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目的探讨胃食管反流病 (GERD)在以呼吸道症状为主时的发病机理、诊断和治疗。方法对 4 2例以呼吸道症状为主的GERD患者进行内镜检查、2 4小时食管内 pH及胆汁监测 ,给予洛赛克、贝洛钠、铝碳酸镁联合用药治疗 4周。疗程结束后复查内镜及 2 4小时食管内 pH和胆汁监测 ,分析胃酸及胆汁反流在GERD中的发病机理以及联合用药的疗效。结果 4 2例患者均有不同程度反流 ,并以酸反流为主。混合反流者食管炎分级和呼吸道症状较单纯反流者重。联合用药治疗后胃镜检查食管炎症消失 ,食管内pH及胆汁监测均正常。结论GERD的呼吸道症状与反流有关 ,胃酸及胆汁在GERD发病机制中起协同作用。对以呼吸道症状就诊而反复治疗欠佳的患者 ,应考虑GERD的可能。进行胃镜及食管内 pH和胆汁监测能明确诊断。对无条件进行上述检查的患者 ,给予联合用药试验性诊断治疗 ,也可取得满意效果。
Objective To investigate the pathogenesis, diagnosis and treatment of gastroesophageal reflux disease (GERD) with respiratory symptoms. Methods Forty-two GERD patients with respiratory symptoms were selected for endoscopy, 24-hour intra-esophageal pH and bile monitoring. Losec, Bello sodium and magnesium aluminum carbonate were used for 4 weeks. Endoscopy after treatment and 24 hours of esophageal endoscopy and bile monitoring, analysis of gastric acid and bile reflux in the pathogenesis of GERD and the efficacy of combination therapy. Results 42 patients had different degrees of reflux, and the main acid reflux. Mixed reflux of esophagitis grading and respiratory symptoms than those who reflow alone. Gastroesophageal reflux esophagitis disappeared after combination therapy, esophageal pH and bile monitoring were normal. Conclusions Respiratory symptoms of GERD are associated with reflux, and gastric acid and bile play a synergistic role in the pathogenesis of GERD. GERD should be considered in patients who have poor respiratory and respiratory symptoms. Gastroscopy and esophageal pH and bile monitoring can confirm the diagnosis. Unconditionally conducted in patients with these tests, given the combination of experimental diagnosis and treatment, but also to obtain satisfactory results.