnosis of gastro-esophageal reflux disease (GERD). Questionnaires such as GerdQ have been developed as diagnostic aids. GerdQ has been thoroughly validated in well-characterized GERD patients, but has not yet been fully evaluated in a population that includes subjects with atypical symptoms.

Aim: To evaluate GerdQ in a population with typical and/or atypical symptoms of GERD, defined by 24-h pH monitoring. The secondary aim was to investigate the outcome of GerdQ depending on the response to proton pump inhibitor (PPI) treatment.

Methods: The study included 646 subjects referred for 24-h pH monitoring due to a clinical suspicion of GERD. All subjects completed GerdQ before performing a 24-h pH monitoring.

Results: In total, 377 (58%) subjects were diagnosed with GERD based on symptoms and 24-h pH monitoring (GERD_pH). Of these, 46% had atypical main symptoms. Overall, GerdQ (at cut-off 8) predicted GERD_pH with a sensitivity and specificity of 62% and 74%, respectively. A high specificity but poor sensitivity for diagnosis of GERD_pH was found for atypical main symptoms such as cough, dysphagia and globus. GerdQ had a relatively high sensitivity and specificity in predicting PPI response and a PPV of 99% at cut-off 8.

Conclusions: GerdQ has a diagnostic value in an unselected population presenting with typical and/or atypical symptoms of GERD, but a low sensitivity for diagnosis of GERD_pH was found in subjects with predominant symptoms such as cough, dysphagia and globus.     

GerdQ量表在胃食管反流病诊断中的应用

目的探讨胃食管反流病量表(GerdQ)应用于诊断胃食管反流病(GERD)的价值。 方法对2013年6月至2014年10月在新疆维吾尔自治区人民医院就诊收住并存在反流相关症状的疑似胃食管反流病的1 000例患者进行问卷调查,按照烧心、反流、上腹痛、恶心、睡眠障碍、是否服用OTC药物等6项症状的发作频率进行评分。采用上消化道内镜检查及食管24 h pH监测作为GERD诊断的标准,并与GerdQ分值进行比较,最后计算出诊断GERD的临界值,进而分析GerdQ量表在GERD中的诊断价值。 结果GERD组的GerdQ积分主要集中于7～12分,非GERD组主要集中于6分以下,差异有统计学意义(P<0.05)。以GerdQ分值8为临界值,Youden指数最大(0.51),ROC曲线下的面积0.765,其敏感度为81.32%,特异性为70.21%,阳性预测值83.24%,阴性预测值61.53%。 结论GerdQ量表简单、易行,可作为临床上筛查诊断GERD的有效方法。     

枳术宽中胶囊联合泮托拉唑治疗胃食管反流病的疗效观察

目的探讨枳术宽中胶囊联合泮托拉唑钠肠溶片治疗胃食管反流病的临床疗效。方法选取2015年12月—2017年1月陵水黎族自治县人民医院收治的胃食管反流病患者160例为研究对象,根据随机数字表法将所有患者分为对照组和治疗组,每组各80例。对照组清晨空腹口服泮托拉唑钠肠溶片,40 mg/次,1次/d。治疗组在对照组基础上口服枳术宽中胶囊,3粒/次,3次/d。两组患者均连续治疗2个月。观察两组的临床疗效,比较两组的症状积分和胃食管反流病诊断问卷(Gerd Q)评分。结果治疗后,对照组和治疗组的总有效率分别为76.3%、93.8%,两组比较差异有统计学意义(P0.05)。治疗1、2个月后,两组症状积分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组症状积分明显低于治疗同期对照组,两组比较差异具有统计学意义(P0.05)。治疗1、2个月后,两组Gerd Q评分均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组Gerd Q评分明显低于治疗同期对照组,两组比较差异具有统计学意义(P0.05)。结论枳术宽中胶囊联合泮托拉唑钠肠溶片治疗胃食管反流病具有较好的临床疗效,能够改善患者的临床症状,提高生活质量,安全性较好,具有一定的临床推广应用价值。     

