以咽异物感为主诉疑诊胃食管反流病的46例患者的临床特点和诊断  

Clinical characteristics and diagnosis of 46 patients with suspected gastroesophageal reflux disease with globus pharyngeus as chief complaint

作　　者：李文燕[1] 孟凡冬[1] 王媛[1] 张澍田[1] LI Wen-yan;MENG Fan-dong;WANG Yuan(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化科,北京100050

出　　处：《临床和实验医学杂志》2021年第16期1790-1792,F0003,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的分析以咽异物感为主诉疑诊胃食管反流病(GERD)患者的临床资料,探讨这类患者的临床特点。方法回顾性选取2018年10月至2019年10月于首都医科大学附属北京友谊医院就诊、主诉咽异物感、需要与GERD鉴别的46例患者的临床症状、食管pH阻抗监测、食管测压、胃镜检查等资料。根据症状分为3组:单一咽异物感症状组、伴有GERD食管症状组、伴有其他症状组;比较胃镜、pH阻抗监测、食管压力测定结果;比较阻抗正常与异常组食管测压参数的差异。结果 46例患者临床症状仅存在咽异物感11例,伴有轻度反酸烧心反流症状15例,6例伴有胸痛,其他伴随症状为:嗳气、咳嗽、声嘶等;根据症状分3组,仅有咽异物感症状组11例;伴有GERD食管症状组21例(伴有轻度反酸烧心反流15例,伴有胸痛6例);伴有其他症状组14例(嗳气、咳嗽、声嘶等)。食管pH阻抗监测病理性反流19例(41.3%),其中酸反流11例、弱酸反流7例、非酸反流1例,近端反流40例;胃镜检查:反流性食管炎10例;pH阻抗监测或胃镜检查胃食管反流25例;3组症状组间病理性反流发生率、胃镜下反流性食管炎诊断率无差异。食管测压:上食管括约肌(UES)静息压减低6例、下食管括约肌(LES)静息压减低26例、食管裂孔疝8例、无效食管动力13例、测压2项以上异常14例;胃镜检查:反流性食管炎10例。根据伴随症状分组,组间pH阻抗监测和胃镜检查异常率无显著差异,食管pH阻抗异常组(19例)与正常组(27例)比较,食管测压参数存在2项以上异常者增多(P<0.05)。结论以咽异物感为主诉的患者,无典型GERD症状时,食管pH阻抗监测、食管测压参数2项以上异常、胃镜检查对诊断有意义。Objective The clinical data of patients with suspected gastroesophageal reflux disease(GERD) with globus pharyngeus as chief complaint were analyzed to explore the clinical characteristics and diagnosis of these patients. Methods The clinical symptoms,pH impedance monitoring,esophageal manometry,gastroscopy and other data of the 46 patients who visited Beijing FriendshipHospital,Capital Medical University from October 2018 to October 2019,complaining of globus pharyngeus,and needing to differentiate from GERD were reviewed. According to the grouping of symptoms,they were divided into single pharyngeal foreign body sensation symptom group,GERD esophageal symptom group,and other symptom group. The results of gastroscopy,pH impedance monitoring,and esophageal pressure measurement were compared.The difference of esophageal pressure measurement parameters between normal and abnormal impedance groups was compared. Results The 46 patients were divided into three groups according to clinical symptoms,group one: 11 patients had a single globus pharyngeus,group two: 21 patients accompany with GRED symptom(15 patients concomitant mild acid reflux,6 patients concomitant chest pain);group three: 14 patients with other symtom(belching,cough,hoarseness,etc). The pH-impedance monitoring result present 19 total pathological reflux cases(41. 3%),among which acid reflux was detected in 11 cases(57. 9%),Weak acid reflux 7 cases(36. 8%),non acid reflux 1 case(5. 3%). proximal reflux 40 cases. Besides,ten patients had light reflux esophagitis by gastroscop,and 25 patients contained either pH impedance monitoring or reflux esophagitis,accorfing to the gastroscopy. There was no difference between the pathology reflux incident rate and light reflux esophagitis rate under the gastroscopy among the three symptom groups. Also,the Esophageal manometry revealed six cases of Upper Esophageal Sphincter(UES) resting pressure decreasing,twenty-six cases of Low Esophageal Sphincter(LES) resting pressure decreasing,eight of hiatus hernia and 13 ine

关 键 词：咽异物感 胃食管反流病 食管pH阻抗监测 食管测压 

分 类 号：R571[医药卫生—消化系统]