无效食管动力对伴呼吸道症状胃食管反流病发病机制及临床意义的研究

目的 观察伴有呼吸道症状的胃食管反流病(GERD)患者食管动力异常的类型及发生率,探讨无效食管动力(IEM)在其发病机制中的作用及临床意义.方法 应用多功能胃肠动力仪对首都医科大学附属北京朝阳医院2005年1月至2007年1月收治的34例伴有哮喘、慢性咳嗽和咽喉部不适等呼吸道症状的GERD患者进行食管压力测定及24h食管动态pH监测,测定下食管括约肌(LES)压力、食管体部蠕动波幅、蠕动时限及蠕动速度,计算pH＜4的时间百分比,卧位及立位pH＜4的时间百分比,平均食管酸清除时间(pH＜4的时间/酸反流次数),算出DeMeester评分.结果 伴有呼吸道症状GERD组LES压力及食管近端、远端蠕动波幅与典型反流症状GERD组及正常对照组比差异无统计学意义;伴有呼吸道症状CERD组的食管动力异常类型主要表现为IEM,IEM发生率为41.2%,明显高于典型反流症状GERD组(18.5%)及正常对照组(0);在伴有呼吸道症状GERD患者中,存在IEM组患者食管pH＜4的总时间百分比及立、卧位食管pH＜4的时间百分比均明显高于食管动力正常组;IEM组患者卧位食管酸清除时间(pH＜4的时间/酸反流次数)较食管动力正常组明显延长.结论 在伴有呼吸道症状GERD患者中,IEM是其最常见的动力异常类型;IEM与食管内酸暴露总时间及立、卧位时间,卧位食管酸清除时间均密切相关,因此,IEM在伴有呼吸道症状GERD患者的发病机制中起重要作用.     

胃食管反流病与特发性肺间质纤维化的关系

目的 明确特发性肺间质纤维化(IPIF)患者胃食管反流病(GERD)的患病率,探讨GERD与IPIF的关系.方法 对2006年12月至2008年1月在首都医科大学附属北京朝阳医院呼吸科住院确诊的24例IPIF患者进行24 h食管pH监测和食管测压,同期住院的23例非IPIF的弥漫性实质性肺疾病患者作为对照.比较两组患者GERD症状、病理性食管酸暴露及无效食管动力(IEM)的发生率.结果 (1)66.7%(16/24)的IPIF患者存在病理性食管酸暴露,明显高于对照组的26.10k(6/23),P<0.05;(2)在具有病理性酸暴露的IPIF(GERD-IPIF)患者中,87.5%(14/16)存在夜间酸暴露事件;(3)典型GERD症状在GERD-IPIF患者中的发生率只有37.5%(6/16);(4)IPIF组和非IPIF组患者IEM发生率相似,分别为42.9%(9/21)和39.1%(9/23),P>0.05.结论 在IPIF患者中GERD患病率较高,但多数患者没有典型GERD症状,IPIF患者应该进行24 h食管pH监测筛查GERD.     

食管体部动力异常在胃食管反流病中的作用

背景:食管酸暴露增加在胃食管反流病(GERD)的发病中起重要作用。食管体部蠕动不完全或缺乏可造成食管清除功能障碍。目的:评估食管体部动力异常,包括非特异性食管动力紊乱(NEMD)和无效食管收缩(IEM)在GERD患者中的发生率,以及NEMD和IEM与胃食管酸反流和内镜下食管炎的关系,以探讨它们在GERD中的作用。方法:对116例GERD患者行标准食管测压和24h食管pH监测,其中75例患者行内镜检查。结果:98例(84.5%)GERD患者存在食管体部动力异常,其中77例为NEMD,NEMD中8例符合IEM的诊断标准。合并NEMD或IEM的GERD患者的pH<4总时间百分比显著高于食管动力正常患者(8.0%±9.3%和15.7%±13.5%对3.0%±4.7%,P<0.05);立位和卧位pH<4时间百分比亦显著高于食管动力正常患者(立位:8.8%±11.1%和17.4%±21.0%对3.6%±4.1%,P<0.01;卧位:7.0%±10.4%和16.1%±12.2%对2.3%±6.7%,P<0.05)。合并IEM的GERD患者总食管酸清除(EAC)时间和立位EAC时间较食管动力正常患者显著延长(总EAC时间:1.89min/反流±1.82min/反流对0.66min/反流±0.58min/反流,P<0.05;立位EAC时间:1.96min/反流±1.96min/反流对0.59min/反流±0.48min/反流,P<0.05)。75例行内镜检查的GERD患者中,合并NEMD和IEM的患者与食管动力正常患者的内镜下食管炎发生率无显著差异     

