反流高敏感与非糜烂性反流病患者症状和食管功能特点研究

目的 研究反流高敏感（reflux hypersensitivity，RH）和非糜烂性反流病（non-erosive reflux disease，NERD）患者症状与食管功能特点。方法 选取于2017年11月至2019年3月在首都医科大学附属北京中医医院同时行胃镜、高分辨率食管测压以及食管腔内多通道阻抗联合pH监测的患者60例，根据症状及检查结果分为RH和NERD两组，每组各30例，比较两组患者GerdQ量表评分、食管测压和pH及pH-阻抗监测情况。结果 RH组患者阴性症状（上腹痛、恶心）的评分明显高于NERD组（即发生率明显低于NERD组），差异具有统计学意义（P<0.05）。两组患者GerdQ总分以及阳性症状（烧心、反流）和阳性影响评分比较，差异无统计学意义（P>0.05）。RH组下食管括约肌（lower esophageal sphincter，LES）残余压明显低于NERD组（P<0.05），LES长度、LES静息压、上食管括约肌（upper esophageal sphincter，UES）、静息压、远端收缩积分（distal contractile integral，DCI）平均值、远端收缩延迟、提前收缩百分比、快速收缩百分比、大型蠕动中断百分比、小型蠕动中断百分比两组之间差异均无统计学意义（均P>0.05）。RH组总反流时间、反流次数，直立位反流时间、反流次数，仰卧位反流时间、反流次数，长反流次数，最长反流持续时间，总酸暴露时间占比和立位、卧位酸暴露时间占比，DeMeester评分，酸反流事件总计明显低于NERD组（P<0.05），两组弱酸反流和非酸反流事件总计差异无统计学意义（P>0.05）。结论 RH组患者上腹痛、恶心的症状发生明显少于NERD组；RH组LES残余压明显低于NERD组；RH组总反流时间、反流次数，直立位反流时间、反流次数，仰卧位反流时间、反流次数，长反流次数，最长反流持续时间，总酸暴露时间占比和立位、卧位酸暴露时间占比，DeMeester评分，酸反流事件总计明显低于NERD组。对于存在典型烧心症状、内镜及活检正常的患者，需行高分辨率食管测压、食管pH及pH-阻抗监测以明确诊断，采取针对性治疗以缓解症状。

Study of symptom and esophageal function in patients with reflux hypersensitivity and non-erosive reflux disease

Objective To investigate the symptom and esophageal function in patients with reflux hypersensitivity (RH) and non-erosive reflux disease(NERD). Methods In this study, 60 patients concurrently taking the examinations of upper gastrointestinal endoscope, high-resolution manometry and impedance (HRiM) and multi-channel intraluminal impedance and pH recording (MII/pH) between Nov. 2017 and Mar. 2019 were selected from Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. The patients were separated into RH group and NRED group with 30 cases in each group, according to their symptoms and examinations, to compare the GerdQ Scale Score, esophageal manometry, and pH & impedance pH monitoring between the two groups. Results The scores of negative symptoms (upper abdominal pain, nausea) in RH group were significantly higher than that in NERD group (ie, the incidence of RH group was lower than NERD group), with statistically significant difference(P<0.05).There was no statistical significant difference in the score of GerdQ, positive symptoms(heartburn, reflux), and positive effects(sleep disorders, the usage of OTC drugs) between the two Groups(P>0.05). The residual pressure of lower esophageal sphincter(LES) in RH group was obviously lower than that in NERD group(P<0.05). There was no statistical significant difference in the length of LES, resting pressure of LES, resting pressure of upper esophageal sphincter(UES), average distal contractile integral(DCI), distal contraction delay, percentage of early contraction, percentage of rapid contraction, percentage of large peristalsis interruption, percentage of small peristalsis interruption between the two groups (average P>0.05).The total reflux duration, reflux times; upright position reflux duration, reflux times; supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group(P<0.05). No statistical significant difference was observed between the two groups in the weak acid reflux and non-acid reflux events(P>0.05). Conclusion The symptoms of upper abdominal pain and nausea were obviously less than those in NERD group. The residual pressure of LES in RH group was obviously lower than that in the NERD group; the total reflux duration, reflux times, upright position reflux duration, reflux times, supine position reflux duration, reflux times; long reflux times, the longest reflux duration, the proportion of total acid exposure and the proportion of standing, supine position acid exposure, De Meester score, and the acid reflux events of RH group were obviously lower than those in the NERD group. For patients with typical heartburn symptoms but normal examined with endoscopy and biopsy, high-resolution esophageal manometry and pH & impedance pH monitoring are required to confirm the diagnosis so that the specific treatments are provided to relieve their clinical symptoms.