Wang Kun, Duan Li-Ping, Chen Hong, Xia Zhi-Wei, Lin San-Ren
Department of Digestive Disease, Third Hospital, Peking University, Beijing 100083, China.
Zhonghua Nei Ke Za Zhi. 2005 Jan;44(1):5-8.
Comparing the esophageal acid exposure characteristics between reflux oesophagitis (RE) and non-erosive reflux disease (NERD) patients to identify the NERD subgroups.
One hundred and twenty-eight patients with heartburn and acid regurgitation were evaluated. Esophageal mucosa injury was assessed by gastroscopy. The extent of esophageal acid exposure was determined by ambulatory 24 h esophageal pH monitoring. DeMeester point >/= 15 was taken as positive.
Thirty-seven patients were found to have RE (28.9%), 91 were diagnosed as NERD. There was no difference at DeMeester point between RE and NERD (P > 0.05). Patients with RE have more long reflux episodes than NERD patients (8.16 +/- 10.27 vs 3.96 +/- 6.87; P = 0.004). Among NERD patients, 46 (50.5%) had an abnormal pH monitoring (NERD+); another 45 were normal (NERD-). Patients with NERD+ were more likely to demonstrate at positive symptom index (SI > 50%) than those with NERD- (43.5% vs 15.6%; P < 0.001). In NERD- group, patients with a positive SI (NERD-SI+) have more reflux episodes than those with a negative SI (NERD-SI-) (55.29 +/- 24.68 vs 34.87 +/- 24.06; P < 0.05), as well as the fraction time of 24 h that pH < 4 in upright (4.16 +/- 2.98 vs 1.88 +/- 1.60; P < 0.05). Twenty-five RE patients have an abnormal pH monitoring (RE+, 67.6%), another 12 were normal (RE-). RE- patients have a higher median of intra-esophageal and gastric pH than RE+ patients respectively (6.75 +/- 0.42 vs 5.18 +/- 1.32; 2.69 +/- 2.59 vs 1.49 +/- 0.66; P < 0.05).
RE patients have longer reflux episodes than NERD. The symptoms of most gastroesophageal reflux disease patients associate with acid reflux. Acid reflux characteristics and symptom patterns suggest subgroups of NERD patients. The bile or mixed reflux may be involved in the pathogenesis of RE- group.
比较反流性食管炎（RE）和非糜烂性反流病（NERD）患者的食管酸暴露特征，以识别NERD亚组。
对128例有烧心和反酸症状的患者进行评估。通过胃镜检查评估食管黏膜损伤情况。采用动态24小时食管pH监测确定食管酸暴露程度。DeMeester积分≥15为阳性。
发现37例患者患有RE（28.9%），91例被诊断为NERD。RE和NERD患者的DeMeester积分无差异（P>0.05）。RE患者的长反流发作次数多于NERD患者（8.16±10.27对3.96±6.87；P=0.004）。在NERD患者中，46例（50.5%）pH监测异常（NERD+）；另外45例正常（NERD-）。NERD+患者比NERD-患者更易出现阳性症状指数（SI>50%）（43.5%对15.6%；P<0.001）。在NERD-组中，SI阳性（NERD-SI+）的患者比SI阴性（NERD-SI-）的患者有更多的反流发作次数（55.29±24.68对34.87±24.06；P<0.05），以及直立位24小时pH<4的时间分数（4.16±2.98对1.88±1.60；P<0.05）。25例RE患者pH监测异常（RE+，67.6%），另外12例正常（RE-）。RE-患者的食管内和胃内pH中位数分别高于RE+患者（6.75±0.42对5.18±1.32；2.69±2.59对1.49±0.66；P<0.05）。
RE患者的反流发作时间长于NERD患者。大多数胃食管反流病患者的症状与酸反流相关。酸反流特征和症状模式提示NERD患者的亚组。胆汁或混合反流可能参与了RE-组的发病机制。
