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陕西医学杂志 2006年第11期35卷 1529-1530页

作者：高宁汉于桂萍西安铁路中心医院西安710054

胃食管返流病(GERD)是消化系统常见病。是指胃十二指肠内容物反流入食管引起的烧心等症状,可引起反流性食管炎以及咽喉、气道等食管以外的损伤。幽门螺杆菌(HP)感染是慢性胃炎和消化性溃疡的主要病因,并与胃癌的发生密切相关。而且在十... 详细信息

胃食管返流病(GERD)是消化系统常见病。是指胃十二指肠内容物反流入食管引起的烧心等症状,可引起反流性食管炎以及咽喉、气道等食管以外的损伤。幽门螺杆菌(HP)感染是慢性胃炎和消化性溃疡的主要病因,并与胃癌的发生密切相关。而且在十二指肠球部溃疡(DU)患者中并发GERD较多。有资料推测HP的感染可能与GERD的发病有关。为此本文对69例GERD患者和对照组77例轻度慢性浅表性胃炎患者进行HP检测,以探讨其相关性。[第一段]

关键词：螺杆菌感染胃食管反流/病理生理学消化性溃疡胃炎

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Predominant symptoms identify different subgroups in functional dyspepsia

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第8期94卷 2080-2085页

作者： Stanghellini, V Tosetti, C Paternicò, A De Giorgio, R Barbara, G Salvioli, B Corinaldesi, R Univ Bologna Dept Internal Med & Gastroenterol Bologna Italy Gen Practice Natl Hlth Serv Regione Emilia Romagna Italy

OBJECTIVE: Dyspepsia is a common syndrome that often defies diagnosis. Whether the unexplained (or "functional") dyspepsia represents a homogeneous syndrome or includes different subgroups with specific clinical features has not been clarified. The aim of this study was to investigate the relationship between symptom severity, demographic features, and gastric dysmotility in a large series of patients with functional dyspepsia. METHODS: Severity of individual digestive symptoms, demographic features, and scintigraphic gastric emptying of solids were evaluated in 483 patients with chronic unexplained dyspepsia. RESULTS: Two main subgroups were identified. The first was characterized by predominant epigastric pain, male gender (61%), and normal gastric emptying. The second subgroup was characterized by predominant nonpainful symptoms, female gender (60%), a high frequency of associated irritable bowel syndrome (30%), and delayed gastric emptying (42%). A third group included approximately one-third of patients who did not present with any predominant symptom, and was characterized by a high frequency of delayed gastric emptying (30%), overlapping irritable bowel syndrome (28%), and gastroesophageal reflux disease (41%). CONCLUSIONS: Different subgroups exist among patients with functional dyspepsia seen in a referral center. They can be identified by the predominant symptom and are characterized by different demographic, clinical, and pathophysiological features. (Am J Gastroenterol 1999;94:2080-2085. (C) 1999 by Am. Coll. of Gastroenterology).

关键词：结肠疾病功能性/诊断结肠疾病功能性/病因学结肠疾病功能性/病理生理学消化不良/诊断消化不良/病因学消化不良/病理生理学胃排空/生理学胃食管反流/诊断胃食管反流/病因学胃食管反流/病理生理学肌平滑/病理生理学危险因素胃/病理生理学成年人老年人女(雌)性人类男(雄)性中年人

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Belching and bloating: facts and fantasy after antireflux surgery

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BRITISH JOURNAL OF SURGERY 2000年第4期87卷 477-481页

作者： Tew, S Ackroyd, R Jamieson, GG Holloway, RH Royal Adelaide Hosp Dept Surg Adelaide SA 5000 Australia Royal Adelaide Hosp Dept Gastrointestinal Med Adelaide SA 5000 Australia

