非典型症状与典型症状胃食管反流病患者临床特点比较
|
摘要
目的比较非典型症状胃食管反流病(a-GERD)患者与典型症状胃食管反流病(t-GERD)患者的高分辨率食管测压(HRM)、24h食管多通道腔内阻抗-pH监测(MII-pH)及质子泵抑制剂(PPI)治疗结果,提高对a-GERD的认识。方法对30例疑诊a-GERD患者行上消化道内镜、HRM、MII-pH检查及PPI治疗,以同期33例t-GERD患者作对照,比较两组患者的临床症状、食管动力、反流及PPI疗效的差异。结果 30例疑诊a-GERD患者中24例确诊为a-GERD,其中1/3的患者年龄在60岁以上,发病年龄、合并症发生率高于t-GERD患者(P<0.05)。两组内镜下食管黏膜糜烂的发生率及食管测压各项指标差异无统计学意义(P>0.05)。24h食管MII-pH监测示a-GERD组无论酸反流、非酸反流时间百分比及次数均高于t-GERD组,差异有统计学意义(P<0.05);且前组反流以卧位、气液体混合反流多见,而后组以立位反流多见。经2周标准剂量的PPI治疗后,a-GERD组的有效率低于t-GERD组,差异有统计学意义(45.8%vs.78.8%,P<0.01);但继续2周2倍标准剂量的PPI联合促动力药治疗,两组有效率的差异无统计学意义(72.7%vs.88.0%,P<0.05)。结论与t-GERD患者相比,aGERD患者的年龄偏大,临床表现为与体位有关的上胸部症状且夜间及进餐可加重,反流更严重且混合反流多见,PPI治疗的剂量更大。
Objective To study the differences between gastroesophageal reflux disease(GERD)with atypical symptoms(a-GERD)and typical symptoms(t-GERD).Methods 30patients of suspected a-GERD were recruited and examined with upper gastrointestinal endoscopy,high-resolution manometry(HRM),24 h esophageal multichannel intra-luminal impedance monitoring with pH sensor(MII-pH)and proton pump inhibitor(PPI)trials.The results were compared with those of 33cases of GERD with typical symptoms.Results Among the 30patients of suspected GERD,24 were confirmed with a-GERD.One third of those patients were over sixty-years old,significantly higher than those with typical GERD(P<0.05).No significant differences in prevalence of esophageal mucosa breakage and esophageal manometry readings were found between the two groups(P>0.05).The a-GERD patients had higher data readings in 24hesophageal MCII-pH monitoring than the t-GERD patients(P<0.05).Supine type of GER and mixed reflux were predominately seen in the a-GERD patients,while upright type of GER was predominate seen in the t-GERD patients.The response rate of PPI in the a-GERD patients was significantly lower than that in the t-GERD patients when a course of standard dosage of PPI was given(45.8% vs.78.8%,P<0.01).But there was no significant difference in PPI response between these two groups when a second course with double standard dosage of PPI combined with pro-motility agents were given(72.7%vs.88.0%,P<0.05).Conclusion Compared with patients of t-GERD,older onset age,more severe degree of acid reflux are presented in patients of a-GERD.a-GERD should be considered when it is hard to explain the symptoms of upper part of the chest in clinical practice.24hesophageal MII-pH monitoring and/or diagnostic therapy with double standard dosage of PPI helps make a correct diagnosis.
Objective To study the differences between gastroesophageal reflux disease(GERD)with atypical symptoms(a-GERD)and typical symptoms(t-GERD).Methods 30patients of suspected a-GERD were recruited and examined with upper gastrointestinal endoscopy,high-resolution manometry(HRM),24 h esophageal multichannel intra-luminal impedance monitoring with pH sensor(MII-pH)and proton pump inhibitor(PPI)trials.The results were compared with those of 33cases of GERD with typical symptoms.Results Among the 30patients of suspected GERD,24 were confirmed with a-GERD.One third of those patients were over sixty-years old,significantly higher than those with typical GERD(P<0.05).No significant differences in prevalence of esophageal mucosa breakage and esophageal manometry readings were found between the two groups(P>0.05).The a-GERD patients had higher data readings in 24hesophageal MCII-pH monitoring than the t-GERD patients(P<0.05).Supine type of GER and mixed reflux were predominately seen in the a-GERD patients,while upright type of GER was predominate seen in the t-GERD patients.The response rate of PPI in the a-GERD patients was significantly lower than that in the t-GERD patients when a course of standard dosage of PPI was given(45.8% vs.78.8%,P<0.01).But there was no significant difference in PPI response between these two groups when a second course with double standard dosage of PPI combined with pro-motility agents were given(72.7%vs.88.0%,P<0.05).Conclusion Compared with patients of t-GERD,older onset age,more severe degree of acid reflux are presented in patients of a-GERD.a-GERD should be considered when it is hard to explain the symptoms of upper part of the chest in clinical practice.24hesophageal MII-pH monitoring and/or diagnostic therapy with double standard dosage of PPI helps make a correct diagnosis.
引文
1 Cho YS,Choi MG,Jeong JJ,et al.Prevalence and clinical spectrum of gastroesophageal reflux:apopulation-based study in Asan-si,Korea.Am J Gastroenterol,2005;100(4):747-753.
2 Wu JC,Cheung CM,Wong VW,et al.Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis.Clin Gastroenterol Hepatol,2007;5(6):690-695.
3 Frye JW,Vaezi MF.Extraesophageal GERD.Gastroenterol Clin North Am,2008;37(4):845-858.
4 张艳芬,王勇.1994-2005年我国被误诊胃食管反流病不典型症状文献分析.中国误诊学杂志,2008;8(34):8351-8352.
