反流性食管炎与非糜烂性反流病食管酸暴露的特点比较

目的　比较反流性食管炎 (RE)与非糜烂性反流病 (NERD)各亚组食管酸暴露特点。方法　具有典型反酸 烧心等症状的 12 8例患者 ,经胃镜等系统检查诊断为胃食管反流病 (GERD)。便携式 pH监测仪行胃食管 2 4hpH监测 ,DeMeester积分≥ 15分为存在病理性酸反流。 结果　 12 8例患者中 ,37例 (2 8 9% )存在RE ,91例 (71 1% )为NERD。pH监测阳性在RE组和NERD组中分别为 2 5例 (6 7 6 % )和 4 6例 (5 0 5 % ) ,差异无统计学意义 ;两组DeMeester积分均值差异亦无统计学意义 (5 3 4 5± 6 2 0 4比 4 0 0 4± 6 1 80 ,P >0 0 5 )。RE组长反流次数显著高于NERD组 (8 16±10 2 7比 3 96± 6 87,P =0 0 0 4 )。以症状指数 >5 0 %为阳性 ,NERD阳性组 (pH值监测异常 )症状指数阳性率显著高于NERD阴性组 (pH值监测正常 ) (43 5 %比 15 6 % ,P <0 0 0 1)。NERD阴性组中具有阳性症状指数的患者 7例 (15 6 % ) ,阴性症状指数者 38例。前者总反流次数及立位反流时间百分比显著高于后者。RE患者中 ,12例 pH监测阴性者食管及胃内pH的中位值显著高于 pH监测阳性者。结论　RE患者长反流发生率高于NERD患者 ;症状的发生与酸反流相关 ;NERD患者根据酸反流与症状关系可分为不同的亚组。RE阴性组可能存在混合反流或胆汁反流

Comparison of esophageal acid exposure characteristics between reflux oesophagitis and non-erosive reflux diseases

OBJECTIVES: Comparing the esophageal acid exposure characteristics between reflux oesophagitis (RE) and non-erosive reflux disease (NERD) patients to identify the NERD subgroups. METHODS: One hundred and twenty-eight patients with heartburn and acid regurgitation were evaluated. Esophageal mucosa injury was assessed by gastroscopy. The extent of esophageal acid exposure was determined by ambulatory 24 h esophageal pH monitoring. DeMeester point >/= 15 was taken as positive. RESULTS: Thirty-seven patients were found to have RE (28.9%), 91 were diagnosed as NERD. There was no difference at DeMeester point between RE and NERD (P > 0.05). Patients with RE have more long reflux episodes than NERD patients (8.16 +/- 10.27 vs 3.96 +/- 6.87; P = 0.004). Among NERD patients, 46 (50.5%) had an abnormal pH monitoring (NERD+); another 45 were normal (NERD-). Patients with NERD+ were more likely to demonstrate at positive symptom index (SI > 50%) than those with NERD- (43.5% vs 15.6%; P < 0.001). In NERD- group, patients with a positive SI (NERD-SI+) have more reflux episodes than those with a negative SI (NERD-SI-) (55.29 +/- 24.68 vs 34.87 +/- 24.06; P < 0.05), as well as the fraction time of 24 h that pH < 4 in upright (4.16 +/- 2.98 vs 1.88 +/- 1.60; P < 0.05). Twenty-five RE patients have an abnormal pH monitoring (RE+, 67.6%), another 12 were normal (RE-). RE- patients have a higher median of intra-esophageal and gastric pH than RE+ patients respectively (6.75 +/- 0.42 vs 5.18 +/- 1.32; 2.69 +/- 2.59 vs 1.49 +/- 0.66; P < 0.05). CONCLUSIONS: RE patients have longer reflux episodes than NERD. The symptoms of most gastroesophageal reflux disease patients associate with acid reflux. Acid reflux characteristics and symptom patterns suggest subgroups of NERD patients. The bile or mixed reflux may be involved in the pathogenesis of RE- group.