无效食管运动与胃食管反流病关系的探讨

目的 探讨无效食管运动(IEM)与胃食管反流病(GERD)的关系.方法 对90例GERD全部进行胃镜检查并做食管压力测定和24h食管动态pH监测,其中反流性食管炎(RE)组62例,非糜烂性反流病(NERD)组28例.研究IEM与食管酸暴露及RE的关系.结果 RE组中确诊IEM 30例(48.4％)明显高于NERD组6例(21.4％)(P＜0.05).36例IEM患者33例(91.7％)食管酸暴露阳性,高于食管动力正常患者( 28/49,57.2％)(P＜0.01);远端食管pH ＜4总反流时间、卧位反流时间百分比、＞5 min长反流周期数、最长反流时间、DeMeester评分IEM者明显高于食管动力正常者(P＜0.01),反流周期数前者明显高于后者(P＜0.05).结论 IEM在GERD中较常见,其食管动力障碍中绝大多数为IEM,IEM与食管远端酸暴露及RE密切相关.     

无效食管运动在胃食管反流病中发病作用的观察

目的　探讨食管无效收缩 (IEM)在胃食管反流病 (GERD)的发病作用。方法　对GERD病人行食管测压和 2 4h食管pH监测 ,分析IEM在GERD的发生率以及比较IEM与食管酸暴露、酸清除和食管炎的关系。结果　 86例GERD病人中 5 9例 (6 8 6 % )存在非特异性食管动力障碍 (NEMD) ;其中 5 5例 (占 93 2 % )符合IEM诊断标准 ;GERD病的IEM发生率为 6 3 95 %。IEM的GERD患者总的pH <4时间 (% ) (5 91)及立位 (4 4 3)和卧位 (6 92 )pH <4时间 (% )显著大于食管正常蠕动的GERD患者 (分别为 3 16 ,1.6 1,和 4 31) ,尤以卧位明显 (P <0 0 1)。IEM患者平均卧位食管酸清除时间 (EAC)为每次 12 6 3min ,显著长于正常食管动力GERD患者的每次 3 15min(P<0 0 1) ,而立位EAC则与正常食管动力组无差异。 2 7例正常食管动力GERD有 10例 (37% )有糜烂性食管炎 ;5 5例IEM患者有 19例 (35 % )有食管炎 ,二组间食管炎发生比例差异无显著性 (P >0 0 5 )。结论　GERD病的食管动力障碍大多数系IEM。IEM比正常食管动力患者更易发生反流和存在食管酸清除障碍。IEM是GERD病的主要异常表现。     

