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日本内镜检查阴性反流性疾病患者与糜烂性食管炎患者临床特征的差异。

Differences in clinical characteristics between patients with endoscopy-negative reflux disease and erosive esophagitis in Japan.

作者信息

Fujiwara Yasuhiro, Higuchi Kazuhide, Shiba Masatsugu, Yamamori Kazuki, Watanabe Yoko, Sasaki Eiji, Tominaga Kazunari, Watanabe Toshio, Oshitani Nobuhide, Arakawa Tetsuo

机构信息

Department of Gastroenterology, Osaka City University, Graduate School of Medicine, Osaka, Japan.

出版信息

Am J Gastroenterol. 2005 Apr;100(4):754-8. doi: 10.1111/j.1572-0241.2005.40966.x.

Abstract

OBJECTIVE

Helicobacter pylori infection and atrophic gastritis are inversely related to erosive esophagitis. Whether these factors affect the pathogenesis of endoscopy-negative reflux disease is not clear. We aimed to elucidate the differences in clinical characteristics between endoscopy-negative erosive disease and erosive esophagitis.

METHODS

253 subjects (89 with endoscopy-negative reflux disease and 164 with erosive esophagitis) were studied. Gastric atrophy was assessed by measurement of serum pepsinogen. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) of endoscopy-negative reflux disease compared with erosive esophagitis.

RESULTS

Among GERD patients, female gender (OR = 2.27, 95% CI, 1.25-4.10), smoking (OR = 0.45, 95% CI, 0.22-0.91), and the presence of hiatal hernia (OR = 0.30, 95% CI, 0.17-0.56) were significantly associated with endoscopy-negative reflux disease compared with male gender, not smoking, and absence of hiatal hernia, respectively. Body mass index (BMI) was also significantly associated with a decreased OR for endoscopy-negative reflux disease. Although H. pylori infection and gastric atrophy were significantly more common in patients with endoscopy-negative reflux disease, these associations did not persist in a multiple-adjustment model. After adjustment for gender, BMI, smoking, and hiatal hernia, a decrease in serum pepsinogen I/II ratio was significantly associated with an increased OR for endoscopy-negative reflux disease (p for trend = 0.018).

CONCLUSIONS

Female gender, low BMI, not smoking, absence of hiatal hernia, and severity of gastric atrophy were positively associated with endoscopy-negative reflux disease compared with erosive esophagitis among Japanese patients.

摘要

目的

幽门螺杆菌感染和萎缩性胃炎与糜烂性食管炎呈负相关。这些因素是否影响内镜检查阴性的反流病的发病机制尚不清楚。我们旨在阐明内镜检查阴性的糜烂性疾病与糜烂性食管炎在临床特征上的差异。

方法

对253名受试者(89名内镜检查阴性的反流病患者和164名糜烂性食管炎患者)进行了研究。通过测量血清胃蛋白酶原评估胃萎缩情况。采用逻辑回归计算内镜检查阴性的反流病与糜烂性食管炎相比的比值比(OR)和95%置信区间(CI)。

结果

在胃食管反流病患者中,与男性、不吸烟和无食管裂孔疝相比,女性(OR = 2.27,95% CI,1.25 - 4.10)、吸烟(OR = 0.45,95% CI,0.22 - 0.91)和食管裂孔疝的存在(OR = 0.30,95% CI,0.17 - 0.56)分别与内镜检查阴性的反流病显著相关。体重指数(BMI)也与内镜检查阴性的反流病的OR降低显著相关。虽然幽门螺杆菌感染和胃萎缩在内镜检查阴性的反流病患者中明显更常见,但在多因素调整模型中这些关联并不持续存在。在调整性别、BMI、吸烟和食管裂孔疝后,血清胃蛋白酶原I/II比值降低与内镜检查阴性的反流病的OR增加显著相关(趋势p = 0.018)。

结论

在日本患者中,与糜烂性食管炎相比,女性、低BMI、不吸烟、无食管裂孔疝和胃萎缩的严重程度与内镜检查阴性的反流病呈正相关。

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