难治性胃食管反流病患者原因分析  

作　　者：赵珂佳 李蒙[2] 金超琼 吕宾[2] 

机构地区：[1]浙江医院,310013 [2]浙江中医药大学附属第一医院,310006

出　　处：《浙江临床医学》2022年第9期1326-1328,共3页Zhejiang Clinical Medical Journal

摘　　要：目的质子泵抑制剂(PPI)是胃食管反流病(GERD)治疗的一线药物,但部分患者对PPI反应不佳,分析其相关原因.方法回顾性分析2013年1月至2018年1月经PPI治疗至少8周反酸、烧心等症状持续的75例患者的临床资料.结果75例患者中18例同时合并功能性消化不良(FD).44例在食管多通道腔内阻抗-pH(MII-pH)监测中出现症状,症状与反流无关(SAP-)15例,症状与反流相关(SAP+)29例,其中症状与酸、弱酸、非酸反流相关分别占58.6%,31.0%,10.3%.根据MII-pH及症状问卷结果,24例最终诊断为GERD,11例为食管高敏感,9例为功能性胃灼热(FH).高分辨食管测压(HRM)显示,5例患者有严重动力障碍,其中2例为贲门失弛缓症,3例分别为结缔组织疾病,远端食管痉挛,高压收缩食管.结论PPI抵抗患者,其病因除了残余酸、弱酸、非酸反流、食管高敏感等反流相关因素外,还可能有其他非反流相关因素.Objective To analyze the phenomenon and related reasons why partial patients which manifested as gastroesophageal reflux disease(GERD)symptom show adverse reaction to proton pump inhibitor(PPI).Methods A retrospective analysis of 75 clinical data has been conducted.These patients had persistent symptoms such as acid reflux and heartburn,and took PPI treatment for at least 8 weeks which from January 2013 to January 2018.Results Totally seventy-five patients organized,18 patients manifested as FD.And there were forty-four patients appeared certain symptoms,but ffeen of them(34.1%)manifest non-related symptoms to reflux(SAP-).Twenty-nine(65.9%)patients showed relative symptom to reflux(SAP+),including 58.6%symptoms are related to acid reflux,31%are related to weakly acid reflux and 10.3%are related to non-acid reflux.Based on MII-pH test and symptom questionnaires,eventually 24 patients(54.5%)were diagnosed as GERD,11 patients(25%)were diagnosed as Esophageal hypersensitivity,9 patients(20.5%)were diagnosed as FH.Based on HRM test,there were five patients out of seventy-five patients(6.7%)have serious motor disorder,inside these five patients,two patients contracted Cardiac retardation,the rest three separately had connective tssue disease,distal esophageal spasm and jackhammer esophagus.ConclusionThe pathogenesis of most GERD patients which resisted PPI treatment is not only include reflux-relative elements such as residual acid,weakly acid,non-acid and esophageal hypersensitivity,but also potentially include other non-related elements to reflux.

关 键 词：难治性 胃食管反流病 质子泵抑制剂 多通道腔内阻抗-pH监测 高分辨食管测压 

分 类 号：R57[医药卫生—消化系统]