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中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 32 -35. doi: 10.3877/cma.j.issn.1674-392X.2019.01.009

所属专题： 文献；

论著

胃食管反流病患者伴有或不伴有食管黏膜损伤与食管上、下括约肌压力相关性研究
王健1, 史以超1, 赵会君1, 王潇潇1, 彭丽华1, 杨云生1,†()   
  1. 1. 100853　北京，解放军总医院消化科
  • 收稿日期:2018-05-12 出版日期:2019-02-18
  • 通信作者: 杨云生

Correlation study between upper/lower esophageal sphincter pressure and gastroesophageal reflux disease with or without esophageal mucosal injury

Jian Wang1, Yichao Shi1, Huijun Zhao1, Xiaoxiao Wang1, Lihua Peng1, Yunsheng Yang1,†()   

  1. 1. Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2018-05-12 Published:2019-02-18
  • Corresponding author: Yunsheng Yang
  • About author:
    Corresponding author: Yang Yunsheng, Email:
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王健, 史以超, 赵会君, 王潇潇, 彭丽华, 杨云生. 胃食管反流病患者伴有或不伴有食管黏膜损伤与食管上、下括约肌压力相关性研究[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(01): 32-35.

Jian Wang, Yichao Shi, Huijun Zhao, Xiaoxiao Wang, Lihua Peng, Yunsheng Yang. Correlation study between upper/lower esophageal sphincter pressure and gastroesophageal reflux disease with or without esophageal mucosal injury[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(01): 32-35.

目的

研究伴或不伴食管黏膜损伤的胃食管反流病（gastroesophageal reflux disease，GERD）患者在食管动力方面的差异。

方法

回顾性分析2015年1月至2017年12月，解放军总医院就诊的有反酸、烧心、胸痛等症状的患者，24 h食管pH监测Demeester积分≥14.72分，根据内镜检查结果分为糜烂性反流病（ERD）组和非糜烂性反流病（NERD）组，比较2组患者食管动力学指标的变化。

结果

NERD组与ERD组UESP平均值数值相似，差异无统计学意义（P=0.168）。其余指标UESRP平均值、LESP最小值、LESP平均值、LESRP平均值、LESRP最大值、DCI中NERD组均高于ERD组，差异均有统计学意义（P<0.001）。NERD组平均年龄明显小于ERD组，差异有统计学意义（P<0.000 1）。NERD组患者身高较ERD组偏低，体重较轻，身体质量指数（body mass index，BMI）也较小，差异有统计学意义（P<0.000 1）。

结论

随着年龄的增大或BMI的增加，可能增加GERD患者食管黏膜损伤的风险。此外，糜烂性反流病患者较非糜烂性反流病的上、下食管括约肌动力障碍更严重。

关键词: 胃食管反流, 食管上括约肌, 食管下括约肌, 高分辨率食管测压
Objective

To study esophageal motility differences with or without esophageal mucosa injury in gastroesophageal reflux disease (GERD).

Methods

A retrospective analysis of patients with symptoms such as acid reflux, heartburn, chest pain and other symptoms was performed in the PLA General Hospital from January 2015 to December 2017. The 24-hour esophageal pH monitoring had a Demeester score ≥14.72 points. The erosive esophagus was classified according to endoscopic findings. In the erosive reflux disease (ERD) group and non-erosive reflux disease (NERD) group, changes in esophageal kinetic parameters were compared between the two groups.

Results

The average value of UESP in NERD group and ERD group was similar, with no significant difference (P=0.168). The UESRP, LESP, LESP, LESRP, LESRP and DCI were higher in NERD group than those in ERD group (P<0.001). The average age of NERD group was significantly lower than ERD group (P<0.000 1), with statistical significance. The height of NERD group was lower than ERD group, and the body weight and the BMI were both smaller in NERD group. The data of three groups were statistically significant.

Conclusion

With age growing and BMI increasing, the severity of GERD may be worse. In addition, the upper and lower esophageal sphincter dysfunction in patients with ERD are more critical than NERD.

