Emerenziani S, Sifrim D, Habib F I, Ribolsi M, Guarino M P L, Rizzi M, Caviglia R, Petitti T, Cicala M
Department of Digestive Diseases, University Campus Bio Medico, Rome, Italy.
Gut. 2008 Apr;57(4):443-7. doi: 10.1136/gut.2007.130104. Epub 2007 Aug 31.
The mechanisms underlying symptoms in gastro-oesophageal reflux disease, particularly in non-erosive reflux disease (NERD), remain to be fully elucidated. Weakly acidic reflux and the presence of gas in the refluxate could be relevant in the pathogenesis of symptoms.
To assess the relationship between symptoms and weakly acidic, acid and mixed (liquid-gas) reflux, 24 h oesophageal pH-impedance monitoring was performed in 32 NERD and in 20 oesophagitis patients. In 12 NERD patients the study was repeated following 4 weeks treatment with a proton pump inhibitor (PPI). Impedance-pH data were compared with those of 10 asymptomatic controls. Heartburn and acid regurgitation were considered in the analysis of symptoms.
15 NERD patients showed a physiological acid exposure time (pH-negative). Weakly acidic reflux was significantly less frequent in patients (25% (2%), mean (SE)) than in controls (54% (4%), p<0.01). Gas was present in 45-55% of reflux events in patient groups and controls, and decreased following PPI treatment. In NERD pH-negative patients, weakly acidic reflux accounted for 32% (10%) (vs 22% (6%) in NERD pH-positive and 12% (8%) in oesophagitis patients) and mixed reflux for more than two-thirds of all symptom-related refluxes. Multivariate logistic analysis showed that in NERD pH-negative patients, the risk of reflux perception was significantly higher when gas was present in the refluxate (odds ratio, 3.2; 95% CI, 1.2 to 10; p<0.01).
The large majority of symptoms, in all patients, are related to acid reflux. In NERD patients, the presence of gas in the refluxate significantly enhances the probability of reflux perception. These patients are also more sensitive to less acidic reflux than oesophagitis patients.
胃食管反流病（GERD），尤其是非糜烂性反流病（NERD）症状背后的机制仍有待充分阐明。弱酸性反流以及反流物中气体的存在可能与症状的发病机制有关。
为评估症状与弱酸性、酸性和混合性（液 - 气）反流之间的关系，对32例NERD患者和20例食管炎患者进行了24小时食管pH - 阻抗监测。12例NERD患者在接受质子泵抑制剂（PPI）治疗4周后重复该研究。将阻抗 - pH数据与10例无症状对照者的数据进行比较。在症状分析中考虑烧心和反酸。
15例NERD患者显示生理性酸暴露时间（pH阴性）。患者中弱酸性反流的频率（25%（2%），均值（标准误））显著低于对照者（54%（4%），p<0.01）。患者组和对照组中45 - 55%的反流事件中存在气体，PPI治疗后气体减少。在NERD pH阴性患者中，弱酸性反流占32%（10%）（NERD pH阳性患者中为22%（6%），食管炎患者中为12%（8%）），混合性反流占所有与症状相关反流的三分之二以上。多因素逻辑分析显示，在NERD pH阴性患者中，当反流物中存在气体时，反流感知风险显著更高（优势比，3.2；95%可信区间，1.2至10；p<0.01）。
在所有患者中，绝大多数症状与酸反流有关。在NERD患者中，反流物中气体的存在显著增加了反流感知的可能性。这些患者对酸性较低的反流也比食管炎患者更敏感。
