目的探讨难治性胃食管反流病的临床特征。方法将质子泵抑制剂治疗有效的胃食管反流病患者51例作为对照组,无效的103例作为难治组。观察两组患者一般资料、胃食管反流病相关症状,采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评定患者精神心理状况,并进行胃镜观察,记录患者幽门螺旋杆菌感染情况及胃镜下食管黏膜炎症分级、Barrett食管情况。结果两组患者性别、年龄、病程、体重指数比较差异均无统计学意义(P>0.05)。难治组患者胸骨后疼痛、嗳气、咽喉梗阻感、呛咳症状及气郁痰阻证的发生率明显高于对照组,烧心的发生率低于对照组(P<0.05)。难治组合并焦虑、抑郁患者数明显多于对照组(P<0.05)。两组患者胃镜下食管黏膜炎症分级、Barrett食管及合并幽门螺旋杆菌感染数比较差异无统计学意义(P>0.05)。结论与质子泵抑制剂治疗有效的胃食管反流病患者相比,难治性胃食管反流病患者临床多表现为疼痛、嗳气、咽喉梗阻感、呛咳,气郁痰阻证多,较易合并心理疾患。 Objective To investigate the clinical features of refractory gastroesophageal reflux disease. Methods Totally 51 cases of patients with gastroesophageal reflux disease treated with proton pump inhibitor were selected as the control group and 103 cases as the refractory group. The general data of two groups were observed. The gastroesophageal reflux disease-related symptoms were evaluated. The anxiety self-rating scale (SAS) and depression self-rating scale (SDS) were used to evaluate the mental health of the patients. Gastroscopy was performed to record the incidence of Helicobacter pylori The esophageal mucosal inflammation was graded according to endoscopy and Barrett’s esophagus. Results There was no significant difference in gender, age, course of disease and body mass index between the two groups (P> 0.05). The incidence of post-sternal pain, belching, throat obstruction, cough symptoms and qi stagnation and phlegm blocking syndrome in patients in refractory group were significantly higher than those in control group, and the incidence of heartburn was lower than that in control group (P <0.05). The number of refractory patients with combined anxiety and depression was significantly higher than that of the control group (P <0.05). Gastroscopy esophageal mucosal inflammation grading, Barrett’s esophagus and Helicobacter pylori infection with no significant difference between the two groups (P> 0.05). Conclusion Compared with patients treated with proton pump inhibitor, patients with refractory gastroesophageal reflux disease have more clinical manifestations of pain, irritation, sore throat, cough, qi and phlegm, and more Easy to merge mental disorders.