Romagnoli R, Collard J M, Bechi P, Salizzoni M
Department of Surgery, Louvain Medical School, Brussels, Belgium.
Surgery. 1999 May;125(5):480-6.
The role of excessive duodenogastric reflux (DRG) in the genesis of gastric symptoms in patients primarily referred for both gastroesophageal reflux (GER) symptoms and esophagitis is poorly understood.
The study is based on the clinical, endoscopic, histologic, and 24-hour gastric data from the Bilitec optoelectronic device (Prodotec, Florence, Italy, licensed by Synectics Medical, Stockholm, Sweden) from 49 patients having both typical GER symptoms and gastric symptoms suggestive of excessive DGR (i.e., epigastric pain, nausea, or bilious vomiting) in the absence of previous esophageal or gastric surgery (group 1). Helicobacter pylori organisms were searched for on antral biopsy specimens with use of the Giemsa method. The percentages of total, upright, and supine time during which absorbance exceeded various thresholds through all the working range of the Bilitec device were calculated. Bilitec data from group 1 were compared with those from 16 patients with endoscopic esophagitis and GER symptoms only (group 2) and 25 healthy subjects (group 3).
The prevalence of an abnormal Bilitec test result in group 1 increased from 27% (13/49) at the 0.25 absorbance threshold to 36% (18/49) at thresholds ranging from 0.40 to 0.60 and to 41% (20/49) when multiple thresholds ranging from 0.25 to 0.60 were considered. In group 2 one patient had an abnormal Bilitec test result at the 0.25 to 0.30 threshold, whereas the other 15 patients had a normal test result. H pylori antral infection was present in 14 group 1 patients. None of these had an abnormal Bilitec test result, whereas the test was positive in 40% of the H pylori-negative patients without endoscopic gastritis and in 70% of H pylori-negative patients with endoscopic gastritis (P = .001).
Twenty-four-hour intragastric bile monitoring provides the clinician with unequivocal evidence of excessive DGR in 41% of patients with an intact stomach having endoscopic esophagitis, GER symptoms, and gastric symptoms suggestive of DGR. The most dependable data are obtained when absorbance thresholds higher than 0.40 are considered. H pylori antral infection and excessive DGR at 24-hour intragastric bile monitoring are mutually exclusive.
在主要因胃食管反流（GER）症状和食管炎而就诊的患者中，十二指肠-胃反流过度（DRG）在胃部症状发生过程中的作用尚未得到充分了解。
本研究基于49例患者的临床、内镜、组织学及24小时胃内数据，这些数据由Bilitec光电设备（意大利佛罗伦萨的Prodotec公司生产，由瑞典斯德哥尔摩的Synectics Medical公司授权）采集。这些患者既有典型的GER症状，又有提示DRG过度的胃部症状（即上腹部疼痛、恶心或胆汁性呕吐），且此前未接受过食管或胃部手术（第1组）。采用吉姆萨染色法在胃窦活检标本中检测幽门螺杆菌。计算在Bilitec设备的所有工作范围内，吸光度超过不同阈值时的总时间、直立位时间和仰卧位时间的百分比。将第1组的Bilitec数据与16例仅患有内镜下食管炎和GER症状的患者（第2组）以及25名健康受试者（第3组）的数据进行比较。
第1组中，Bilitec检测结果异常的发生率从吸光度阈值为0.25时的27%（13/49），增加到阈值在0.40至0.60之间时的36%（18/49），当考虑0.25至0.60的多个阈值时增加到41%（20/49）。在第2组中，1例患者在0.25至0.30阈值时有异常的Bilitec检测结果，而其他15例患者检测结果正常。第1组中有14例患者存在胃窦幽门螺杆菌感染。这些患者中没有一例Bilitec检测结果异常，而在无内镜下胃炎的幽门螺杆菌阴性患者中，40%检测呈阳性，在有内镜下胃炎的幽门螺杆菌阴性患者中，70%检测呈阳性（P = 0.001）。
24小时胃内胆汁监测为临床医生提供了明确证据，表明在41%的患有内镜下食管炎、GER症状且有提示DRG的胃部症状的未接受过胃部手术的患者中存在DRG过度。当考虑高于0.40的吸光度阈值时可获得最可靠的数据。胃窦幽门螺杆菌感染与24小时胃内胆汁监测时DRG过度相互排斥。