无效食管动力临床特征分析

目的 分析无效食管动力(IEM)的临床特征。方法 选择2021年7月至2022年7月因胃食管反流病(GERD)样症状或吞咽梗阻于四川大学华西医院行高分辨率食管测压及食管24 h pH监测的患者338例。根据IEM发生情况将其分为正常食管动力组(n=264)和IEM组(n=74)。比较两组人口学特征、食管测压数据、酸暴露时间百分比(AET)、临床症状及对质子泵抑制剂治疗的反应情况。结果 IEM组男性人数比例大于正常食管动力组,胃食管结合部(EGJ)基础压低于正常食管动力组,差异有统计学意义(P<0.05)。两组年龄、体质量指数、EGJ分型比较差异无统计学意义(P>0.05)。两组反酸/烧心、胸痛、咽喉不适、吞咽梗阻、非特异症状发生情况比较差异无统计学意义(P>0.05)。IEM组总AET>4.0%、立位AET>6.0%及卧位AET>2.0%人数比例均高于正常食管动力组,差异有统计学意义(P<0.05)。两组抑酸治疗有效率差异无统计学意义(52.08%vs 47.37%;χ²=0.341,P=0.559)。多因素logisti...     

无效食管动力在胃食管反流病中作用的探讨

目的探讨无效食管动力(IEM)在胃食管反流病(GERD)发病中的作用。方法选取2014年7月至2016年2月在上海同济大学附属东方医院就诊的GERD患者,所有患者均接受高分辨率(HRM)食管测压和24h动态pH监测,排除食管-胃连接处(EGJ)压力和(或)形态异常的情况,共纳入49例GERD患者。根据HRM测压下食管远端收缩积分(DCI)将GERD患者分为IEM组、异常动力组和正常动力组。比较各组间食管动力及反流情况。结果 49例GERD患者中,IEM组19例,异常动力组15例,正常动力组15例。IEM组中反流性食管炎所占比例显著高于异常动力组和正常动力组(P0.05),正常动力组与异常动力组相比较差异无统计学意义。IEM组平均吞咽DCI显著低于异常动力组及正常动力组(P0.01),异常动力组显著低于正常动力组(P0.01)。IEM组食管体部蠕动中断长度相较于异常动力组及正常动力组显著延长(P0.01),异常动力组较正常动力组显著延长(P0.01)。各组间酸反流次数、弱酸反流次数、非酸反流次数和总反流次数比较差异无统计学意义。IEM组DeMeester得分及合计酸反流时间较异常动力组及正常动力组显著增加,差异有统计学意义(P0.05),异常动力组及正常动力组DeMeester得分及合计酸反流时间比较差异无统计学意义。49例GERD患者中,平均吞咽DCI与食管蠕动中断长度呈负相关(P0.01),平均吞咽DCI与合计酸反流时间呈负相关(P0.01)。结论 GERD患者中食管动力障碍与酸反流相关,食管体部收缩力度减弱,蠕动中断延长,与酸反流严重程度相关。IEM患者食管收缩力度较弱,酸反流时间较长,更易导致食管炎发生。     

食管动力学障碍不同亚型对胃食管反流病的影响

目的探讨食管动力学障碍不同亚型在胃食管反流病(gastroesophageal reflux disease,GERD)中的作用。方法收集40例GERD典型症状患者,全部行食管高分辨率测压(high-resolution manometry,HRM)和24 h食管动态p H阻抗监测,根据HRM结果,分为动力正常组、失蠕动收缩组、弱蠕动收缩组、间断收缩组。分析食管动力学障碍不同亚型及正常食管动力患者胃食管病理性反流情况。结果 40例典型GERD症状患者中动力正常组10例(25.0%),失蠕动收缩组11例(27.5%),弱蠕动收缩组19例(47.5%),间断收缩组30例(75.0%)。失蠕动收缩组及弱蠕动收缩组反流次数明显多于食管动力正常组(96.7±65.5、92.7±49.1 vs 69.5±31.3,P0.05),以弱酸反流(53.3±52.2、47.7±34.6 vs 20.3±15.3,P0.05)为主;而病理性酸暴露程度无明显差别。与食管动力正常组相比,间断收缩组患者总p H4时间(%)明显升高(8.4±3.9 vs 14.3±7.6,P0.05);De Meester评分有升高趋势,但差异无统计学意义(27.9±43.9 vs 50.6±60.6,P0.05)。结论食管收缩力差的患者更易出现反流次数增加且以弱酸反流为主;而食管收缩模式障碍的患者则与食管远端酸暴露更为相关。     

