Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Am J Gastroenterol. 2010 May;105(5):1053-61. doi: 10.1038/ajg.2009.670. Epub 2009 Dec 8.
OBJECTIVES: We sought to compare reflux and symptom association patterns in patients with nonerosive reflux disease (NERD), erosive esophagitis (EE), and in healthy volunteers (HVs). METHODS: Patients with EE and NERD underwent combined impedance-pH monitoring. Normal values were defined on the basis of previously collected data from 48 HVs. We evaluated distal esophageal acid exposure time (AET), number and type of reflux episodes (acid, nonacid), acid and bolus clearance times, proximal extension of reflux episodes, and symptom association probability (SAP). RESULTS: Distal AET (percentage time, pH<4) was higher (P<0.01) in 58 EE patients (median 7.4%, 25-75th percentile 4.2-9.9%) compared with 168 NERD patients (4.2% (1.2-6.4%)) and 48 HVs (0.7% (0.2-1.4%)). Patients with EE and NERD had a higher (P<0.01) number of acid reflux episodes compared with HVs (51 (37-66) vs. 34 (22-51) vs. 17 (8-31); P<0.05), but a similar number of nonacid reflux episodes (22 (15-39) vs. 23 (15-38) vs. 18 (14-26); P=NS). The percentage of reflux episodes reaching the proximal esophagus was higher (P<0.01) in EE patients (57% (45-73%)) than in NERD patients (45% (36-60%)) and HVs (33% (19-46%)). A positive SAP for heartburn or regurgitation was found in 161 of 168 (96%) NERD and 54 of 58 (93%) EE patients (P=NS). CONCLUSIONS: Acid reflux episodes, volume, and acid clearance are important factors in the pathogenesis of reflux-induced lesions. Nonacid reflux contributes less to esophageal mucosa damage, but is involved in the development of reflux symptoms in both NERD and EE patients.
目的：我们旨在比较非糜烂性反流病（NERD）、糜烂性食管炎（EE）患者与健康志愿者（HV）的反流和症状关联模式。
方法：EE 和 NERD 患者接受联合阻抗-pH 监测。正常值是基于此前从 48 名 HV 中收集的数据定义的。我们评估了远端食管酸暴露时间（AET）、反流事件的数量和类型（酸、非酸）、酸和食团清除时间、反流事件的近端延伸以及症状关联概率（SAP）。
结果：58 名 EE 患者的远端 AET（百分比时间，pH 值<4）明显高于 168 名 NERD 患者（4.2%（1.2-6.4%））和 48 名 HV（0.7%（0.2-1.4%））（P<0.01）。EE 患者和 NERD 患者的酸反流事件数量明显高于 HV（51（37-66）比 34（22-51）比 17（8-31）；P<0.01），而非酸反流事件数量相似（22（15-39）比 23（15-38）比 18（14-26）；P=NS）。到达近端食管的反流事件百分比在 EE 患者中明显高于 NERD 患者（57%（45-73%））和 HV（33%（19-46%））（P<0.01）。168 名 NERD 患者中有 161 名（96%）和 58 名 EE 患者中有 54 名（93%）的烧心或反流症状与 SAP 呈阳性（P=NS）。
结论：酸反流事件、容量和酸清除是反流引起的病变发病机制中的重要因素。非酸反流对食管黏膜损伤的贡献较小，但在 NERD 和 EE 患者的反流症状发展中均有涉及。
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