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目的探讨对具有典型胃食管反流病(gastroesophageal reflux disease,GERD)症状的患者进行高分辨食管测压时胃食管连接部(esophagogastric junction,EGJ)形态与胃镜结果及24 h食管pH-阻抗监测结果的相关性。方法收集2015年9月-2016年7月因典型GERD症状于首都医科大学附属北京同仁医院行食管高分辨测压、24 h食管pH-阻抗监测及胃镜的85例患者资料。回顾性分析EGJ形态与胃镜及24 h食管pH-阻抗监测结果的相关性。结果最终纳入病例85例,其中EGJⅠ型者36例,EGJⅡ型者33例,EGJⅢ型者16例。三组间年龄、BMI、腹围比较,差异均无统计学意义(P>0.05)。三组患者内镜下食管炎比例分别为EGJⅠ型53.4%、EGJⅡ型33.3%及EGJⅢ型75.0%,EGJⅢ型患者食管炎发生率明显高于Ⅰ、Ⅱ型,且胃镜下LA-B级及以上食管炎所占比例随EGJ分型升高而升高。EGJⅢ型组相较于Ⅰ型组及Ⅱ型组的AET4、最长酸反流时间、De Meester评分均显著升高(P<0.05),且症状反流相关性阳性者比例最高(18.8%)。EGJⅢ型组酸反流次数显著高于EGJⅠ型组(38.69±33.74 vs 19.69±19.33,P<0.05)。功能性烧心所占比例Ⅰ型最高(16.6%),Ⅲ型最少(6.2%)。结论有典型GERD症状的患者中EGJⅢ型患者食管炎发生率、酸反流次数及症状反流相关性阳性者比例明显高于Ⅰ、Ⅱ型。
Objective To investigate the esophagogastric junction (EGJ) morphology and endoscopy results and the results of 24-h esophageal pH-impedance monitoring in patients with typical gastroesophageal reflux disease (GERD) symptoms under high-resolution esophageal manometry Relevance. METHODS: From September 2015 to July 2016, 85 patients with typical GERD symptoms under high esophagectomy pressure, 24-h esophageal pH-impedance monitoring and gastroscopy at Beijing Tongren Hospital, Capital Medical University were collected. The correlation between the morphology of EGJ and the monitoring results of gastroscopy and 24 h esophageal pH-impedance was analyzed retrospectively. Results The final cases were enrolled in 85 cases, including 36 cases of EGJ Ⅰ type, 33 cases of EGJ Ⅱ type and 16 cases of EGJ Ⅲ type. There was no significant difference in age, BMI and abdominal circumference between the three groups (P> 0.05). The endoscopic esophagitis rates of the three groups were 53.4% for EGJⅠ, 33.3% for EGJⅡ and 75.0% for EGJⅢ, and the incidence of esophagitis in EGJ Ⅲ was significantly higher than those in Ⅰ and Ⅱ, and the gastroscope under LA-B and above The proportion of esophagitis increased with EGJ typing. Compared with type A and group AET4, EGMⅢgroup showed the longest time of acid reflux and De Meester score were significantly increased (P <0.05), and the proportion of patients with positive relapse of reflux syndrome was the highest (18.8%) . EGJ Ⅲ acid reflux group was significantly higher than EGJ Ⅰ group (38.69 ± 33.74 vs 19.69 ± 19.33, P <0.05). The proportion of functional heartburn type Ⅰ highest (16.6%), type Ⅲ at least (6.2%). Conclusions The incidence of esophagitis, the number of acid reflux and the relapse of symptoms and signs of esophagitis in patients with typical GERD were significantly higher than those in patients with type Ⅰ and Ⅱ.