无效食管动力在胃食管反流病中的作用

胃食管反流病(GERD)是临床上常见的胃肠动力障碍性疾病,食管黏膜的酸暴露是反流性食管炎的主要原因,而食管的酸清除能力在食管黏膜损伤中起着重要作用.近年人们将食管远端大于30%的湿咽蠕动波为低幅蠕动[波幅<30 mm Hg(1 kPa=7.5 mm Hg )]或为非传导性收缩定义为无效食管动力(IEM)[1],并将IEM作为一明确的动力异常提出[2,3].对酸清除与食管动力异常的关系研究较多[4],但目前尚无GERD患者伴IEM发生率及IEM在GERD发生中作用的研究.本研究是为明确IEM在GERD中的发生率及IEM在胃食管酸反流及酸清除、食管黏膜损伤中的作用.     

胃食管反流病患者食管动力紊乱对食管外症状发生的影响

背景:近年来对胃食管反流病(GERD)的食管外症状已有了较深入的了解,但对此类患者的研究多集中于检测反流的存在,而很少正式评估食管动力紊乱在其发病中的作用。目的:研究GERD患者食管动力紊乱对食管外症状发生的影响。方法:39例根据临床表现和内镜检查结果诊断为具有食管炎的GERD患者分为两组,A组:仅有食管症状(n=21);B组:既有食管症状,又有食管外症状(n=18,其中癔球感10例,慢性咳嗽5例,咽痛3例)。采用静态食管测压和24h食管pH监测对两组患者进行研究。结果:B组患者的食管正常蠕动百分比(15.7%±23.3%)和食管不协调蠕动百分比(69.4%±33.6%)分别显著低于和高于A组(55.0%±37.3%和29.8%±32.8%),食管下括约肌(LES)和食管上括约肌(UES)压力均略低于A组,但无显著差异。B组患者的pH<4总时间(218.2min±278.8min)、pH<4反流次数(153.9±181.2)、pH<4总时间百分比(15.6%±20.0%)和立位pH<4时间百分比(17.1%±19.3%)均显著高于A组(83.9min±112.6min、61.2±83.4、5.9%±7.9%和7.1%±9.5%)。结论:食管动力紊乱可使酸反流加重,导致酸直接作用于咽喉部而引起一系列食管外症状。鉴于食管动力紊乱是GERD发病机制中的首要和关键因素,促动力药的应用必不可少。     

Ineffective motility is not a marker for gastroesophageal reflux disease

OBJECTIVE: Previous studies have suggested that ineffective esophageal motility (IEM) may be a marker for gastroesophageal reflux disease (GERD), particularly supraesophageal reflux disease. We evaluated the relationship between esophageal acid exposure and esophageal body motility in patients undergoing both esophageal manometry and 24-h pH metry in the absence of antisecretory therapy. METHODS: We conducted a retrospective database review of 84 patients (mean age 47 yr, 46% male) evaluated in our GI physiology laboratory. The indication for testing was recorded and characterized as esophageal or supraesophageal. Abnormal esophageal acid exposure was defined as a distal esophageal pH <4 for more than 4.2% of the total monitoring time (>6.3% upright, >1.2% supine) or a proximal esophageal acid exposure time of greater than 1.1% total (>1.3% upright, 0% supine). IEM was defined as more than two of 10 ineffective peristaltic waves. RESULTS: Seventy-two patients had esophageal-presenting symptoms, and 12 had supraesophageal symptoms. The prevalence of abnormal esophageal acid exposure was similar in patients with esophageal and supraesophageal symptoms (69% vs 92%, p = 0.17). Abnormal motility was identified in 26 patients (31%). IEM was the most common motility disturbance (77%, 20 patients). The frequency of motility disorders was similar in patients with and without abnormal esophageal acid exposure (30% vs 35%, p = 0.79), in patients with esophageal or supraesophageal symptoms (32% vs 25%, p = 0.75, for all patients; 30% vs 27%, p = 1.00, for patients with abnormal esophageal acid exposure), and among upright, supine, and combined refluxers (33%, 9%, and 35%, p = 0.26).CONCLUSIONS: IEM does not stand alone as a significant marker for the presence of GERD in general or supraesophageal reflux disease in particular.     

