Pace F, Santalucia F, Bianchi Porro G
Gastrointestinal Unit, L Sacco Hospital, Milan, Italy.
Gut. 1991 Aug;32(8):845-8. doi: 10.1136/gut.32.8.845.
This retrospective study was undertaken to characterise the clinical course and reflux pattern of patients with gastro-oesophageal reflux without evidence of oesophagitis. We investigated 33 patients (12 women, 21 men; mean age 36 years) with typical symptoms, a negative oesophagoscopy, and a 24 hour oesophageal pH-metry indicative of pathological gastro-oesophageal reflux. All patients received antacids or prokinetic drugs or both for three to six months. Nineteen of 33 patients still had symptoms at the end of treatment, of whom five had developed erosive changes of the oesophageal mucosa. The other 14 discontinued treatment and remained asymptomatic during a six month follow up period. Comparison of the pretreatment pH-metry data of the 19 symptomatic patients and the 14 asymptomatic patients showed no differences in the pattern of gastro-oesophageal reflux in the two groups. We conclude that in a substantial proportion of patients with pathological reflux without oesophagitis symptoms may persist and mucosal lesions may develop during conventional treatment without any apparent change in the reflux. Patients who developed endoscopic oesophagitis did not have a more severe pretreatment pattern of gastro-oesophageal reflux when compared with those who did not develop oesophageal mucosal damage.
本回顾性研究旨在描述无食管炎证据的胃食管反流患者的临床病程和反流模式。我们调查了33例患者（12名女性，21名男性；平均年龄36岁），这些患者有典型症状，食管镜检查阴性，且24小时食管pH测定表明存在病理性胃食管反流。所有患者接受抗酸药或促动力药或两者联合治疗三至六个月。33例患者中有19例在治疗结束时仍有症状，其中5例出现食管黏膜糜烂性改变。另外14例停止治疗，在六个月的随访期内无症状。对19例有症状患者和14例无症状患者治疗前的pH测定数据进行比较，结果显示两组胃食管反流模式无差异。我们得出结论，在相当一部分无食管炎的病理性反流患者中，症状可能持续存在，在传统治疗期间可能会出现黏膜病变，而反流无任何明显变化。与未发生食管黏膜损伤的患者相比，发生内镜下食管炎的患者治疗前的胃食管反流模式并不更严重。