Background: Fundoplication is commonly complicated by belching difficulty and abdominal bloating. Postoperative belching ability, however, is difficult to assess;subjective patient reporting is often used but may be unreliable. Manometric measurement of the gastro-oesophageal 'common cavity' is an objective marker of gastro-oesophageal gas reflux. Methods: Twenty patients who had undergone Nissen fundoplication and 11 healthy controls underwent oesophageal manometry at rest and during gastric distension for 10 min with 750 ml of gas. Results: Half of the patients reported an inability to belch;the other half reported varying degrees of belching difficulty, most of whom were rarely able to relieve bloating by belching. During gastric distension, none of the patients had transient lower oesophageal sphincter relaxation, while the controls had a median of 1 (range 0-1). Patients had fewer common cavities than controls;however, none of the belch urges experienced during gastric distension in patients was associated with a common cavity, compared with 48 per cent in controls. Conclusion: After fundoplication, patients do not belch as a result of gastro-oesophageal gas reflux;rather it may be due to oesophagopharyngeal reflux of swallowed air. Subjective reporting of belching ability is inaccurate and manometric measurement of common cavities provides a better means of assessment.

关键词：病例对照研究食管/病理生理学胃食管反流/病因学胃食管反流/病理生理学测压法统计学非参数胃/病理生理学成年人老年人女(雌)性人类男(雄)性中年人

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Oral and intravenous dosage forms of pantoprazole are equivalent in their ability to suppress gastric acid secretion in patients with gastroesophageal reflux disease

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第3期95卷 626-633页

作者： Metz, DC Pratha, V Martin, P Paul, J Maton, PN Lew, E Pisegna, JR Univ Penn Sch Med Div Gastroenterol Med CtrDept MedGastrointestinal Physiol Lab Philadelphia PA 19104 USA Clin Applicat Labs San Diego CA USA Wyeth Ayerst Res Dept Clin Pharmacol Radnor PA USA Digest Dis Res Inst Oklahoma City OK USA Univ Calif Los Angeles CURE W Los Angeles Vet Affairs Med Ctr Dept MedDiv Digest DisDigest Dis Res Ctr Los Angeles CA USA

OBJECTIVE: The aim of this study was to assess the ability of pantoprazole to maintain gastric acid suppression in patients with gastroesophageal reflux;disease who are switched from an oral (p.o.) to an intravenous (i.v.) dosage form. METHODS: A total of 65 patients with gastroesophageal reflux disease were administered either 40 or 20 mg of p.o. pantoprazole daily for 10 days, then were switched to either a matching dose of i.v. pantoprazole or to placebo for 7 days. Acid output (basal and maximal) was measured at the end of the p.o. treatment period and on the first and last days of i.v. therapy. In the primary efficacy analysis: the acid output Values at the end of the p.o. pantoprazole treatment were compared with those at the end of the i.v. treatment. Safety was monitored by periodic vital sign measurements, clinical laboratory evaluations, ophthalmic examinations, electrocardiograms, and reports of adverse events. The data were tested by an analysis of covariance and by Wilcoxon signed rank and t tests. RESULTS: Maximal acid output (mean +/- SD) in the 40 mg and 20 mg pantoprazole group after p.o. treatment was 6.5 +/- 5.6 mEq/h and 14.5 +/- 15.5 mEq/h, respectively;whereas, at the end of the i.v. treatment period, the Values were 6.6 +/- 6.3 mEq/h and 11.1 +/- 10.2 mEq/h. respectively. In patients given i.v. placebo, acid output was significantly (p < 0.05) increased to 29.2 +/- 13.0 mEq/h by day 7. Both p.o. and i.v. pantoprazole dosage forms had similar favorable safety and tolerability profiles. CONCLUSIONS: The p.o. and i.v. formulations of pantoprazole (40 and 20 mg) are equivalent in their ability to suppress gastric acid output. The i.v. form of pantoprazole offers an alternative for gastroesophageal reflux disease patients who are unable to take the p.o. formulation. (Am J Gastroenterol 2000;95:626-633. (C) 2000 by Am. Coll. of Gastroenterology).

