非典型症状与典型症状胃食管反流病患者临床特点比较  

Comparison of Clinical Features Between Gastroesophageal Reflux Diseases with Atypical and Typical Symptoms

作　　者：门若庭[1] 易智慧[1] 杨正兵[1] 肖琴[1] 杨丽[1] 

机构地区：[1]四川大学华西医院消化内科,成都610041

出　　处：《四川大学学报（医学版）》2014年第3期484-488,共5页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅项目(No.2013FZ0085;No.2009FZ0097);成都市科技局项目(No.13PPYB994SF-014)资助

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 30 patients 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 33 cases of GERD with typical symptoms. Results Among the 30 patients 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 24 h esophageal 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. 24 h esophageal MII-pH monitoring and/or diagnostic therapy with double standard dosage of PPI helps make a correct diagnosis.

关 键 词：胃食管反流病 非典型症状 24 h食管MCII—pH监测PPI治疗试验 

分 类 号：R571[医药卫生—消化系统]