Newton M, Kamm M A, Quigley T, Burnham W R
St. Mark's Hospital, Harrow, Middlesex, England.
Dig Dis Sci. 1999 Jan;44(1):140-8. doi: 10.1023/a:1026618620480.
Patients admitted acutely to hospital may be at risk of increased morbidity and mortality as a result of gastroesophageal reflux and its complications. The recognized association of gastroesophageal reflux with cardiac and respiratory disease, the use of drugs that reduce lower esophageal sphincter pressure, and the supine position in which many patients are nursed may increase the risk of gastroesophageal reflux. This study aimed to determine the prevalence and severity of refluxlike symptoms in a series of consecutive unselected patients admitted acutely through the accident and emergency department of a district general hospital and to study the effect of hospitalization on these symptoms. Patients were interviewed by questionnaire on two occasions: immediately following admission and again 7-10 days later. The frequency of symptoms of heartburn, acid regurgitation, dysphagia, nausea, and belching were recorded on a 6-point scale, in addition to whether these symptoms occurred at night. Medication history, the number of days spent on bed rest, nasogastric intubation, and operation history were also recorded. In all, 275 patients were interviewed, of whom 229 had a second interview; 27% (62) had symptoms at least once a week (49% reported symptoms at least once a month) prior to admission, of whom 4% (9) had daily heartburn and/or acid regurgitation. Following admission to hospital there was a significant (P < 0.001) fall in the prevalence and frequency of refluxlike symptoms. There was a significant association of refluxlike symptoms with number of days spent in bed (P < 0.05) and with the use of nonsteroidal antiinflammatory drugs in hospital (P < 0.0001). Logistic regression analysis confirmed the association of NSAIDs with refluxlike symptoms. Nasogastric intubation and surgery were not associated with heartburn. In conclusion, symptoms of heartburn and acid regurgitation become less frequent following admission to hospital. This probably relates to a reduction in physical exertion following hospital admission but may reflect a reduction in anxiety levels or treatment of underlying disease. Patients on prolonged bed rest and those given non-steroidal anti-inflammatory drugs are at increased risk of refluxlike symptoms and may require antireflux measures.
因急性病入院的患者可能因胃食管反流及其并发症而面临发病率和死亡率增加的风险。胃食管反流与心脏和呼吸系统疾病之间已被认可的关联、使用降低食管下括约肌压力的药物以及许多患者接受护理时的仰卧位，都可能增加胃食管反流的风险。本研究旨在确定一系列通过地区综合医院急诊科连续收治的未经过筛选的急性病患者中反流样症状的患病率和严重程度，并研究住院对这些症状的影响。对患者进行了两次问卷调查：入院后立即进行一次，7 - 10天后再进行一次。除了记录烧心、反酸、吞咽困难、恶心和嗳气症状出现的频率（采用6分制）以及这些症状是否在夜间出现外，还记录了用药史、卧床休息天数、鼻胃管插管情况和手术史。总共对275名患者进行了访谈，其中229名患者接受了第二次访谈；27%（62名）患者在入院前至少每周出现一次症状（49%报告至少每月出现一次症状），其中4%（9名）患者每天有烧心和/或反酸症状。入院后，反流样症状的患病率和频率显著下降（P < 0.001）。反流样症状与卧床天数（P < 0.05）以及住院期间使用非甾体类抗炎药（P < 0.0001）之间存在显著关联。逻辑回归分析证实了非甾体类抗炎药与反流样症状之间的关联。鼻胃管插管和手术与烧心无关。总之，入院后烧心和反酸症状的出现频率降低。这可能与入院后体力活动减少有关，但也可能反映出焦虑水平的降低或潜在疾病的治疗。长期卧床的患者以及使用非甾体类抗炎药的患者出现反流样症状的风险增加，可能需要采取抗反流措施。