5 Poelmans J,Tack J.Extra-esophageal manifestations of gastroesophageal reflux.Gut,2005;54(10):1492-1499.
6 谢勇,黄德强,周小江等.以呼吸系统症状为主要表现的胃食管反流病.中国现代医学杂志,2002;12(4):37-39.
7 赖克方,陈如冲,刘春丽等.不明原因慢性咳嗽的病因分布及诊断程序的建立.中华结核和呼吸杂志,2006;29(2):96-99.
8 Amarasiri LD,Pathmeswaran A,de Silva HJ,et al.Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma.BMC Pulm Med,2010;10(15):49-56.
9 Vaezi MF,Hicks DM,Abelson TI,et al.Laryngeal signs and symptoms and gastroesophageal reflux disease(GERD):A critical assessment of cause and effect association.Clin Gastroenterol Hepatol,2003;1(5):333-344.
10 王亚峰.胃食管反流病和口腔相关疾病的研究.胃肠病学和肝病学杂志,2008;17(5):429-430.
11 Richter JE.Chest pain and gastroesophageal reflux disease.J Clin Gastroenterol,2000;30(3Suppl):S39-S41.
12 Adachi K,Fujishiro H,Katsube T,et al.Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis.J Gastroenterol Hepatol,2001;16(11):1191-1196.
13 Bresadola V,Adani GL,Londero F,et al.Non-erosive and uncomplicated erosive reflux diseases:difference in physiopathological and symptom pattern.World J Gastrointest Pathophysiol,2011;2(3):42-48.
14 Javorkova N,Varechova S,Pecova R,et al.Acidification of the oesophagus acutely increases the cough sensitivity in patients with gastro-oesophageal reflux and chronic cough.Neurogastroenterol Motil,2008;20(2):119-124.
15 Karamanolis G,Stevens W,Vos R,et al.Oesophageal tone and sensation in the transition zone between proximal striated and distal smooth muscle oesophagus.Neurogastroenterol Motil,2008;20(4):291-297.
16 Emerenziani S,Sifrim D,Habib FI,et al.Presence of gas in the refluxate enhances reflux perception in non-erosive patients with physiological acid exposure of the oesophagus.Gut,2008;57(4):443-447.
17 Lim HC,Kim JH,Youn YH,et al.Effects of the addition of mosapride to gastroesophageal reflux disease patients on proton pump inhibitor:aprospective randomized,double-blind study.J Neurogastroenterol Motil,2013;19(4):495-502.
18 Vela MF,Camacho-Lobato L,Srinivasan R,et al.Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux:effect of omeprazole.Gastroenterology,2001;120(7):1599-1606.
2 Wu JC,Cheung CM,Wong VW,et al.Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis.Clin Gastroenterol Hepatol,2007;5(6):690-695.
3 Frye JW,Vaezi MF.Extraesophageal GERD.Gastroenterol Clin North Am,2008;37(4):845-858.
4 张艳芬,王勇.1994-2005年我国被误诊胃食管反流病不典型症状文献分析.中国误诊学杂志,2008;8(34):8351-8352.
5 Poelmans J,Tack J.Extra-esophageal manifestations of gastroesophageal reflux.Gut,2005;54(10):1492-1499.
6 谢勇,黄德强,周小江等.以呼吸系统症状为主要表现的胃食管反流病.中国现代医学杂志,2002;12(4):37-39.
7 赖克方,陈如冲,刘春丽等.不明原因慢性咳嗽的病因分布及诊断程序的建立.中华结核和呼吸杂志,2006;29(2):96-99.
8 Amarasiri LD,Pathmeswaran A,de Silva HJ,et al.Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma.BMC Pulm Med,2010;10(15):49-56.
9 Vaezi MF,Hicks DM,Abelson TI,et al.Laryngeal signs and symptoms and gastroesophageal reflux disease(GERD):A critical assessment of cause and effect association.Clin Gastroenterol Hepatol,2003;1(5):333-344.
10 王亚峰.胃食管反流病和口腔相关疾病的研究.胃肠病学和肝病学杂志,2008;17(5):429-430.
11 Richter JE.Chest pain and gastroesophageal reflux disease.J Clin Gastroenterol,2000;30(3Suppl):S39-S41.
12 Adachi K,Fujishiro H,Katsube T,et al.Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis.J Gastroenterol Hepatol,2001;16(11):1191-1196.
13 Bresadola V,Adani GL,Londero F,et al.Non-erosive and uncomplicated erosive reflux diseases:difference in physiopathological and symptom pattern.World J Gastrointest Pathophysiol,2011;2(3):42-48.
14 Javorkova N,Varechova S,Pecova R,et al.Acidification of the oesophagus acutely increases the cough sensitivity in patients with gastro-oesophageal reflux and chronic cough.Neurogastroenterol Motil,2008;20(2):119-124.
15 Karamanolis G,Stevens W,Vos R,et al.Oesophageal tone and sensation in the transition zone between proximal striated and distal smooth muscle oesophagus.Neurogastroenterol Motil,2008;20(4):291-297.
16 Emerenziani S,Sifrim D,Habib FI,et al.Presence of gas in the refluxate enhances reflux perception in non-erosive patients with physiological acid exposure of the oesophagus.Gut,2008;57(4):443-447.
17 Lim HC,Kim JH,Youn YH,et al.Effects of the addition of mosapride to gastroesophageal reflux disease patients on proton pump inhibitor:aprospective randomized,double-blind study.J Neurogastroenterol Motil,2013;19(4):495-502.
18 Vela MF,Camacho-Lobato L,Srinivasan R,et al.Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux:effect of omeprazole.Gastroenterology,2001;120(7):1599-1606.