Wayman J, Griffin S M, Campbell F C
Northern Oesophago-Gastric Cancer Unit, University of Newcastle upon Tyne, UK.
Baillieres Clin Gastroenterol. 1998 Sep;12(3):463-76. doi: 10.1016/s0950-3528(98)90018-5.
Functional dyspepsia is a chronic disorder of unknown aetiology. The lack of endoscopic abnormalities in patients with this disorder has led many physicians to believe that gastro-oesophageal reflux disease may be responsible for most symptoms. Our group has addressed this issue, by pathophysiological studies in a large cohort of Dundee patients with persistent dyspeptic symptoms. Peptic ulcer and gallstones were excluded in all patients by appropriate tests. Ambulatory pH monitoring showed oesophageal acid reflux that lay above the conventional diagnostic threshold in approximately 20% of patients. This subset was diagnosed as having gastro-oesophageal reflux disease. In the remainder, moderate or severe reflux-like symptoms were reported by approximately 44% patients, who were categorized as reflux-like functional dyspepsia. Reflux symptoms were mild or absent in 36% patients, who were categorized as non-reflux-like dyspepsia. While oesophageal pH profiles lay within the conventional normal range in both of these functional dyspepsia subgroups, patients with reflux-like functional dyspepsia had significantly greater acid exposure values, including total oesophageal acid exposure time, percentage time at a pH of less than 4.0, DeMeester scores and pain reflux event correlation. Hence patients with reflux-like functional dyspepsia have oesophageal acid exposure that lies below the diagnostic threshold for gastro-oesophageal reflux disease but exceeds that of patients with non-reflux dyspepsia. The high pain/reflux event correlation in reflux-like functional dyspepsia suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
功能性消化不良是一种病因不明的慢性疾病。该疾病患者缺乏内镜异常表现，这使得许多医生认为胃食管反流病可能是大多数症状的病因。我们团队通过对一大群患有持续性消化不良症状的邓迪患者进行病理生理学研究来解决这个问题。通过适当的检查排除了所有患者的消化性溃疡和胆结石。动态pH监测显示，约20%的患者食管酸反流高于传统诊断阈值。这一亚组被诊断为患有胃食管反流病。在其余患者中，约44%的患者报告有中度或重度反流样症状，这些患者被归类为反流样功能性消化不良。36%的患者反流症状轻微或无反流症状，这些患者被归类为非反流样消化不良。虽然这两个功能性消化不良亚组的食管pH曲线都在传统正常范围内，但反流样功能性消化不良患者的酸暴露值明显更高，包括总的食管酸暴露时间、pH值低于4.0的时间百分比、DeMeester评分以及疼痛与反流事件的相关性。因此，反流样功能性消化不良患者的食管酸暴露低于胃食管反流病的诊断阈值，但超过了非反流性消化不良患者的酸暴露。反流样功能性消化不良中疼痛/反流事件的高相关性表明，阈下食管酸暴露可能与令人烦恼的反流症状有关。
