Xu Jing, Qu Qiu, Yang Yu, Yang Jie, Fang Ting, Yin Jiajia, Mo Qiquan, Wu Zihan, Zeng Linran, He Huiping, Fu Jinxiao, Zhou Hongjian, Huang Wei, Yang Hong Ju
Geriatric Medical Center, Division of geriatric Gastroenterology, The First Afliated Hospital of Kunming Medical University, Yunnan, China.
Department of Geriatrics, Affiliated Hospital of Yunnan University, Yunnan, China.
J Clin Gastroenterol. 2025;59(5):448-455. doi: 10.1097/MCG.0000000000002031. Epub 2024 Jun 13.
The diagnosis of RGERD in patients typically involves 24-hour esophageal pH monitoring, but due to its invasiveness and low patient compliance, new screening methods are needed. In this study, a lactulose breath test (LBT) was conducted to detect the growth of small intestine bacteria (SIBO) and explore the potential relationship between LBT and RGERD to identify a new treatment method for RGERD.
A total of 178 patients with gastroesophageal reflux were enrolled from June 2020 to December 2022 in the Gastroenterology Department, Building 3, the First Affiliated Hospital of Kunming Medical University; these patients included 96 patients with nonrefractory GERD (NRGERD) and 82 patients with RGERD. The Gerd Q score, reflux symptom index (RSI) score, gastroscopy results, clinical symptoms, and other related indicators were collected. Statistical methods were used to analyze the gathered data.
The incidence of acid reflux and heartburn in patients with RGERD was significantly greater than that in patients with NRGERD (67.10% vs. 42.70%, P <0.01 and 65.00% vs. 34.40%, P <0.01). The CH 4 values of patients with RGERD were significantly greater than those of patients with NRGERD at each time point, and there was a correlation between the CH 4 values at 60 min and RGERD ( P <0.05). For patients with RGERD, the incidence of abdominal pain, acid regurgitation, and heartburn was greater in the CH 4 -positive group than in the CH 4 -negative group (61.90% vs. 57.50%, 69.05% vs. 65.00%, 69.05% vs. 57.50%, P >0.05). The incidence of nausea was also greater in the CH 4 -positive group than in the CH 4 -negative group (61.90% vs. 35.00%, P <0.05).
Increased CH 4 levels are correlated with RGERD. In addition, patients with RGERD may develop SIBO after long-term use of PPIs, and interventions involving SIBO could provide new ideas for the treatment of RGERD.
反流性食管炎（RGERD）患者的诊断通常涉及24小时食管pH监测，但由于其具有侵入性且患者依从性低，因此需要新的筛查方法。在本研究中，进行了乳果糖呼气试验（LBT）以检测小肠细菌过度生长（SIBO），并探讨LBT与RGERD之间的潜在关系，以确定RGERD的新治疗方法。
2020年6月至2022年12月期间，从昆明医科大学第一附属医院3号楼消化内科招募了178例胃食管反流患者；这些患者包括96例非难治性GERD（NRGERD）患者和82例RGERD患者。收集Gerd Q评分、反流症状指数（RSI）评分、胃镜检查结果、临床症状及其他相关指标。采用统计学方法对收集的数据进行分析。
RGERD患者的反酸和烧心发生率显著高于NRGERD患者（67.10%对42.70%，P<0.01；65.00%对34.40%，P<0.01）。RGERD患者在各个时间点的CH4值均显著高于NRGERD患者，且60分钟时的CH4值与RGERD之间存在相关性（P<0.05）。对于RGERD患者，CH4阳性组的腹痛、反酸和烧心发生率高于CH4阴性组（61.90%对57.50%、69.05%对65.00%、69.05%对57.50%，P>0.05）。CH4阳性组的恶心发生率也高于CH4阴性组（61.90%对35.00%，P<0.05）。
CH4水平升高与RGERD相关。此外，RGERD患者长期使用质子泵抑制剂（PPI）后可能会发生SIBO，针对SIBO的干预措施可为RGERD的治疗提供新思路。
