Zhang Mengyu, Chen Minhu, Peng Sui, Xiao Yinglian
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
United European Gastroenterol J. 2018 Apr;6(3):358-366. doi: 10.1177/2050640617735084. Epub 2017 Sep 27.
The phenotypes of heartburn patients are heterogeneous.
The objective of this study was to investigate the proportion of heartburn phenotypes in a Chinese population and to compare the Rome IV and III criteria for heartburn diagnosis.
A retrospective study was performed among heartburn patients referred for upper endoscopy and esophageal function tests in a tertiary hospital. Their symptoms fulfilled Rome IV and III criteria.
A total of 233 patients were included. Fifty-nine patients (25%) were diagnosed with esophagitis, 96 (41%) with non-erosive reflux disease (NERD) and 78 (34%) with functional heartburn (FH) based on Rome III criteria. Approximately 70% of the Rome III NERD patients were changed based on Rome IV criteria, with 36 patients (15%) diagnosed with reflux hypersensitivity (RH) and 32 patients (14%) who didn't fulfill the criteria considered unclassified. The FH and RH patients showed higher esophagogastric junction-contractile integral (EGJ-CI) and less hiatal hernia than did Rome IV NERD patients. The unclassified had more hiatal hernias than the FH and RH ( < 0.05). The EGJ-CI was similar between Rome III NERD and FH cases.
The Rome IV criteria were stricter for heartburn diagnosis and superior in distinguishing NERD from functional disorders on motility patterns than Rome III.
烧心患者的表型具有异质性。
本研究旨在调查中国人群中烧心表型的比例，并比较罗马IV和III标准在烧心诊断中的应用。
对一家三级医院中因烧心而接受上消化道内镜检查和食管功能测试的患者进行回顾性研究。他们的症状符合罗马IV和III标准。
共纳入233例患者。根据罗马III标准，59例（25%）被诊断为食管炎，96例（41%）为非糜烂性反流病（NERD），78例（34%）为功能性烧心（FH）。根据罗马IV标准，约70%的罗马III标准NERD患者诊断发生了变化，36例（15%）被诊断为反流高敏（RH），32例（14%）不符合标准被视为未分类。与罗马IV标准NERD患者相比，FH和RH患者的食管胃交界收缩积分（EGJ-CI）更高，食管裂孔疝更少。未分类患者的食管裂孔疝比FH和RH患者更多（<0.05）。罗马III标准NERD和FH病例之间的EGJ-CI相似。
罗马IV标准在烧心诊断方面比罗马III标准更严格，在区分NERD与动力模式方面的功能性疾病方面更具优势。
