胃食管反流病患者中胃食管连接部形态与24 h食管pH-阻抗监测及胃镜结果的相关性研究

摘要

目的 探讨对具有典型胃食管反流病(gastroesophageal reflux disease, GERD)症状的患者进行高分辨食管测压时胃食管连接部(esophagogastric junction, EGJ)形态与胃镜结果及24 h食管pH-阻抗监测结果的相关性.方法 收集2015年9月-2016年7月因典型GERD症状于首都医科大学附属北京同仁医院行食管高分辨测压、24 h食管pH-阻抗监测及胃镜的85例患者资料.回顾性分析EGJ形态与胃镜及24 h食管pH-阻抗监测结果的相关性.结果 最终纳入病例85例,其中EGJⅠ型者36例,EGJⅡ型者33例,EGJⅢ型者16例.三组间年龄、BMI、腹围比较,差异均无统计学意义(P>0.05).三组患者内镜下食管炎比例分别为EGJⅠ型53.4%、EGJ Ⅱ型33.3%及EGJ Ⅲ型75.0%,EGJ Ⅲ型患者食管炎发生率明显高于Ⅰ、Ⅱ型,且胃镜下LA-B级及以上食管炎所占比例随EGJ分型升高而升高.EGJ Ⅲ型组相较于Ⅰ型组及Ⅱ型组的AET4、最长酸反流时间、DeMeester评分均显著升高(P<0.05),且症状反流相关性阳性者比例最高(18.8%).EGJ Ⅲ型组酸反流次数显著高于EGJ Ⅰ型组(38.69±33.74 vs 19.69±19.33,P<0.05).功能性烧心所占比例Ⅰ型最高(16.6%),Ⅲ型最少(6.2%).结论 有典型GERD症状的患者中EGJ Ⅲ型患者食管炎发生率、酸反流次数及症状反流相关性阳性者比例明显高于Ⅰ、Ⅱ型.%Objective To investigate the association of esophagogastric junction morphology (EGJ) subtypes with the 24 hours impedance-pH monitoring and endoscopy results in patients with gastroesophageal reflux disease (GERD) symptoms.Methods Eighty-five patients with typical GERD symptoms from Sep.2015 to Jul.2016 in Beijing Tongren Hospital Affiliated to Capital Medical University were analyzed retrospectively.These patients all underwent endoscopy, high-resolution manometry and 24 hours impedance-pH monitoring.Results Eighty-five patients were involoved and identified 36 type ⅠEGJ, 33 type Ⅱ, and 16 type Ⅲ patients.There were no significant differences in age, BMI and abdominal circumference among three groups (P>0.05).Type Ⅲ patients had a higher rate of esophagitis in endoscopy (75.0%) than type Ⅰ(53.4%) and type Ⅱ(33.3%), and a higher portion of severe esophagitis.Type Ⅲ patients had a greater mean AET 4, the longest acid reflux time and DeMeester score compared with type Ⅱ and type Ⅰ patients, respectively (P<0.05), and the highest positive symptom association (18.8%).Furthermore, type Ⅲ subjects showed statistically significant increased acid reflux compared with type Ⅰ patients (38.69±33.74 vs 19.69±19.33, P<0.05).The portion of functional heartburn was 16.6% in type Ⅰ, while 6.2% in type Ⅲ.Conclusion Type Ⅲ EGJ morphology patients have a higher rate of esophagitis, a significant increase in acid relux and higher positive symptom association than type Ⅰ and type Ⅱ patients.