Cicala M, Emerenziani S, Caviglia R, Guarino M P L, Vavassori P, Ribolsi M, Carotti S, Petitti T, Pallone F
Department of Digestive Disease, University Campus Bio Medico, Rome, Italy.
Aliment Pharmacol Ther. 2003 Sep 15;18(6):605-13. doi: 10.1046/j.1365-2036.2003.01702.x.
The majority of patients with gastro-oesophageal reflux disease do not present with erosive oesophagitis and make up a heterogeneous group. Patients with non-erosive gastro-oesophageal reflux disease are less responsive than patients with oesophagitis to acid-suppressive therapy.
To assess the role of acid reflux in gastro-oesophageal reflux disease symptoms.
The spatio-temporal characteristics of reflux events were analysed and related to reflux perception in 45 patients with non-erosive gastro-oesophageal reflux disease and 20 patients with erosive oesophagitis.
Compared with healthy controls, all patients showed a higher intra-oesophageal proximal spread of acid, which was prominent in patients with non-erosive gastro-oesophageal reflux disease (> 50% of events lasting for 1-2 min). Irrespective of mucosal injury, the risk of reflux perception was very high when acid reached proximal sensors (odds ratio, 7.6; 95% confidence interval, 4.6-12.5), being maximal in patients with non-erosive gastro-oesophageal reflux disease with normal acid exposure time (odds ratio, 11; 95% confidence interval, 5.2-22.3).
Patients with non-erosive gastro-oesophageal reflux disease are characterized by a significantly higher proportion of proximal acid refluxes and a higher sensitivity to short-lasting refluxes when compared with patients with oesophagitis. The highest proximal acid exposure and highest perception occurred in patients with non-erosive gastro-oesophageal reflux disease presenting with a normal pH-metric profile. The assessment of acid distribution and its perception in the oesophageal body can better identify reflux patients who should benefit from acid-suppressive treatment.
大多数胃食管反流病患者并无糜烂性食管炎，且构成一个异质性群体。非糜烂性胃食管反流病患者对抑酸治疗的反应不如食管炎患者。
评估胃酸反流在胃食管反流病症状中的作用。
分析了45例非糜烂性胃食管反流病患者和20例糜烂性食管炎患者反流事件的时空特征，并将其与反流感知相关联。
与健康对照相比，所有患者食管内近端酸扩散均较高，在非糜烂性胃食管反流病患者中尤为突出（超过50%的事件持续1 - 2分钟）。无论黏膜损伤情况如何，当酸到达近端传感器时，反流感知风险非常高（比值比，7.6；95%置信区间，4.6 - 12.5），在酸暴露时间正常的非糜烂性胃食管反流病患者中最高（比值比，11；95%置信区间，5.2 - 22.3）。
与食管炎患者相比，非糜烂性胃食管反流病患者的特征是近端酸反流比例显著更高，对短暂反流的敏感性更高。近端酸暴露最高和感知最强发生在pH测量曲线正常的非糜烂性胃食管反流病患者中。评估食管体部酸分布及其感知情况能够更好地识别应从抑酸治疗中获益的反流患者。
