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目的:评价便携式光纤分光光度计(bilitec2000)24小时监测食管腔内胆红素水平用于诊断十二指肠胃食管反流(DGER)的可行性及可靠性,探讨DGER在胃食管反流病(GERD)中的意义。方法:用便携式光纤分光光度计对60例GERD患者(包括食管炎18例)及33名健康人进行24小时食管腔内胆红素监测,以胆红素吸收值达到或超过0.14作为胆汁反流的阈值,计算反流总次数、反流总时间百分比、反流超过5分钟的次数及最长反流时间。以健康人的反流总时间百分比第九十五百分位作为正常值上限,用于判断GERD患者胆汁反流是否阳性。结果:GERD患者24小时胆汁反流总时间百分比的中位数为1.9%(0～12.6%),高于对照组的0.5%(0～2.1%,P<0.05);食管炎患者相应为3.7%(0.95%～12.6%),明显高于非食管炎患者的1.4%(0～7.6%,P<0.05);GERD患者中有20例(34%)胆汁反流阳性(混合反流);混合反流的20例食管炎占12例(60%),而胆汁反流阴性的39例中食管炎只有6例(15%),P<0.05。10例GERD患者两次监测结果胆汁反流总时间百分比无显著性差异(P>0.05)。结论:用便携式光纤分光光度计监测食管胆红素水平用于诊断DGER是可行和可靠的;34%的GERD患者存在酸和胆汁混合反流,混合反流可加重食管黏膜损害。
OBJECTIVE: To evaluate the feasibility and reliability of bilitec2000 for 24-hour monitoring of bilirubin in esophageal cavity for diagnosing gastroesophageal reflux disease (DGER), and to explore the role of DGER in gastroesophageal reflux disease (GERD) in the meaning. METHODS: Sixty patients with GERD (including 18 with esophagitis) and 33 healthy individuals underwent 24-hour esophageal endoscopic bilirubin monitoring using a portable fiber optic spectrophotometer with a bilirubin absorbance of 0.14 or greater as bile response Flow Threshold, Calculate the total number of reflux, the total reflux time percentage, the number of reflux more than 5 minutes and the longest reflux time. The 95th percentile of the total reflux time of healthy people was used as the upper limit of normal to determine whether bile reflux was positive in GERD patients. Results: The median time to total 24-hour bile reflux in patients with GERD was 1.9% (0-12.6%), which was higher than that of the control group (0.5%, 0-2.1%, P <0.05) and esophagitis was 3.7 % (0.95% ~ 12.6%) were significantly higher than those in non-esophagitis patients (1.4%, 0 ~ 7.6%, P <0.05); 20 cases (34%) had positive biliary reflux (mixed reflux) 20 cases of esophagitis with mixed reflux accounted for 12 cases (60%), whereas in 39 cases with bile reflux negative, only 6 cases (15%) had esophagitis (P <0.05) .10 cases of GERD had two monitoring results bile reflux The percentage of total time had no significant difference (P> 0.05). Conclusion: It is feasible and reliable to monitor the esophageal bilirubin level with a portable fiber spectrophotometer for the diagnosis of DGER. In 34% of patients with GERD, reflux of acid and bile is present, and mixed reflux can aggravate esophageal mucosal damage.