Lee Jun Haeng, Kim Nayoung, Chung Il Kwun, Jo Yun-Ju, Seo Geom Seog, Kim Sang Wook, Im Eui Hyeog, Kim Hye Rang, Park Soo Hyun, Lee So-Young, Cha Hyun-Min, Lee Kyoung Soo, Hyun Dong Hyo, Kim Hyun Young, Kim Sun-Mi, Shin Jeong Eun, Park Soo-Heon, Chung Hyun Chae, Chung In-Sik
Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1153-7. doi: 10.1111/j.1440-1746.2008.05299.x. Epub 2008 Jan 19.
At least half of the patients with typical reflux symptoms have non-erosive reflux disease (NERD). Minimal change lesions are commonly seen in the screening endoscopic examinations for individuals without clinically significant symptoms. We evaluated the correlation between minimal changes and symptoms in individuals visiting the hospital for routine health check-up by a nationwide survey in 2006.
Upper gastrointestinal endoscopic examinations as a health check-up were performed for 25,536 patients. Among them, symptom questionnaires were given in 23,350 patients without mucosal break or Barrett's esophagus. Endoscopic findings of the lower esophagus were divided into normal or minimal changes. Minimal changes in the present study included white turbid discoloration and Z-line blurring.
Among a total of 25,536 subjects, reflux esophagitis was found in 2019 subjects (7.91%) and 3043 patients (11.9%) were classified as having minimal changes. History of gastroesophageal reflux disease (GERD) was more commonly found in individuals with minimal changes. Among the reflux-related symptoms, heartburn, acid regurgitation, globus sensation, and epigastric soreness were related to the minimal changes of the esophagus. Especially, individuals with globus sensation or epigastric soreness were more likely to have minimal changes compared to individuals without respective symptoms. Male gender, current smoker, history of H. pylori eradication, frequent stooping at work, hiatal hernia, and atrophic/metaplastic gastritis were found to be risk factors for minimal changes.
The minimal changes were closely related with upper gastrointestinal symptoms and had similar risk factors for GERD, suggesting that minimal changes could be considered as early endoscopic findings of GERD.
至少一半有典型反流症状的患者患有非糜烂性反流病（NERD）。在对无明显临床症状个体进行的筛查性内镜检查中，微小病变很常见。我们通过2006年的一项全国性调查，评估了在因常规健康检查而就诊的个体中，微小病变与症状之间的相关性。
对25536例患者进行了作为健康检查的上消化道内镜检查。其中，在23350例无黏膜破损或巴雷特食管的患者中发放了症状问卷。食管下段的内镜检查结果分为正常或微小病变。本研究中的微小病变包括白色浑浊变色和Z线模糊。
在总共25536名受试者中，2019名受试者（7.91%）发现有反流性食管炎，3043例患者（11.9%）被归类为有微小病变。胃食管反流病（GERD）病史在有微小病变的个体中更常见。在与反流相关的症状中，烧心、反酸、咽部异物感和上腹部酸痛与食管的微小病变有关。特别是，有咽部异物感或上腹部酸痛的个体比没有相应症状的个体更有可能有微小病变。男性、当前吸烟者、幽门螺杆菌根除史、工作中频繁弯腰、食管裂孔疝以及萎缩性/化生性胃炎被发现是微小病变的危险因素。
微小病变与上消化道症状密切相关，且有与GERD相似的危险因素，这表明微小病变可被视为GERD的早期内镜表现。
