Bresadola Vittorio, Adani Gian Luigi, Londero Francesco, Leo Cosimo Alex, Cherchi Vittorio, Lorenzin Dario, Rossetto Anna, Vit Gianmatteo, Baccarani Umberto, Terrosu Giovanni, Anna Dino De
Vittorio Bresadola, Gian Luigi Adani, Francesco Londero, Cosimo Alex Leo, Vittorio Cherchi, Dario Lorenzin, Anna Rossetto, Gianmatteo Vit, Umberto Baccarani, Giovanni Terrosu, Dino De Anna, Department of Surgery and Transplantation, University Hospital of Udine, P.le S.M. della Misericordia, Udine 33100, Italy.
World J Gastrointest Pathophysiol. 2011 Jun 15;2(3):42-8. doi: 10.4291/wjgp.v2.i3.42.
To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 h pH monitoring.
For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the reflux symptoms, manometric characteristics of the lower esophageal sphincter (LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study, patients had to have NERD or ERD and be found positive on pH monitoring (NERD+). Patients with Gastroesophageal reflux disease (GERD) complicated by stenosis, ulcers or Barrett's esophagus were ruled out.
214 patients were involved in the study, i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender- or age-related differences between the two groups. The ERD group had more cases of hiatal hernia (P = 0.02) and more acid reflux, both in terms of number of reflux episodes (P = 0.01) and as a percentage of the total time with a pH < 4 (P = 0.00), when upright (P = 0.007) and supine (P = 0.00). The NERD+ cases had more reflux episodes while upright (P = 0.02) and the ERD cases while supine (P = 0.01). The LES pressure was higher in cases of NERD+ (P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group (P >0.05). The NERD+ patients presented more often with atypical symptoms (P = 0.01).
The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position (unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.
探讨24小时pH监测呈阳性的非糜烂性反流病（NERD）和糜烂性反流病（ERD）患者在生理病理检查结果（测压和pH监测）及症状方面的差异。
对总共670例行24小时pH监测的患者进行回顾性评估，包括食管测压和上消化道内镜检查，评估反流症状、食管下括约肌（LES）和食管体的测压特征以及食管炎和食管裂孔疝的有无。还评估了典型和非典型症状。纳入研究的患者必须患有NERD或ERD且pH监测呈阳性（NERD+）。排除患有合并狭窄、溃疡或巴雷特食管的胃食管反流病（GERD）患者。
214例患者参与研究，即107例NERD+患者和107例ERD患者。两组之间在性别或年龄方面无显著差异。ERD组食管裂孔疝病例更多（P = 0.02），酸反流更多，无论是反流发作次数（P = 0.01）还是pH < 4的总时间百分比（P = 0.00），直立位时（P = 0.007）和仰卧位时（P = 0.00）均如此。NERD+病例直立位时反流发作更多（P = 0.02），ERD病例仰卧位时反流发作更多（P = 0.01）。NERD+病例的LES压力更高（P = 0.03），其食管蠕动波的幅度和持续时间往往优于ERD组（P > 0.05）。NERD+患者更常出现非典型症状（P = 0.01）。
NERD+患者反流发作较少且主要发生在直立位（与ERD病例不同）可能是不利于食管炎发生的两个因素。对于NERD+患者中常见的非典型症状，出于治疗目的需要进行准确评估，因为患有GERD和非典型症状的患者通常对药物和手术治疗仅部分有效。
