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抗胃食管反流机制及胃食管反流病非药物治疗途经的研究
【作者】 孙晓红；
【作者基本信息】 中国协和医科大学 ， 内科学， 2002， 博士
【摘要】 胃食管反流病(gastroesophageal reflux disease，GERD)是指胃、十二指肠内容物反流到食管引起食管内、外的一系列临床表现。是多因素促成的上胃肠道动力障碍、与酸相关的慢性病。本症易反复发作。目前主要采用抑酸药物对症治疗。虽然抑酸药物能有效缓解临床症状和治愈反流性食管炎，但不能增强和恢复食管的抗反流功能，停药后易复发。常需要长期药物维持治疗，甚至需终身应用抑酸剂。本研究的目的通过对影响上胃肠动力相关因素的深入研究，寻找有效的、能够改善抗反流功能的治疗方法。 研究方法 (1) 对156例应用抑酸药物治疗的GERD患者进行疗效分析，探讨GERD药物疗效的影响因素。(2) 观察内镜阴性和内镜阳性GERD的食管粘膜组织学变化；通过免疫组化，观察食管粘膜肥大细胞计数及其活化性在GERD发病中的作用；观察GERD患者食管粘膜NSE、SP、5-TH以及TGF-α的表达与反流程度和症状之间的关系。(3) 应用食管压力和食管pH同步监测的方法，探讨膈脚张力在抗胃食管反流中的作用；在生理状态下，观察食物的质和量对8例健康人(HS)(每一研究对象间隔1周，重复3次，进不同试餐接受食管测压和食管pH监测)和8例GERD患者(每一研究对象间隔1周，重复2次，进不同试餐接受食管测压和食管pH监测)食管动力和酸反流机制的影响。(4) 对37例GERD患者进行自主神经功能的评定，探讨GERD自主神经功能状态及其与食管动力、反流性食管炎的程度、反流症状之间的关系；(5) 对于门诊顺序入组的19例GERD患者进行膈肌生物反馈训练，疗程为8周，探讨膈肌生物反馈训练对EGJ的加强作用，及对GERD的疗效作用。 结果 (1) 对156例GERD患者疗效因素分析，结果显示96.7％的患者药物治疗有效，其中58.9％的患者需间断药物维持治疗，37.8％需长期药物维持治疗，3.3％药物治疗无效。病程长、食管动力功能差、食管炎症程度重、反流症状积分是需要长期维持治疗的影响因素。 (2) 30例GERD患者食管粘膜组织学显示，即使内镜下无反流性食管炎的10
【Abstract】 Gastroesophageal reflux disease (GERD) refers to the effortless movement of gastric contents from the stomach or duodenum to the esophagus and producing symptoms and signs within esophagus or extra-esophagus. GERD is a chronic relapsing disease caused by upper gastrointestinal tract motility disfunction. Symptoms and esophagitis recur quickly after withdrawal or decrease of drug dosage. Although proton pump inhibitors can relieve symptoms and cure injury of esophagus, long-term therapy is required. This study aimed to investigate the influencing factors of upper gastrointestinal tract motility and find out the alternative therapy for GERD.Methods(1) To evaluate the influencing factors of medication in GERD. (2) To observe inflammation of esophageal mucosa with erosive resophagitis and non-erosive reflux disease. To investigate the effect of mast cell counting and activity in esophageal mucosa on GERD by immunohistochemistry . To investigate the levels of 5-TH 、 NSE、 SP and TGF-α expression in esophageal mucosa by immunohistochemistry in GERD and its relationship with symptoms.(3) To study the roles of diaphragmatic crural barrier and esophageal body clearance in GER and the effect of compositions and amounts of diet in physiological state on frequency of TLESRs and mechanisms of acid reflux episodes in GERD and HS by simultaneous esophageal motility and esophageal pH recording, (4) To evaluated the effect of ANS disfunction on GERD and its relationship with esophageal motility, degree of reflux esophagitis and reflux symptoms. (5) To investigate the effect of diaphragm biofeedback on enhancing the function of EGJ.Results(1) Result of analysis on 156 pts. identified GERD showed that acid supression therapy was effective. 92 pts. (58.9%) requird intermittent maintenance therapy, 59 pts(37.8%) required continuous maintenance therapy and 3(3.3%) pts. showed no effect .The influencing factors of medication therapy in GERD were closely associated with course, symptom score, degree of RE, hiatus hernia and esophageal motility.