三种试餐进行高分辨率食管测压在检测难治性胃食管反流病患者食管动力障碍中的价值

发布时间：2018-06-17 22:31

本文选题：高分辨率食管测压 + 胃食管反流病　；参考：《浙江大学》2016年硕士论文

【摘要】：背景：胃食管反流病(GERD)是一种常见的消化科疾病,其病理生理机制尚未完全阐明,目前较多研究认为GERD是胃食管动力障碍性疾病。随着质子泵抑制剂(PPI)的出现使GERD的治疗得到极大改善,但仍有一部分患者经PPI治疗后症状无改善,被称为难治性胃食管反流病。有研究发现近一半的GERD患者食管体部蠕动功能存在障碍,而在难治性GERD患者中食管动力障碍占多少比例尚无报道。高分辨率食管测压(HRM)是在传统食管测压的基础上发展而来的一种直观和准确的固态测压方法。目前临床上采用10口5m1水吞咽法,然而这种检测方法不符合正常生理习惯,难以诱发出患者食管的动力异常,而且当检测结果缺乏主要动力障碍时,应用常规饮水吞咽很难解释患者的食管症状和疾病的病因。国外有研究发现应用快速多口水吞咽、固体吞咽进行HRM检测能够提高食管动力障碍的检出率。但目前国内缺乏应用连续饮水和固体吞咽进行高分辨率食管测压检测食管动力的研究。目的：应用高分辨率食管测压技术对难治性胃食管反流病患者进行食管测压,分析胃食管反流病患者不同亚组的食管动力特征,进一步分析比较三种试餐(常规饮水、连续饮水和固体吞咽)在检测食管动力障碍中的作用。方法：收集2014年5月至2015年12月于浙江大学医学院附属邵逸夫医院消化内科胃肠动力实验室行高分辨率食管测压检查的难治性胃食管反流患者的临床资料,根据患者症状、胃镜检查及24hpH-阻抗联合监测结果,将患者分为反流性食管炎(reflux esophagitis, RE)组、非糜烂性反流病(non-erosive reflux disease, NERD)组和症状-反流无关联组,应用常规10口5m1饮水、200m1连续饮水和150g米饭固体吞咽进行高分辨食管测压,比较三种方法在检测食管动力障碍的价值。食管动力障碍标准分别是,常规饮水：根据芝加哥分类V3.0标准；连续饮水：两次饮水试餐后均无有效食管收缩；固体吞咽：有效吞咽口数50%为食管动力障碍。结果：共纳入符合条件的GERD患者51例,其中反流性食管炎(RE)组11例,非糜烂性反流病(NERD)组25例,症状-反流无关联组15例。1.RE组远端收缩积分(distal contraction integral, DCI)明显低于NERD组和症状-反流无关联组(P=0.039)。RE组食管蠕动率明显低于其他两组(P=0.002)。2.RE组和NERD组Demeester评分、酸反流次数明显高于症状-反流无关联组(P0.001)。RE组和NERD组中位酸暴露时间较症状-反流无关联组明显延长(P=0.001)。3.常规饮水方法测得共有31.4%(16/51)患者有食管动力障碍,其中11例(68.8%)患者诊断为无效的食管动力(ineffective esophageal motility, IEM);5例(31.2%)患者诊断为完全性失蠕动。4.将51例受试者分为完全性失蠕动组(5例)、无效食管动力组(11例)和无食管动力障碍组(35例),其中完全性失蠕动组的酸反流次数明显高于其他两组(P=0.024)。5.200m1连续饮水法共检测出28例(54.9%)食管动力障碍,食管动力障碍检出率明显高于常规10口5m1饮水方法,差异具有统计学意义(P=0.017)。6.150g米饭固体吞咽法食管动力障碍的检出率(33/51,64.7%)明显高于常规10口5m1饮水方法(P0.001)。其中RE组食管动力障碍检出率(90.9%)和NERD组(68.0%)明显高于症状-反流无关联组(40.0%)(P=0.024)。RE组固体吞咽有效口数明显低于其他两组(P=0.027)。结论：难治性胃食管反流病患者中食管动力障碍常见,包括食管蠕动功能减弱、消失以及无效的食管动力,其中无效的食管动力最为常见。在行HRM检测时应用200m1连续饮水和150g米饭固体吞咽检测方法食管动力障碍的检出率明显高于10口5m1常规饮水方法,其临床应用价值有待进一步评估。
[Abstract]:Background: gastroesophageal reflux disease (GERD) is a common digestive disease. Its pathophysiological mechanism has not been fully elucidated. At present, many studies have shown that GERD is a gastroesophageal motility disorder. With the emergence of proton pump inhibitor (PPI), the treatment of GERD has been greatly improved, but some patients still have no improvement in the symptoms after the treatment of PPI. Studies have found that nearly half of GERD patients have an obstacle to the peristaltic function of the esophagus, while the proportion of esophageal motility disorders in refractory GERD patients is not reported. High resolution esophageal manometry (HRM) is an intuitive and accurate solid-state measurement developed on the basis of traditional esophageal manometry. Pressure method. At present, 10 5m1 water swallowing methods are used clinically. However, this method does not conform to normal physiological habits, and it is difficult to induce the abnormal motility of the esophagus. And when the results lack major dynamic disorders, it is difficult to explain the causes of the patients' esophagus symptoms and diseases by using conventional water swallowing. Rapid multi mouth swallowing and solid swallowing for HRM detection can improve the detection rate of esophageal motility disorders. However, there is a lack of high resolution esophageal manometry for detecting esophageal motility with continuous drinking water and solid swallowing. Objective: high resolution esophageal manometry is applied to patients with refractory gastroesophageal reflux disease. Pressure measurement was used to analyze the esophageal motility characteristics of different subgroups of gastroesophageal reflux disease patients and to further analyze the role of three test meals (regular drinking water, continuous drinking water and solid swallowing) in the detection of esophageal motility disorders. Methods: from May 2014 to December 2015, the gastrointestinal