Hollenz M, Stolte M, Labenz J
Allgemeinärztliche Praxis, Rödental, Germany.
Dtsch Med Wochenschr. 2002 May 10;127(19):1007-12. doi: 10.1055/s-2002-28325.
While there is an ever rising prevalence of gastro-oesophageal reflux disease among people in the western world, the actual number are usually underestimated, because many afflicted persons do not seek medical care. This study was undertaken to determine the frequency of unrecognized reflux disease among an unselected patient cohort in general practice. In addition, answers by these patients to a questionnaire were evaluated.
162 consecutive patients of a general practice without known gastro-oesophageal reflux took part. After the questionnaire had been filled in a history was obtained with semi-quantitative grading of dyspeptic symptoms, and all underwent a physical examination. A gastroscopy was offered to all patients. Gastro-oesophageal reflux was diagnosed when endoscopy revealed typical oesophageal lesions and/or there were at least moderately severe reflux symptoms that had reduced the patient's quality of life.
82 patients (51%) had reflux disease. 121 patients underwent endoscopy. Structural changes (reflux oesophagitis, Barrett metaplasia) were seen in 28 of the 82 patients with reflux disease (34%), 17% of the entire cohort. Axial hiatus hernia, positive family history, advancing age, over-weight, female gender and treatment with NSAIDs or aspirin were significant risk factors in the development of reflux disease. Patients with reflux disease significantly more frequently suffered from hoarseness and/or cough. Positive or negative predictability of the questionnaire regarding the diagnosis of reflux disease was 94% each way.
The prevalence of unrecognized gastro-oesophageal reflux disease in the population is extraordinarily high. One quarter to one third of those with reflux disease have cough or hoarseness. The disease can apparently be reliably diagnosed by a standardized questionnaire.
在西方世界，胃食管反流病的患病率不断上升，但实际患病人数通常被低估，因为许多患者未寻求医疗护理。本研究旨在确定普通诊所中未经过挑选的患者队列中未被识别的反流病的发生率。此外，还对这些患者对一份问卷的回答进行了评估。
162名连续就诊于普通诊所且无已知胃食管反流病的患者参与了研究。在填写问卷后，获取了消化不良症状的半定量分级病史，并对所有患者进行了体格检查。所有患者均接受了胃镜检查。当内镜检查发现典型的食管病变和/或存在至少中度严重的反流症状且已降低患者生活质量时，诊断为胃食管反流。
82名患者（51%）患有反流病。121名患者接受了内镜检查。在82名反流病患者中的28名（34%）可见结构改变（反流性食管炎、巴雷特化生），占整个队列的17%。轴向裂孔疝、家族史阳性、年龄增长、超重、女性以及使用非甾体抗炎药或阿司匹林治疗是反流病发生的显著危险因素。反流病患者出现声音嘶哑和/或咳嗽的频率明显更高。问卷对反流病诊断的阳性或阴性预测率均为94%。
人群中未被识别的胃食管反流病的患病率极高。四分之一至三分之一的反流病患者有咳嗽或声音嘶哑。显然，通过标准化问卷可以可靠地诊断该病。
