Kim M J, Kwon K H, Lee S W
Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
Adv Perit Dial. 1998;14:98-101.
Upper gastrointestinal (GI) symptoms are frequently observed in continuous ambulatory peritoneal dialysis (CAPD) patients. We conducted esophageal manometry and 24-hour esophageal pH monitoring in 4 CAPD patients (Group I) who had upper GI symptoms such as nausea and vomiting and compared them with 9 patients (Group II) who did not. The mean age in Group I was 48.5 +/- 13.7 years, and the male-to-female ratio was 1:3. One patient was diabetic. There were no significant differences in clinical and biochemical data between the two groups. Comparing the results of esophageal manometry, supine lower esophageal sphincter pressure (LESP) at 2000 mL of infused dialysate was significantly lower in Group I than in Group II (23.2 +/- 4.4 vs 31.2 7.1 mmHg, P < 0.05), but supine LESPs at empty state and sitting LESPs were not different. Group I had a significantly higher total number of reflux episodes (89.0 +/- 16.5 vs 26.5 +/- 19.4, P < 0.05), number of reflux episodes longer than 5 minutes (2.3 +/- 2.6 vs 0.3 +/- 0.5, P < 0.05), total time of pH < 4.0 (75.5 +/- 55.5 vs 11.0 +/- 6.8, P < 0.05), and total reflux score (19.7 +/- 10.2 vs 4.2 +/- 2.3, P < 0.05) in 24-hour esophageal pH monitoring. Three of 4 Group I patients met the criteria for abnormal gastroesophageal reflux set by the DeMeester scoring system. CAPD patients with upper GI symptoms such as nausea, vomiting, and epigastric discomfort should be evaluated for gastroesophageal reflux disease with esophageal manometry and pH monitoring.
上消化道（GI）症状在持续性非卧床腹膜透析（CAPD）患者中很常见。我们对4例有恶心、呕吐等上消化道症状的CAPD患者（第一组）进行了食管测压和24小时食管pH监测，并与9例无此类症状的患者（第二组）进行了比较。第一组的平均年龄为48.5±13.7岁，男女比例为1:3。1例患者患有糖尿病。两组在临床和生化数据方面无显著差异。比较食管测压结果，第一组在注入2000 mL透析液时仰卧位下食管括约肌压力（LESP）显著低于第二组（23.2±4.4对31.2±7.1 mmHg，P<0.05），但空腹状态下的仰卧位LESP和坐位LESP无差异。第一组在24小时食管pH监测中的反流发作总数（89.0±16.5对26.5±19.4，P<0.05）、反流发作持续超过5分钟的次数（2.3±2.6对0.3±0.5，P<0.05）、pH<4.0的总时间（75.5±55.5对11.0±6.8，P<0.05）以及总反流评分（19.7±10.2对4.2±2.3，P<0.05）均显著更高。第一组4例患者中有3例符合DeMeester评分系统设定的胃食管反流异常标准。对于有恶心、呕吐和上腹部不适等上消化道症状的CAPD患者，应通过食管测压和pH监测评估胃食管反流病。