motility in the digestive department of the Sir Run Run Shaw Hospital of the Medical College of Zhejiang University was collected. The clinical data of patients with refractory gastroesophageal reflux with high resolution esophageal manometry were divided into reflux esophagitis (reflux esophagitis, RE) group, non erosive reflux disease (non-erosive reflux disease, NERD) group and symptomatic reflux, according to the patient's symptoms, gastroscopy and 24hpH- impedance monitoring results. Group, using 10 5m1 drinking water, 200m1 continuous drinking water and 150g rice solid swallowing for high resolution esophageal manometry, compared the value of the three methods in detecting esophageal motility disorder. The standard of esophageal motility disorder was the conventional drinking water: according to the Chicago classification V3.0 standard; continuous drinking water: no effective esophageal contraction after two drinking water test meals. Solid swallowing: 50% of the effective swallowing mouth was 50% of the esophageal motility disorder. Results: 51 cases of GERD patients were included, including 11 cases of reflux esophagitis (RE) and 25 cases of non erosive reflux disease (NERD) group. The distal contraction integral (distal contraction integral, DCI) in the symptom reflux non association group (distal contraction integral, DCI) was significantly lower than that of the NERD group and the disease. The rate of esophageal peristalsis in group P=0.039.RE group was significantly lower than that of other two groups (P=0.002).2.RE group and NERD group Demeester score, acid reflux frequency was significantly higher than that of symptomatic reflux non associated group (P0.001).RE group and NERD group. 1.4% (16/51) patients had esophageal motility disorder, of which 11 cases (68.8%) were diagnosed as ineffective esophageal motility (ineffective esophageal motility, IEM); 5 (31.2%) patients were diagnosed as complete lost peristaltic.4., 51 cases were divided into complete non peristalsis group (5 cases), ineffective esophageal motility group (11 cases) and no esophageal motility disorder group (35 cases). The number of acid reflux in the complete lost peristaltic group was significantly higher than that of the other two groups (P=0.024).5.200m1 continuous drinking water method. The esophageal motility disorder was detected in 28 cases (54.9%), and the detection rate of esophageal motility disorder was significantly higher than that of the conventional 10 mouth 5m1 drinking water method. The difference was statistically significant (P=0.017) the detection rate of esophageal motility disorder in.6.150g rice swallowing method (P=0.017). 33/51,64.7%) was significantly higher than the conventional 10 mouth 5m1 drinking water method (P0.001). The detection rate of esophageal motility disorder in group RE (90.9%) and NERD group (68%) were significantly higher than that in the symptom reflux group (40%) (P=0.024) the number of solid swallowing in the.RE group was significantly lower than that of the other two groups (P= 0.027). Conclusion: the esophageal motility barrier in patients with refractory gastroesophageal reflux disease Obstruction of the esophageal peristalsis, including diminished esophageal peristalsis, and ineffective esophageal motility, is the most common of the esophageal motility. In the case of HRM detection, the detection rate of esophageal motility with 200m1 continuous drinking water and 150g rice solid swallowing detection is significantly higher than that of 10 5m1 conventional drinking water methods, and its clinical value needs to be further studied. Assessment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R571

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