症状量表、食管24h pH及阻抗监测对Barrett食管、反流性食管炎和非糜烂性反流病的诊断价值

目的 比较GerdQ量表、24 h pH-DeMeester(pH-DeM)及阻抗-pH联合监测3种方法在Barrett食管(BE)、反流性食管炎(RE)和非糜烂性反流病(NERD)的阳性诊断率以及胃食管反流事件特点.方法 参考蒙特利尔共识意见纳入2009年6月1日至2010年9月30日于北京大学第三医院就诊的胃食管反流病(GERD)患者205例,胃镜检查将患者分为BE、RE和NERD 3组.患者均接受GerdQ量表调查、食管24 h pH及阻抗监测.结果 共纳入GERD患者205例.其中BE患者10例,RE 28例,NERD 167例.(1)24 h阻抗-pH法对GERD患者的阳性诊断率为74.1%,显著高于GerdQ(51.7%)和24 h pH-DeM法(29.2%)(P<0.05).(2)GerdQ及24 h pH-DeM法对BE及RE患者阳性诊断率高于NERD患者,而24 h阻抗-pH法在3种类型GERD的阳性诊断率均在较高水平(70.0%、82.1%及73.1%).(3)GerdQ量表得分值与pH-DeM积分及阻抗-pH酸反流分值呈正相关(r=0.242,P=0.000及r=o.182,P=0.009);pH-DeM积分与阻抗-pH酸反流分值呈显著正相关(r=0.632,P=0.000).(4)阻抗-pH监测对GerdQ问卷及pH-DeM积分法具有较强的补充诊断能力:GerdQ问卷阴性者,阻抗-pH的阳性诊断率为58.4%(59/101);pH.DeM积分法阴性者,阻抗-pH监测的阳性诊断率为74.5%(108/145).GerdQ问卷及pH-DeM积分法漏诊的患者均以弱酸反流为主.(5)RE患者酸反流事件检出率及积分均显著高于NERD[53.6%比23.4%,45.6(35.0～67.5)比23.1(9.3～35.0),均PGerdQ量表、24 h pH-DeM积分法及24 h阻抗-pH联合监测对其阳性诊断率差异无统计学意义;BE及NERD患者弱酸反流事件显著,GerdQ量表和单纯食管酸反流监测对其的阳性诊断率较低,阻抗-pH联合监测对此类患者的诊断独具优势.

Abstract：

Objective To compare the diagnostic values of GerdQ questionnaire,24-h pH monitoring and 24-h impedance-pH monitoring for gastroesophageal reflux disease(GERD)and to analyze the reflux patterns of Barrett's esophagus(BE),reflux esophagitis(RE)and non-erosive disease(NERD).Methods From June 1,2009 to September 30,2010,205 GERD patients were included according to the Montreal consensus.All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pH monitoring The diagnostic sensitivities of GerdQ,24-h pH-DeM and 24-h IMP-pH were compared and the reflux pattern of BE,RE and NERD analyzed.Results A total of 205 GERD patients including 10 BE,28RE and 167 NERD were recruited.(1)The diagnostic rate of 24-h IMP-pH was 74.1%.It was significantly higher than that of GerdQ(51.7%)and 24-h pH-DeM(29.2%).(2)The diagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that for NERD.But there were no significant differences of 24-h IMP-pH for three types of GERD(70.O%,82.1%and 73.1%).(3)There were positive correlations among the scores of GerdQ,pH-DeM scores and acid scores in IMP-pH(r=0.242,P=0.000;r=0.182.,P=0.009 and r=0.632,P=0.000).(4)Added diagnostic values of IMP-pH were 58.5%and 74.5%respectively in patients who would have been missed by GeraQ and pH-DeM.(5)The detection rate and score of acid reflux in RE patients were higher than that of NERD [53.6%vs 23.4%,P<0.05;45.6(35.0-67.5)vs 23.1(9.3-35.0),P<0.05].But gas score and separate acid reflux were lower than that in NERD[17(0-194)vs 30(0-500),P<0.05;57.4%VS 28.6%,P<0.05].Conclusions Acid reflux plays an important role in RE.The value of GerdQ and 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE.Weak acid may be more important for BE and NERD patients than separate acid reflux.And 24-h IMP-pH monitoring has a distinct advantage in diagnosing these two types.