Zhang Ajing, Yao Wenzhu, Di Jia, Cui Manli, Zhang Mingxin, Zhang Jun
First Affiliated Hospital of Xi'an Medical College, Xi'an 710077, China.
Xi'an Medical University, Xi'an 710032, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Oct 30;40(10):1507-1512. doi: 10.12122/j.issn.1673-4254.2020.10.18.
To analyze the differences in reflux patterns in 24-hour esophageal pH-impedance monitoring in patients with non-erosive reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH) and explore the possible mechanism of symptoms in patients with heartburn and negative endoscopic findings.
Seventy-nine patients with heartburn as the main symptoms but negative endoscopic findings, including 35 with NERD, 16 with RH and 28 with FH, were enrolled in this study.All the patients underwent 24-h esophageal pH-impedance monitoring and esophagogastroscopy, and the results were compared among the 3 groups.
Acid reflux episode was significantly increased and weakly alkaline reflux episode was significantly decreased in NERD group in comparison with RH group and FH group ( < 0.05).The patients in NERD group showed significantly increased total reflux episode, mixed reflux episode, proximal acid reflux episode, proximal weak acid reflux episode, total proximal reflux episode, percentage of proximal acid reflux, percentage of proximal weak acid reflux, and percentage of total proximal reflux as compared with the other two groups (all < 0.05).Bolus clear time was significantly prolonged in NERD group compared with that in the other two groups ( < 0.05).Analysis of the reflux acidity showed that the percentages of different reflux episodes differed significantly among the 3 groups ( < 0.05);acid reflux was the main reflux in NERD, while weak acid reflux was the main reflux in RH and FH groups, which had also significantly increased weakly alkaline reflux episodes compared with NERD group.
Patients with NERD, RH and FH had different reflux patterns.Acid reflux is predominant in the NERD, while weakly alkaline reflux is significantly increased RH and FH.In patients with normal esophageal acid exposure but without symptoms or without recorded symptoms during esophageal pH-impedance monitoring, analysis of the total reflux episode, mixed reflux episode, proximal acid reflux episode and percentage can help in the differential diagnosis between RH and FH.
分析非糜烂性反流病（NERD）、反流高敏（RH）和功能性烧心（FH）患者24小时食管pH-阻抗监测中的反流模式差异，探讨烧心且内镜检查结果阴性患者症状的可能机制。
本研究纳入79例以烧心为主要症状但内镜检查结果阴性的患者，其中35例为NERD患者，16例为RH患者，28例为FH患者。所有患者均接受24小时食管pH-阻抗监测和食管胃镜检查，并对3组结果进行比较。
与RH组和FH组相比，NERD组的酸反流发作次数显著增加，弱碱性反流发作次数显著减少（P<0.05）。与其他两组相比，NERD组患者的总反流发作次数、混合反流发作次数、近端酸反流发作次数、近端弱酸反流发作次数、总近端反流发作次数、近端酸反流百分比、近端弱酸反流百分比和总近端反流百分比均显著增加（均P<0.05）。与其他两组相比，NERD组的食团清除时间显著延长（P<0.05）。反流酸度分析显示，3组不同反流发作的百分比差异有统计学意义（P<0.05）；酸反流是NERD的主要反流类型，而弱酸反流是RH和FH组的主要反流类型，且与NERD组相比，RH和FH组的弱碱性反流发作次数也显著增加。
NERD、RH和FH患者有不同的反流模式。酸反流在NERD中占主导地位，而在RH和FH中弱碱性反流显著增加。在食管酸暴露正常但无症状或在食管pH-阻抗监测期间无记录症状的患者中，分析总反流发作次数、混合反流发作次数、近端酸反流发作次数和百分比有助于RH和FH的鉴别诊断。
