胃食管反流病食管外表现的临床研究  

A study of extraesophageal presentations in gastroesophageal reflux disease

作　　者：李兆申[1] 徐晓蓉[1] 邹多武[1] 谢渭芬[2] 于晓峰[3] 陈锡美[4] 林勇[2] 夏俊[3] 朱风尚[4] 温武[5] 苏暾[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]第二军医大学长征医院消化内科 [3]上海华东医院消化内科 [4]上海同济医院消化内科 [5]第二军医大学长海医院耳鼻喉科,上海200433

出　　处：《中华内科杂志》2006年第1期13-16,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨胃食管反流病(GERD)食管外表现(EED)的临床特征和质子泵抑制剂对EED的治疗效果。方法本研究为多中心、开放、前瞻性临床研究,在上海市的4家医院同期入选GERD患者,均符合内镜下有反流性食管炎(RE)的诊断标准,无RE者则为24 H食管PH监测阳性的非糜烂性反流病(NERD)。进行GERD典型症状和EED相关症状的问卷调查并记录积分,有EED症状者行电子喉镜检查并记录有关征象,然后对上述资料进行统计、比较分析。结果共分析200例符合标准的GERD患者,伴有EED者95例,无EED者105例;NERD患者66例,RE 134例,其中65例为具有EED的RE患者。EED的症状最常见的为咽球感和(或)咽部异物感,发生率为27%,其他常见的依次为咳嗽、咽喉灼痛、声音嘶哑,哮喘较少,其发生率分别为21%、16%、11%、3%。有EED的患者中并存典型GERD症状的发生率为56%,EED症状的严重程度在RE和NERD患者间差异无统计学意义。喉镜检查示声带红斑、水肿32%,杓区红肿25%,咽后壁淋巴增生20%,未见明显异常的42%。95%的EED患者治疗8周后症状基本消失。结论较大比例的GERD患者中有EED存在,而喉镜、常规24 H PH监测对诊断的阳性预测值不高,高剂量质子泵抑制剂对EED的治疗有效。Objective The aim of this prospective multi-center study was to evaluate the clinical characteristics of extraesophageal reflux disorders （EED） in gastroesophageal reflux disease （GERD） patients and the therapeutic effect of proton pump inhibitor （PPI） on EED. Methods We investigated GERD patients in 4 hospitals in Shanghai in a same time period. These patients were diagnosed as GERD by finding reflux esophagitis （ RE ） on endoscopy or with abnormal reflux during 24 h esophageal pH monitoring. Typical GERD symptoms and EED symptoms were evaluated by questionnaire. Patients with EED symptoms underwent videolaryngoscopy and abnormalities were recorded. Results Totally 200 subjects were enrolled in this study. Among them 95 patients complained of EED. The RE cases were 134 in number and EED occurred in 65 of the RE patients . The commonest presenting symptom of EED was globus or foreign body feeling in the throat （27%）, followed by cough,soar throat and hoarseness. Asthma was a rare symptom, the occurrence being 21%, 16%, 11% and 3 % respectively. The rate of typical GERD symptoms existing in EED group was 56%. The severity of EED symptoms showed no significant difference between RE and NERD patients. Abnormalities were found in 58% of subjects with EED on laryngoscopy, the occurrence of arytenoids medial wall erythema/edema was 25%, vocal cord erythema/edema was 32%, posterior pharyngeal wall cobble stoning was 20%, and 42% of the patients showed no abnormalities on laryngoscopy. Higher dosage PPI therapy showed effects on the relief of EED, and the relief rate was 95% after 8 weeks of treatment. Conclusions Our results suggest that a significant part of GERD patients suffered from EED, and value of laryngoscopy and 24 h pH monitoring is limited for the diagnosis of EED. Higher dosage of PPI was effective for the treatment of EED.

关 键 词：胃食管反流 食管炎 消化性 食管外表现 

分 类 号：R571[医药卫生—消化系统]