关键词： 2-吡啶甲基亚硫酰苯咪唑类投药口服抗溃疡病药/投药和剂量苯咪唑类/投药和剂量剂量效应关系药物双盲法胃酸/分泌胃液酸度测定胃食管反流/药物疗法胃食管反流/病理生理学输注静脉内奥美拉唑/类似物和衍生物亚砜类/投药和剂量治疗结果成年人女(雌)性人类男(雄)性中年人

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第8期95卷 1881-1887页

作者： Eloubeidi, MA Provenzale, D Duke Univ Med Ctr Vet Affairs Med Ctr Inst Clin Epidemiol Res Durham NC USA Duke Univ Med Ctr Div Gastroenterol Dept Med Durham NC USA

OBJECTIVES: The aims of this study were: 1) to compare the health-related quality of life (HRQL) of patients with Barrett's esophagus (BE) to that of patients with GERD who did not have BE;2) to compare HRQL of gastroesophageal reflux disease (GERD) patients to that of normative data for the US general population;and 3) to examine the impact of GERD symptom frequency and severity on HRQL. METHODS: The SF-36 and a validated GERD questionnaire were administered to 107 patients with biopsy-proven BE and to 104 patients with GERD but no BE by endoscopy. Frequent symptoms were defined as symptoms that occurred at least once weekly. Severity of symptoms was rated on a scale from 1 to 4 (mild to very severe). RESULTS: In all, 85% of the GERD patients and 82% of BE patients completed the questionnaires. There was no difference in the scores of the eight subscales of the SF-36 between BE patients and those with GERD but without BE (p > 0.05). However, both groups scored below average on all subscales of the SF-36 compared to published US norms for an age- and gender-matched group. Using multivariable linear regression, the social functioning subscale of the SF-36 correlated with the presence of heartburn or acid regurgitation, severity of acid regurgitation, frequency of heartburn, frequency of acid regurgitation, and number of comorbidities. Similarly, the physical functioning subscale correlated with age, frequency of heartburn, and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and the severity of dysphagia, whereas the role emotional subscale correlated with the frequency of heartburn and the presence of dysphagia. CONCLUSIONS: Although there were no differences in HRQL between BE and GERD patients, both groups scored below average on the subscales of the SF-36 compared to normal controls. GERD symptom frequency and severity were

关键词： Barrett食管/并发症 Barrett食管/病理生理学 Barrett食管/心理学胃食管反流/并发症胃食管反流/病理生理学胃食管反流/心理学健康状况胃灼热/病因学胃灼热/病理生理学人际关系多元分析生活质量问卷调查参考值老年人女(雌)性人类男(雄)性中年人

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Area under pH 4: A more sensitive parameter for the quantitative analysis of esophageal acid exposure in adults

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第11期94卷 3139-3144页

作者： Dinelli, M Passaretti, S Di Francia, I Fossati, D Tittobello, A Univ Milan Hosp San Raffaele Gastroenterol Unit I-20132 Milan Italy Deltron Ltd Milan Italy

OBJECTIVE: Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH of reflux episodes. Area under pH 4 (AU4) is a recently introduced parameter that describes the acid exposure rate through both duration and depth of pH falls. METHODS: In Study A, we enrolled 20 healthy controls and 42 patients (18 without esophagitis, 24 with Savary I-III esophagitis) in a study evaluating reference values for 24-h reflux time at pH <4 (RT) and 24-h AU4 by means of receiver operating characteristic (ROC) discriminant analysis. For Study B, we next prospectively applied the resulting cutoffs to 16 healthy controls and to 110 gastroesophageal reflux (GERD) patients (55 with esophagitis) to adjust sensitivity, specificity, and predictive values of both RT and AU4. RESULTS: In Study A, the best cutoff values were 5.1% for RT (Area Index +/- SE, 0.899 +/- 0.038;95% confidence interval [C.I.], 0.796 +/- 0.961) and 36.1 pH x min for AU4 (Area Index +/- SE, 0.935 +/- 0.03;95% C.I., 0.842 +/- 0.981);AU4 gave the best performance (p = 0.038 vs RT) in discriminating controls and GERD patients. In Study B, RT was abnormal in three controls and 79 patients;AU4 identified all the controls and patients with abnormal RT and also 10/31 patients (32.3%) with so-called "normal" acid exposure (according to RT). In the whole GERD group of patients, AU4 and RT specificity was 81.2%, whereas sensitivity was 71.8% for RT and 80.9% for AU4 (chi(2), 61.831;DF, 1;p < 0.005);PPV/NPV were 96.3%/29.5% for RT. and 96.7%/38.2% for AU4. CONCLUSIONS: AU4 appears to be a simple and sensitive quantitative parameter to measure the esophageal acid exposure in adults submitted to 24-h pH monitoring, and it could be an useful clinical aid in evaluating normal RT tests where, from a clinical point of view, a reflux disease is highly likely. (C) 1999 by Am. Cell. of Gastroenterology.

