摘要
目的 研究分析部分GERD经临床常规抑酸治疗失败的原因 ,为临床处理难治性GERD提供理论依据。方法 16例难治性GERD患者 (R组 )及 16例初诊为GERD的患者 (P组 ) ,行内镜及病理组织学检查 ,14 C呼气试验检测HP ,以便携式PH及胆反流监测仪 2 4小时同步监测食管下端PH及胆反流情况。结果 R组与P组间食管炎严重程度差异有显著性 ;胃内Hp检出率R组显著低于P组 ;2 4小时PH及胆反流监测结果显示 ;R组食管酸暴露时间与P组比较差异无显著性 ,而胆红素吸收值≥ 0 .14的总时间百分比R组较P组显著升高 ,R组混合反流、单纯胆反流与P组差异有显著性 ;R组反流事件以夜间明显。结论 1 GERD合并严重食管炎 ,尤其是Barrett食管及出现并发症是GERD治疗困难的原因。 2 难治性GERD存在严重DGER ,混合反流加重食管损伤 ,而单纯胆反流及夜间反流可能造成晨起时服用PPI治疗失败。 3 HP感染及酸反流可能不是GERD治疗失败的直接原因。 4 少数GERD患者症状控制失败 ,但PH及胆反流监测结果正常 ,必须对疾病重新作出诊断。
Aim To study the causes of management failure of refractory GERD patients.Methods Sixteen refractory GERD patients (R group) and 16 cases of GERD diagnosed primarily (P group) were studied.Endoscopy,pathologic examination and 14 C respiratory test were undergone in every patients.Twenty four hour ambulatory acid and bilirubin measurements on the lower part of esophagus were obtained with synectics Bilitec 2000 and Digitrapper Mk Ⅲ.Results The esophagitis in group R was more severe than that in group P.The positive rate of HP in group R was significantly lower than that in group P.The percentage time of esophageal acid exposure(pH<4) was not longer while the rate of bile reflux represented by total percentage time of bilirubin absorbance≥0.14 was higher in group R compared with that in group P.The mixed reflux and bile reflux between the two groups had significant differences.Most DGER episodes occurred in an environment of PH<4.The reflux episodes in group R happened mainly during night.Conclusions 1.Severe esophagitis,especially in Barrett's esophagus with complications makes it difficult to control GERD.2.There are severe DGER in patients with refractory GERD.Mixed reflux aggravates the injury of esophagus.Bile reflux and reflux during night may cause failure of curing with PPI on the morning.3.HP infection and acid reflux may not be the direct causes of refractoriness.4.Individual refractory GERD patient without abnormal detective results on PH or bile reflux should be diagnosed again.
出处
《胃肠病学和肝病学杂志》
CAS
2002年第4期358-360,共3页
Chinese Journal of Gastroenterology and Hepatology
