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目的研究胃食管反流病(GERD)不同亚型患者的精神心理异常及其对患者自然病史的影响。方法对临床考虑GERD的患者行胃镜和24 h胃食管pH值监测.询问并填写症状问卷。调查反流症状的发作频率和严重程度,患者自填SCL-90评分表。对初诊后1年以上的患者再次进行症状和治疗情况询问。结果115例患者随访12～37个月,平均(18.0±6.1)个月。GERD患者躯体化、焦虑、抑郁、强迫和精神病性因子分及异常项目数高于正常值;反流性食管炎(RE)患者躯体化、焦虑、抑郁、强迫和异常项目数等项高于正常值;非糜烂性胃食管反流病(NERD)患者躯体化、精神病性和异常项目数高于正常值,上述差异均有统计学意义(P<0.05)。在无病理性酸反流的NERD患者中,随访时有症状组的躯体化、强追、人际关系敏感、偏执、其他及总分明显高于无症状组。在GERD患者中.持续用药组的躯体化、抑郁、敌对、偏执、精神病性、其他等6项因子分和总分均明显高于非用药组。结论GERD患者总体及其不同亚型均有多种异常精神心理特征。在无病理性酸反流的NERD患者中,精神心理异常是影响其长期症状有无的重要因素。精神心理异常的患者宜采用持续性药物治疗方式。
Objective To investigate the psychiatric disorders in patients with different subtypes of gastroesophageal reflux disease (GERD) and their impact on the natural history of patients. Methods Gastroscopy and 24-h gastro-esophageal pH monitoring were performed on patients with clinically considered GERD. Questioning and completing the questionnaire were completed. To investigate the frequency and severity of recurrent symptoms, patients self-fill SCL-90 score sheet. For patients who have been diagnosed for more than 1 year after initial diagnosis, ask about symptoms and treatment again. Results A total of 115 patients were followed up for 12 to 37 months (mean, 18.0 ± 6.1) months. The number of somatization, anxiety, depression, obsessive-compulsive disorder and psychotic factors in GERD patients were higher than normal. The number of somatization, anxiety, depression, forced and abnormal items in patients with reflux esophagitis (RE) was higher than normal (P <0.05). The number of somatization, psychosis and abnormal items in non-erosive gastroesophageal reflux disease (NERD) patients were higher than normal values. In patients with NERD without pathological acid reflux, there was a tendency of somatization, strong chase, interpersonal sensitivity and paranoid in the symptom group at the follow-up, and the others and the total score were significantly higher than those in the asymptomatic group. In GERD patients, the scores of somatosensory, depression, hostility, paranoid, psychotic, and others in continuous medication group were significantly higher than those in non-medication group. Conclusion There are many abnormal psychopathological features in GERD patients and their subtypes. In NERD patients without pathological acid reflux, psychiatric abnormalities are important factors affecting their long-term symptoms. Patients with abnormal mental health should adopt continuous drug treatment.