关键词：曲线下面积置信区间吞咽障碍/诊断吞咽障碍/病理生理学判别分析食管炎消化性/诊断食管炎消化性/病理生理学胃酸/分泌胃食管反流/诊断胃食管反流/病理生理学胃灼热/诊断胃灼热/病理生理学氢离子浓度监测生理学试验预期值前瞻性研究 ROC曲线敏感性与特异性时间因素成年人老年人女(雌)性人类男(雄)性中年人

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Effect of sumatriptan, a 5HT₁ agonist, on the frequency of transient lower esophageal sphincter relaxations and gastroesophageal reflux in healthy subjects

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第11期94卷 3158-3164页

作者： Sifrim, D Holloway, RH Tack, J Zelter, A Missotten, T Coulie, B Janssens, J Katholieke Univ Leuven Ctr Gastroenterol Res Louvain Belgium Royal Adelaide Hosp Dept Gastroenterol Adelaide SA 5000 Australia

OBJECTIVE: Meals increase the rate of transient lower esophageal sphincter (LES) relaxations, in part by gastric distension. The 5HT(1) agonist sumatriptan reduces fasting fundic tone, prolongs the meal-induced fundic relaxation, and delays gastric emptying. We therefore hypothesized that sumatriptan might have a significant effect on the rate of postprandial transient LES relaxations and gastroesophageal reflux. We aimed to study the effect of sumatriptan on postprandial transient LES relaxations and reflux in healthy subjects. METHODS: Esophageal manometry and pH monitoring were performed in 13 healthy volunteers for 30 min before and 90 min after a semiliquid meal (790 kcal). Sumatriptan 6 mg subcutaneous (s.c.) or s.c, placebo were administered on separate days 30 min after the meal. RESULTS: Sumatriptan significantly increased postprandial LES pressure from 11.0 +/- 1.2 mm Hg to 17.6 +/- 1.2 mm Hg (p < 0.05). However, reflux events were not diminished. In the contrary, reflux was more frequent after sumatriptan than after placebo (3 [1.5-4.5]/30 min res 2 [0-3]/30 min, p < 0.05). Transient LES relaxations were more frequent after sumatriptan, particularly in the second 30-min period after drug administration (3 [2.5-5]/30 min cs 2 [1.5-2]/30 min, p < 0.05). CONCLUSIONS: Sumatriptan prevents the natural decay in rate of transient LES relaxations that occurs after a meal and favors the occurrence of gastroesophageal reflux despite increasing LES pressure. The sustained postprandial high rate of transient LES relaxations after sumatriptan may be a consequence of a prolonged fundus relaxation and retention of meal in the proximal stomach. (C) 1999 by Am. Cell. of Gastroenterology.

关键词：进食/生理学食管胃接合处/药物作用胃排空/药物作用胃排空/生理学胃底/药物作用胃底/病理生理学胃食管反流/药物疗法胃食管反流/病理生理学氢离子浓度注射皮下肌松弛/药物作用安慰剂压力血清素激动药/投药和剂量血清素激动药/治疗应用单盲法胃/药物作用胃/病理生理学舒马普坦/投药和剂量舒马普坦/治疗应用青少年成年人女(雌)性人类男(雄)性

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Effect of different recumbent positions on postprandial gastroesophageal reflux in normal subjects

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第10期95卷 2731-2736页

作者： van Herwaarden, MA Katzka, DA Smout, AJPM Samsom, M Gideon, M Castell, DO Univ Med Ctr Utrecht Dept Gastroenterol Gastrointestinal Res Unit NL-3508 GA Utrecht Netherlands Univ Med Ctr Utrecht Dept Surg NL-3508 GA Utrecht Netherlands Grad Hosp Philadelphia Dept Med Philadelphia PA 19146 USA

