Zimmerman Joseph, Hershcovici Tiberiu
Gastroenterology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Clin Gastroenterol. 2008 Mar;42(3):261-5. doi: 10.1097/MCG.0b013e31802fc591.
Nonerosive gastroesophageal reflux disease (NERD) patients frequently show features of the irritable bowel syndrome (IBS).
To investigate the prevalence and intensity of bowel symptoms and their relationship to esophageal acid exposure in NERD patients.
Bowel and reflux symptoms and IBS status were assessed in NERD patients (normal upper endoscopy; esophageal pH <4 for >or= 5% of the time on 24-h pH monitoring; n=326), in relation to nonpatient controls. Bowel symptoms were scored on the 3 scales: diarrhea, constipation, and pain/gas symptoms.
NERD and age were independently associated with bowel symptoms. NERD patients scored significantly higher than controls on all bowel scales. In a multivariate analysis, the scores on the pain/gas scale were independently associated with NERD. In NERD patients, reflux symptoms independently predicted the bowel symptoms while acid exposure did not. Forty-nine percent of the NERD patients and 18% of the controls met the criteria for IBS [IBS(+)NERD]. IBS(+)NERD patients scored significantly higher than those not meeting IBS criteria [IBS(-)] on all bowel scales. Yet IBS(-) patients scored significantly higher than controls on the scales of constipation and pain/gas. IBS(+)NERD patients scored higher than IBS(-) also on the GERD symptoms scale.
(1) NERD patients scored significantly higher than controls on all the bowel scales; (2) Bowel symptoms were associated with reflux symptom scores, but not with acid exposure. (3) The presence of IBS features in a large proportion of NERD patients reflects a high prevalence of visceral hypersensitivity that may aggravate acid reflux symptoms.
非糜烂性胃食管反流病（NERD）患者常表现出肠易激综合征（IBS）的特征。
调查NERD患者肠道症状的患病率、严重程度及其与食管酸暴露的关系。
评估NERD患者（上消化道内镜检查正常；24小时pH监测食管pH＜4的时间≥5%；n = 326）的肠道和反流症状及IBS状态，并与非患者对照进行比较。肠道症状采用腹泻、便秘和疼痛/气体症状三个量表进行评分。
NERD和年龄与肠道症状独立相关。NERD患者在所有肠道量表上的得分均显著高于对照组。多因素分析显示，疼痛/气体量表得分与NERD独立相关。在NERD患者中，反流症状可独立预测肠道症状，而酸暴露则不能。49%的NERD患者和18%的对照组符合IBS标准[IBS(+)NERD]。IBS(+)NERD患者在所有肠道量表上的得分均显著高于未符合IBS标准的患者[IBS(-)]。然而，IBS(-)患者在便秘和疼痛/气体量表上的得分也显著高于对照组。IBS(+)NERD患者在GERD症状量表上的得分也高于IBS(-)患者。
（1）NERD患者在所有肠道量表上的得分均显著高于对照组；（2）肠道症状与反流症状评分相关，但与酸暴露无关；（3）大部分NERD患者存在IBS特征，反映了内脏高敏感性的高患病率，这可能会加重酸反流症状。