Key words: Gastroesophageal reflux disease, Upper esophageal sphincter, Lower esophageal sphincter, High-resolution esophageal manometry
表2 NERD组与ERD组食管括约肌压力指标比较（±s）
组别 例数 UESP平均值(mmHg) UESRP平均值(mmHg) LESP最小值(mmHg) LESP平均值(mmHg) LESRP平均值(mmHg) LESRP最大值(mmHg) DCI(mmHg/s·cm)
NERD组 254 63.88±2.10 12.67±0.46 11.31±0.41 16.27±0.47 7.99±0.26 10.31±0.32 1 029.24±58.174
ERD组 124 58.77±3.04 9.91±0.66 7.69±0.60 11.81±0.68 6.22±0.38 8.16±0.47 731.87±88.262
P值 ? 0.168 0.000 7 <0.000 1 <0.000 1 0.000 2 0.000 2 0.005 2
表3 ERD组不同分级间的比较（±s）
洛杉矶分级 例数 UESP平均值(mmHg) UESRP平均值(mmHg) LESP最小值(mmHg) LESP平均值(mmHg) LESRP平均值(mmHg) LESRP最大值(mmHg) DCI(mmHg/s·cm)
LA-A 56 58.16±4.17 10.30±0.92 9.28±0.70 13.42±0.84 6.87±0.46 8.92±0.54 833.42±113.79
LA-B 43 56.54±4.17 10.43±0.92 6.47±0.70 10.57±0.84 5.57±0.46 7.47±0.54 654.94±119.34
LA-C 11 61.08±8.54 10.19±1.88 6.28±1.44 9.98±1.73 6.40±0.94 8.10±1.11 273.76±266.86
LA-D 10 61.74±8.95 9.88±1.97 6.49±1.52 10.18±1.81 5.07±0.98 6.70±1.16 447.15±285.29
P值 ? 0.934 0.995 0.026 0.060 0.161 0.177 0.192
[1]
Fock KM, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux diseaseand Barrett's oesophagus[J]. Gut 2016, 65(9): 1402-1415.
[2]
Eggleston A, Katelaris PH, Nandurkar S, et al. Clinical trial: the treatment of gastro-oesophageal reflux disease inprimary care-prospective randomized comparison of rabeprazole 20 mg with esomeprazole 20 and 40 mg[J]. Aliment Pharmacol Ther, 2009, 29(9): 967-978.
[3]
Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review[J]. Gut, 2015, 54(5): 710-717.
[4]
史燕妹, 赵公芳, 黄华胃. 食管反流病的发病机制及其诊治的进展[J]. 世界华人消化杂志, 2012, 20(35): 3713-3718.
[5]
孙晓红, 柯美云, 王智凤, 等. 非糜烂性胃食管反流病和反流性食管炎的食管动力特点[J]. 中华医学杂志, 2014, 94(22): 1718-1721.
[6]
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classifcation of Esophageal Motility Disorders, v3. 0[J]. Neurogastroenterol Motil, 2015, 7(2): 160-174.
[7]
孙晓红, 柯美云, 王智凤, 等. 非糜烂性胃食管反流病和反流性食管炎的食管动力特点[J]. 中华医学杂志, 2014, 94(22): 1718-1721.
[8]
Ho SC, Chang CS, Wu CY, et al. Ineffective esophageal motility is a primary motility disorder in gastrophaageal reflux[J]. Dig Dis Sci, 2002, 47(3): 652-656.
[9]
Katz PO, Gerson LB, vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2013, 108(3): 308-328.
[10]
郑松柏, 项平, 徐富星, 等. 老年人反流性食管炎1119例分析[J]. 中华老年医学杂志, 2005, 24(8): 574-576.
[11]
李兆申, 王雯, 许国铭, 等. 反流性食管炎1827例临床分析[J]. 中华内科杂志, 2001, 40(1): 9-12.
[12]
高建萍, 王虹, 顾清, 等 胃食管反流病患者的临床分析[J]. 中华消化杂志, 2006, 26(5): 350-351.
[13]
郝坤艳, 林琳, 李学良, 等. 老年胃食管反流病患者临床特征分析[J]. 中华消化杂志, 2010, 30(6): 382-385.
[14]
Pilotto A, Franceschi M, Leandro G, ’et al. Clinical features of reflux esophagitis in older people: a study of 840 consecutive patients[J]. Am Geriatr Soc, 2006, 54(10): 1537-1542.
[15]
Richter JE. Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications[J]. Am J Gastroenterol, 2000, 95(2): 368-373.
[16]
Ou J L, Tu C C, Hus P I, et al. Prevalence and risk factors of erosive esophagitis in Taiwan[J]. J Chin Med Assoc, 2012, 75(2): 60-64.
[17]
Aro P, Ronkainen J, Talley N J, et al. Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study[J]. Gut, 2005, 54(10): 1377-1383
[18]
Nilsson M, Lundegardh G, Carling L, et al. Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study[J]. Scand J Gastroenterol, 2002, 37(6): 626-630.
[19]
Corley D A, Kubo A, Zhao W. Abdominal obesity, ethnicity and gatro-oesophageal reflux symptoms[J]. Gut, 2007, 56(7): 756-762.
[20]
Luo Z, Luo J, Liu E, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2014, 49(4): 377-380.
[21]
Chavez YH, Ciarleglio MM, Clarke JO, et al. Upper esophageal sphincter abnormalities frequent finding on high-resolution esophageal manometry and associated with poorer treatment response in achalasia[J]. J Clin Gastroenterol, 2015, 49(1): 17-23.
[22]
Shaker R, Babaei A, Naini SR. Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier[J]. Laryngoscope, 2014, 124(10): 2268-2274.
[23]
Fulp SR, Dalton CB, Castell JA, et al. Aging-related alterations in human upper esophageal sphincter function[J]. Am J Gastroenterol, 1990, 85(12): 1569-1572.
[24]
马欣, 彭丽华, 王潇潇, 等. 上食管括约肌异常与食管动力障碍疾病的相关性[J]. 解放军医学院学报, 2016, 37(8): 833-836.
[25]
陈帝, 王慧, 张玲, 等. 高分辨率食管测压下胃食管反流病吞咽延迟时间与食管动力的相关性研究[J]. 中华消化内镜杂志, 2014, 31(6): 304-307.
[26]
Pandolfino JE, Roman S. High-resolution manometry: an atlas of esophageal motility disorders and findings of GERD using esophageal pressure topography[J]. Thorac Surg Clin, 2011, 21(4): 465-475.
[27]
Xenos E S. The role of esophageal motility and hiatal hernia in esophageal exposure to acid[J]. Surg Endosc, 2002, 16(6): 914-920.
[28]
史伟东, 苏秉忠. 无效食管动力对胃食管反流病食管外并发症发病机制及临床意义[J]. 中华消化杂志, 2012, 32(10): 674-678.
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