南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (10): 1507-1512.doi: 10.12122/j.issn.1673-4254.2020.10.18

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非糜烂性反流病、反流高敏感和功能性烧心患者食管pH-阻抗反流模式比较

张阿静，姚文柱，狄 佳，崔曼莉，张明鑫，张 军   

  • 出版日期:2020-10-20 发布日期:2020-10-20

Esophageal pH-impedance monitoring of reflux patterns in non-erosive reflux disease, reflux hypersensitivity and functional heartburn

  • Online:2020-10-20 Published:2020-10-20

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摘要： 目的 通过分析比较非糜烂性反流病（NERD）、反流高敏感（RH）和功能性烧心（FH）患者的食管24 h pH-阻抗监测反流模式，探讨内镜阴性烧心患者症状可能的发生机制。方法 选取我院消化科门诊和胃肠功能室的以烧心为主要症状的患者，通过胃镜、24 h pH-阻抗监测，最终纳入79例患者，包括NERD 35例，RH 16例和FH 28例，进行pH-阻抗数据分析。结果 NERD组较RH组、FH组酸反流次数显著性增加、弱碱反流次数显著性减少，差异有统计学意义（P均<0.05）；NERD组、RH组合计反流次数、混合反流次数、近端酸反流次数及百分比、近端弱酸反流次数及百分比、近端合计反流次数及百分比较FH组显著性增加，差异有统计学意义（P均<0.05）；分析反流的酸度，NERD、RH和FH三组中各种反流所占的比例之间差异有统计学意义（P<0.05），在NERD组以酸反流为主，但在RH和FH组，则以弱酸反流为主，且弱碱反流也较NERD组显著性增加。结论 NERD患者与RH患者、FH患者反流模式不同，前者以酸反流为主，后两者弱碱反流明显增多；对于pH-阻抗监测期间无症状或未记录症状的食管酸暴露正常患者，合计反流次数、混合反流次数、近端反流次数及百分比等阻抗监测指标将有助于鉴别RH和FH。

关键词: 24 h pH-阻抗监测, 非糜烂性胃食管反流病, 反流高敏感, 功能性烧心

Abstract: Objective 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. Methods 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. Results 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 (P<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 P<0.05). Bolus clear time was significantly prolonged in NERD group compared with that in the other two groups (P<0.05). Analysis of the reflux acidity showed that the percentages of different reflux episodes differed significantly among the 3 groups (P<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. Conclusions 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.

Key words: 24-hour pH-impedance monitoring, non-erosive esophagus reflux disease, reflux hypersensitivity, functional heartburn