OBJECTIVE: Gastroesophageal reflux (GER) is increased in the right compared to the left recumbent position. Esophageal acid exposure is related to the acidity at the cardia, but the effect of body position on the acidity at the cardia has not yet been investigated. We aimed to investigate the mechanisms underlying increased esophageal acid exposure in the right recumbent position. METHODS: On 2 separate days a 4-h combined esophageal and lower esophageal sphincter (LES) manometry and pH recording of esophagus, gastric cardia, and corpus was performed in the right and left recumbent position after a high fat meal in 10 healthy subjects. RESULTS: In the right recumbent position a prolonged esophageal acid exposure (7.0% vs 2.0%, p < 0.03), a higher incidence of reflux episodes (3.8 vs 0.9/h, p < 0.03), more transient LES relaxations (TLESRs) (6.5 vs 3.2/h, p < 0.03), and higher percentage TLESRs associated with reflux (57.0% vs 22.4% p < 0.03) was recorded than in the left supine position. Acidity at gastric cardia and corpus was not affected by body position. CONCLUSIONS: Increased esophageal acid exposure in the right recumbent position relative to the left recumbent position is the result of a higher incidence of GER episodes caused by an increased incidence of TLESRs and higher percentage of TLESRs associated with GER. Body position does not affect the acidity at the gastric cardia and corpus. (Am J Gastroenterol 2000;95:2731-2736. (C) 2000 by Am. Coll. of Gastroenterology).

关键词：食管胃接合处/病理生理学胃液酸度测定胃食管反流/病理生理学饭后期间/生理学参考值仰卧位/生理学成年人人类男(雄)性中年人

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Saliva in health and disease: an appraisal and update

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INTERNATIONAL DENTAL JOURNAL 2000年第3期50卷 140-161页

作者： Sreebny, LM SUNY Stony Brook Sch Dent Med Dept Oral Biol & Pathol Stony Brook NY 11794 USA

Saliva plays an important role in oral health monitoring, regulating and maintaining the integrity of the oral hard tissues and some soft tissues. This paper reviews the role of saliva, the prevalence of oral dryness and the consequent importance of salivary flow as well as the relationship between xerostomia and salivary gland hypofunction amongst the causes of oral dryness. Other aspects of oral conditions associated with saliva are also reviewed including Sjogren's Syndrome and oesophageal function. Finally, knowledge, and the current use of salivary tests and the utilisation of saliva as a diagnostic fluid are surveyed.

关键词：年龄因素衰老/生理学胃食管反流/病理生理学唾液/生理学唾液/分泌涎腺/药物作用涎腺/辐射效应涎腺/分泌分泌率干燥综合征/病理生理学口腔干燥/流行病学口腔干燥/病理生理学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Supraesophageal complications of gastroesophageal reflux

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DM DISEASE-A-MONTH 2000年第3期46卷 196-232页

作者： Hogan, WJ Shaker, R Med Coll Wisconsin Div Gastroenterol & Hepatol Milwaukee WI 53226 USA

Gastroesophageal reflux (GER) is a recognized cause of esophageal symptoms and inflammatory damage. GER has been suspected of causing complications in structures above the esophagus. Although there is a growing body of clinical and research evidence to support an association of GER with supraesophageal disorders (Table 1), proof of a direct cause-and-effect relationship has been elusive. A variety of issues have prevented the establishment of a firm connection between GER and supraesophageal complications that occur in the bronchopulmonary or laryngopharyngeal areas. The presence of gastric acid in supraesophageal structures has been difficult to document. The classic symptom of heartburn or evidence of inflammatory injury are often absent in patients with suspected supraesophageal problems. Many of these problems occur so frequently in the general population that chance association cannot be ignored. Finally, considerable controversy and disagreement exist in the medical literature about the results of investigations on the role of GER and apparent supraesophageal-related complications. Furthermore, the majority of reports that imply that there is a connection between gastric reflux and supraesophageal disorders are reports of uncontrolled studies of small patient groups.

关键词：食管胃接合处/病理生理学胃食管反流/并发症胃食管反流/诊断胃食管反流/流行病学胃食管反流/病理生理学胃食管反流/治疗喉疾病/诊断喉疾病/病因学喉疾病/治疗呼吸道疾病/诊断呼吸道疾病/药物疗法呼吸道疾病/病因学口颌疾病/诊断口颌疾病/药物疗法口颌疾病/病因学成年人老年人女(雌)性人类中年人

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