[GerdQ、24小时动态食管pH监测及阻抗-pH监测在巴雷特食管、反流性食管炎和非糜烂性反流病中的诊断价值]

[Diagnostic values of GerdQ, 24-h ambulatory oesophageal pH and impedance-pH monitoring in Barrett's esophagus, reflux esophagitis and non-erosive reflux disease].

作者信息

Wang Kun, Duan Li-Ping, Ge Ying, Xu Zhi-Jie, Xia Zhi-Wei

机构信息

Department of Digestive Diseases, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2011 May 17;91(18):1228-32.

PMID:21756791

Abstract

OBJECTIVE

To compare the diagnostic values of GerdQ questionnaire, 24-h pH monitoring and 24-h impedance-pH monitoring for gastroesophageal reflux disease (GERD) and to analyze the reflux patterns of Barrett's esophagus (BE), reflux esophagitis (RE) and non-erosive disease (NERD).

METHODS

From June 1, 2009 to September 30, 2010, 205 GERD patients were included according to the Montreal consensus. All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pH monitoring. The diagnostic sensitivities of GerdQ, 24-h pH-DeM and 24-h IMP-pH were compared and the reflux pattern of BE, RE and NERD analyzed.

RESULTS

A total of 205 GERD patients including 10 BE, 28 RE and 167 NERD were recruited. (1) The diagnostic rate of 24-h IMP-pH was 74.1%. It was significantly higher than that of GerdQ (51.7%) and 24-h pH-DeM (29.2%). (2) The diagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that for NERD. But there were no significant differences of 24-h IMP-pH for three types of GERD (70.0%, 82.1% and 73.1%). (3) There were positive correlations among the scores of GerdQ, pH-DeM scores and acid scores in IMP-pH (r = 0.242, P = 0.000; r = 0.182, P = 0.009 and r = 0.632, P = 0.000). (4) Added diagnostic values of IMP-pH were 58.5% and 74.5% respectively in patients who would have been missed by GerdQ and pH-DeM. (5) The detection rate and score of acid reflux in RE patients were higher than that of NERD [53.6% vs 23.4%, P < 0.05; 45.6 (35.0 - 67.5) vs 23.1 (9.3 - 35.0), P < 0.05]. But gas score and separate acid reflux were lower than that in NERD [17 (0 - 194) vs 30 (0 - 500), P < 0.05; 57.4% vs 28.6%, P < 0.05].

CONCLUSIONS

Acid reflux plays an important role in RE. The value of GerdQ and 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE. Weak acid may be more important for BE and NERD patients than separate acid reflux. And 24-h IMP-pH monitoring has a distinct advantage in diagnosing these two types.

摘要

目的

比较GerdQ问卷、24小时pH监测和24小时阻抗-pH监测对胃食管反流病（GERD）的诊断价值，并分析巴雷特食管（BE）、反流性食管炎（RE）和非糜烂性疾病（NERD）的反流模式。

方法

2009年6月1日至2010年9月30日，根据蒙特利尔共识纳入205例GERD患者。所有患者均接受GerdQ问卷调查并进行24小时阻抗-pH监测。比较GerdQ、24小时pH-DeM和24小时IMP-pH的诊断敏感性，并分析BE、RE和NERD的反流模式。

结果

共纳入205例GERD患者，其中BE 10例，RE 28例，NERD 167例。（1）24小时IMP-pH的诊断率为74.1%，显著高于GerdQ（51.7%）和24小时pH-DeM（29.2%）。（2）GerdQ和24小时pH-DeM对BE和RE的诊断敏感性高于NERD。但24小时IMP-pH对三种类型GERD的诊断敏感性无显著差异（70.0%、82.1%和73.1%）。（3）GerdQ评分、pH-DeM评分与IMP-pH中的酸反流评分呈正相关（r = 0.242，P = 0.000；r = 0.182，P = 0.009；r = 0.632，P = 0.000）。（4）在GerdQ和pH-DeM漏诊的患者中，IMP-pH的附加诊断价值分别为58.5%和74.5%。（5）RE患者的酸反流检出率和评分高于NERD[53.6%对23.4%，P < 0.05；45.6（35.0 - 67.5）对23.1（9.3 - 35.0），P < 0.05]。但气体反流评分和单纯酸反流低于NERD[17（0 - 194）对30（0 - 500），P < 0.05；57.4%对28.6%，P < 0.05]。