Division of Gastroenterology and Hepatology, Department of Veterans Affairs Medical Center, 4801 E. Linwood Blvd, Kansas City, MO 64128-2295, USA.
Aliment Pharmacol Ther. 2011 Jun;33(11):1202-8. doi: 10.1111/j.1365-2036.2011.04643.x. Epub 2011 Mar 31.
Mechanisms of symptom perception among patients with gastro-oesophageal reflux disease (GERD) remain to be fully elucidated.
To correlate quantitative reflux symptom scores with microscopic oesophageal histopathology.
Prior to endoscopy, patients with reflux symptoms completed a validated reflux disease questionnaire (score 0-36). Erosive oesophagitis (EO) was graded using the LA classification. Oesophageal biopsies were graded 0-2 for basal cell hyperplasia, papillary elongation, dilated intercellular spaces (DIS), necrosis or erosion, eosinophils and neutrophils by a blinded gastrointestinal pathologist as previously described. Additionally, lymphocyte density was also evaluated. Pearson's correlation coefficients were computed.
Thirty-two EO and 21 non-erosive reflux disease (NERD) patients were prospectively enrolled. For EO vs. NERD, mean reflux symptom scores (10.7 vs. 8.8, P=0.35) and histology scores were similar (4.29 vs. 4.25; P=0.9). However, when symptom scores were compared with histology scores, a correlation was found in the EO group, but not in the NERD group (r=0.34, P=0.05 vs. r=0.22, P=0.36). On further analysis, DIS was associated with symptom scores in the EO group (P≤0.001), but not in the NERD group (P=N.S.). Similarly, lymphocyte density was associated with symptom scores in the EO group (r=0.56, P=0.0009), but not in the NERD group (r=0.002, P=0.9).
Although mean symptom and histology scores were similar in the EO and NERD groups, a significant correlation of symptom scores with histology scores, DIS and lymphocytes was found in the former, but not in the latter. EO and NERD patients may have different symptom perception mechanisms and thus, dissimilar symptom resolution rates with acid suppression.
胃食管反流病（GERD）患者的症状感知机制仍有待充分阐明。
将定量反流症状评分与食管微观组织病理学相关联。
在进行内镜检查之前，有反流症状的患者完成了一份经过验证的反流疾病问卷（评分 0-36）。使用洛杉矶分类法对糜烂性食管炎（EO）进行分级。食管活检标本由一名盲法胃肠病学家按照先前的描述，对基底细胞增生、乳头伸长、细胞间空间扩大（DIS）、坏死或糜烂、嗜酸性粒细胞和中性粒细胞进行 0-2 级分级。此外，还评估了淋巴细胞密度。计算了 Pearson 相关系数。
前瞻性纳入 32 例 EO 和 21 例非糜烂性反流病（NERD）患者。与 NERD 相比，EO 患者的平均反流症状评分（10.7 对 8.8，P=0.35）和组织学评分相似（4.29 对 4.25；P=0.9）。然而，当将症状评分与组织学评分进行比较时，在 EO 组中发现了相关性，但在 NERD 组中没有（r=0.34，P=0.05 对 r=0.22，P=0.36）。进一步分析显示，在 EO 组中，DIS 与症状评分相关（P≤0.001），但在 NERD 组中不相关（P=N.S.）。同样，在 EO 组中，淋巴细胞密度与症状评分相关（r=0.56，P=0.0009），但在 NERD 组中不相关（r=0.002，P=0.9）。
尽管 EO 和 NERD 组的平均症状和组织学评分相似，但在前者中，症状评分与组织学评分、DIS 和淋巴细胞呈显著相关，而在后者中则不相关。EO 和 NERD 患者可能具有不同的症状感知机制，因此，酸抑制治疗后的症状缓解率也不同。
