反流性食管炎1 827例临床分析

目的　通过研究10年间内镜所诊断的反流性食管炎（RE）病例，探讨中国人RE的内镜和临床特点。方法　1990至1999年胃镜诊断的1827例RE患者，按洛杉矶标准及中国试行标准进行分级，部分患者还进行食管运动功能检查。分析患者年龄、性别、症状、伴发疾病及与各项检查的关系。结果　RE占总胃镜检查人数的2.02％，男女之比为3.9∶1。平均年龄（52.02±14.38）岁，58.62％的原发性RE超过50岁。仅36.29％有典型的反流症状。RE以中、轻度者（洛杉矶标准的A、B级或烟台标准Ⅰ级）多见，近80％，重度少见。RE患者的平均pH<4总时间百分比及平均胆红素吸收值>0.14总时间百分比均显著高于正常(P＜0.01)，重度RE显著高于轻度(P＜0.05)，而平均下食管括约肌压与正常相比差异无显著性(P>0.05)。结论　中国人RE患病率较西方国家低，以男性老年人多见，程度多较轻，与胃及十二指肠内容物反流均有密切关系。仅依据反流症状来诊断RE的敏感性较低，内镜对RE的诊断具有重要意义。

Clinical analysis of 1 827 patients with reflux esophagitis

OBJECTIVE: To investigate clinical and endoscopic characteristics of reflux esophagitis (RE) in Chinese. METHODS: 1 827 patients with RE, diagnosed by endoscopy in the past 10 years, were divided into different grades according to Los Angeles System and Chinese Standard. A part of them underwent esophageal manometry, 24-hour pH monitoring, and 24-hour bilirubin monitoring. The relationship between age, sex, symptom, accompanied diseases and each examinations were analyzed. RESULTS: RE was 2.02% of the total endoscopy number, and male vs female was 3.9:1, mean age was (52.02 +/- 14.38) years old. Only 36.29% of RE patients have typical reflux symptom. Patients with light mordent (Los Angeles System A, B and Chinese Standard I) RE were more than those with severe RE. Both of the time of esophageal acid exposure and total percent time bilirubin absorbance >or=0.14 for RE was significantly more than normal (P < 0.01). CONCLUSION: The incidence of RE in Chinese is lower than that in Western and the severity is less. Most of RE are male and aged. There is a close association between RE and both of gastroesophageal reflux and duodenogastroesophageal reflux. Endoscopy is very important for diagnosis of RE.