Yamaguchi Toru, Sugimoto Toshitsugu, Yamauchi Mika, Matsumori Yoshinobu, Tsutsumi Masaharu, Chihara Kazuo
Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1192, Japan.
J Bone Miner Metab. 2005;23(1):36-40. doi: 10.1007/s00774-004-0538-7.
We examined the frequency of multiple vertebral fractures (MVFs) and esophageal hiatal hernia (HH) in 18 Japanese postmenopausal women (74.1 +/- 9.9 years, mean +/- SD), with refractory reflux esophagitis (RRE) that had needed a proton pump inhibitor for more than 6 months to suppress symptoms such as heartburn and acid regurgitation, as well as in 57 control subjects without RE (71.4 +/- 5.9 years). MVFs (two or more VFs), HH, and both features were found in 11 (61%), 16 (89%), and 11 (61%) subjects, respectively, in the RRE group. All 11 patients with MVFs also had HH, suggesting their strong association. On the other hand, MVFs, HH, and both were found in 15 (26%), 23 (40%), and 8 (14%) subjects, respectively, in those without RE. The differences in frequencies of MVFs, HH, and both between the two groups were significant (chi2 = 7.3, 12.9, and 16.0; P = 0.015, 0.0009, and 0.0002, respectively). When univariate logistic regression analysis was performed with the presence of RRE as a dependent variable and the presence of MVFs, HH, and both as independent variables, MVFs, HH, and both were selected as indices affecting the presence of RRE (age-adjusted odds ratios: 4.34, 11.07, and 10.30; 95% confidential intervals: 1.40-13.45, 2.30-53.22, and 2.96-35.86; P = 0.0109, 0.0027, and 0.0002, respectively). These results show that the presence of MVFs is associated with the presence of RRE in Japanese postmenopausal women, and this association becomes more significant when HH is present. Thus, a kyphotic lumbar spine with MVFs may cause HH and RE by raising the intraabdominal pressure. As recent therapeutic agents for osteoporosis, alendronate and risedronate, are known to be very effective for suppressing the occurrence of new VFs, these agents may also prevent gastrointestinal disorders such as HH and RRE in osteoporotic women when administered to subjects without VFs.
我们对18名日本绝经后女性（平均年龄74.1±9.9岁，均值±标准差）进行了研究，这些女性患有难治性反流性食管炎（RRE），需要使用质子泵抑制剂超过6个月以抑制烧心和反酸等症状；同时还纳入了57名无反流性食管炎的对照受试者（平均年龄71.4±5.9岁）。在RRE组中，分别有11名（61%）、16名（89%）和11名（61%）受试者存在多发性椎体骨折（MVF）、食管裂孔疝（HH）以及两者并存的情况。所有11名患有MVF的患者也都有HH，提示二者关联紧密。另一方面，在无反流性食管炎的受试者中，分别有15名（26%）、23名（40%）和8名（14%）受试者存在MVF、HH以及两者并存的情况。两组之间MVF、HH以及两者并存情况的频率差异具有统计学意义（卡方值分别为7.3、12.9和16.0；P值分别为0.015、0.0009和0.0002）。当以是否存在RRE作为因变量，以是否存在MVF、HH以及两者并存作为自变量进行单因素逻辑回归分析时，MVF、HH以及两者并存均被选为影响RRE存在的指标（年龄调整后的比值比分别为4.34、11.07和10.30；95%置信区间分别为1.40 - 13.45、2.30 - 53.22和2.96 - 35.86；P值分别为0.0109、0.0027和0.0002）。这些结果表明，在日本绝经后女性中，MVF的存在与RRE的存在相关，并且当HH存在时这种关联更为显著。因此，伴有MVF的脊柱后凸可能通过升高腹内压导致HH和RRE。由于已知作为近期骨质疏松治疗药物的阿仑膦酸盐和利塞膦酸盐对于抑制新椎体骨折的发生非常有效，当将这些药物给予无椎体骨折的受试者时，它们也可能预防骨质疏松女性出现诸如HH和RRE等胃肠道疾病。
