难治性胃食管反流病食管动力异常与反流特点的研究

目的研究难治性胃食管反流病(refractory gastroesophageal reflux disease,rGERD)食管动力学特征和反流特点。方法应用高分辨率食管测压(HRM)监测87例GERD患者和70例rGERD患者食管动力学数据,同时应用便携式24 h食管pH-阻抗监测仪记录两组患者的酸暴露特点、反流类型及反流特点,分析比较两组患者间差异。结果rGERD患者中UES压力、LES压力显著低于GERD患者(P<0.05),rGERD患者LES的长度与GERD患者比较,差异无统计学意义(P>0.05)。rGERD患者中食管动力障碍比例高于GERD患者(70.00%vs 33.33%,χ2=4.891,P<0.05),DCI下降为特征的食管蠕动收缩障碍及间断收缩为特征的食管收缩节律障碍者比例两组比较,差异无统计学意义(57.14%vs 62.07%;42.86%vs 37.93%,χ2=3.275、2.822,P>0.05)。rGERD患者DeMeester评分高于GERD患者(P=0.014),rGERD患者反流性质中弱酸反流及非酸反流明显多于GERD患者(P弱酸=0.001,P非酸=0.017),而酸反流次数差异无统计学意义(P酸=0.385);rGERD患者反流性状中气体反流及气液混合反流次数多于GERD患者(P气=0.022,P气液=0.031),而液体反流次数差异无统计学意义(P液=0.742)。结论rGERD患者与GERD患者相比,存在UES压力偏低、LES压力下降和食管蠕动收缩障碍等食管动力学异常;rGERD患者反流以弱酸反流及碱反流为主,而GERD患者以酸反流为主,同时rGERD患者中气液混合反流所占比例大,而GERD患者以液体反流为主。

Analysis of esophageal dynamic abnormality and reflux characteristics in refractory gastroesophageal reflux disease

Objective To study esophageal dynamic characteristics and the reflux characteristics of the refractory gastroesophageal reflux disease(rGERD).Methods The esophageal dynamic data of 87 gastroesophageal reflux disease(GERD)patients and 70 rGERD patients were detected by HRM,and the acid exposure characteristics,reflux types and reflux characteristics of the two groups were recorded by 24 h-MII-pH,and the differences between the two groups were analyzed and compared.Results The pressures of UES and LES in rGERD patients were lower than those in GERD patients(P<0.05).The number of patients with esophageal motility disorder was higher in patients with rGERD than that in patients with GERD(70.00%vs 33.33%,χ2=4.891,P<0.05),there was no significant difference in the proportion of esophageal peristaltic contraction disorder characterized by decreased DCI and esophageal contraction rhythm disorder characterized by intermittent contraction between two groups(57.14%vs 62.07%;42.86%vs 37.93%,χ2=3.275,2.822,P>0.05).DeMeester score of rGERD patients was higher than that in GERD patients(P=0.014),weak acid reflux and non-acid reflux in rGERD patients were significantly higher than those in GERD patients(P weak acid=0.001,P non-acid=0.017),and there was no significant difference in the number of acid reflux(P acid=0.385).The number of gas reflux and gas-liquid mixed reflux in rGERD patients were higher than those in GERD patients(P gas=0.022,P gas-liquid=0.031),while there was no significant difference in the number of liquid reflux(P liquid=0.742).Conclusion Compared with GERD patients,patients with rGERD have esophageal dynamic abnormalities such as low UES pressure,LES pressure drop and esophageal peristatic contraction disorder.In rGERD patients,weak acid reflux and non-acid reflux are the main reflux,while in GERD patients,acid reflux is the main reflux.Meanwhile,gas-liquid mixed reflux accounts for a large proportion in rGERD patients,while liquid reflux is the main reflux in GERD patients.