Ineffective Esophageal Motility Is a Primary Motility Disorder in Gastroesophageal Reflux Disease

The relationship between esophageal motor abnormalities and GERD has been widely studied. The purpose of this study was to identify the prevalence of ineffective esophageal motility (IEM) in patients with GERD. In addition, we also evaluated esophageal acid exposure, acid clearance, and endoscopic esophagitis in GERD patients with IEM. Of 89 patients enrolled in this study, 47 (52.8%) were found to have nonspecific esophageal motility disorder (NEMD). Forty-four of the 47 (93.6%) patients with NEMD met the diagnostic criteria for IEM. The overall incidence of IEM in GERD patients was 49.4%. Patients with IEM had significant increases in upright and recumbent mean fraction of time pH < 4 (6.70% and 4.38%) and mean recumbent esophageal acid clearance (12.45 min/reflux) when compared to those with other motility findings. Seventeen of the 44 (39%) IEM patients did not have endoscopic esophagitis. On the other hand, 26 of the 39 (67%) patients with normal manometry had endoscopic esophagitis. We concluded that not only is the prevalence of IEM high in GERD, but also that IEM patients have more recumbent gastroesophageal reflux and delayed acid clearance. Combined with endoscopic findings, we propose that IEM can be viewed as a specific entity of primary esophageal motility disorder in patients with GERD.     

以慢性咳嗽为主要表现的胃食管反流病患者的食管功能及反流特点

目的 通过对以慢性咳嗽为主要表现的胃食管反流病(GERD)患者行高分辨食管内压力-阻抗联合测定(MII-HRM)及24h联合多通道腔内阻抗-pH( MII-pH)监测的结果分析,探讨此类患者食管运动功能及胃食管反流的特点.方法 选取2010年3-11月在首都医科大学附属北京朝阳医院就诊的19例GERD伴慢性咳嗽患者为研究对象.应用MII-HRM及24 h MII-pH监测系统测定上食管括约肌(UES)和下食管括约肌压力、食管体部蠕动功能、对液体和黏液性物质的传输功能、立位及卧位酸及非酸反流的次数、近端反流的次数、酸暴露时间、酸清除时间以及食团清除时间.以同期仅表现为典型胃食管反流症状的17例GERD患者作为对照,比较两组间食管运动功能以及胃食管反流参数的差异.结果 与仅表现为典型胃食管反流症状的GERD患者相比,以慢性咳嗽为主要表现的GERD患者的UES静息压力明显更低[(122.55 ±60.48)mm Hg比(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],食管体部异常蠕动的比例更高[(9.47±15.63)％比(22.16±17.45)％,P＜0.05],食管体部对液体物质传输能力减低[(88.82±12.23)％比(71.68±23.06)％,P＜0.05],卧位时酸及非酸反流次数及卧位近端非酸反流次数明显增多(P＜0.05),卧位食团清除时间延长(P＜0.05).结论 以慢性咳嗽为主要表现的GERD发病机制可能与单纯典型GERD不同,其与UES静息压力减低、卧位酸及非酸反流、近端反流的增多以及食管清除功能障碍密切相关.     

伴特发性肺纤维化的胃食管反流病患者夜间酸暴露特点

背景:胃食管反流是特发性肺纤维化(IPF)发生的危险因素之一,夜间反流在胃食管反流病(GERD)食管外表现中起重要作用。目的:研究伴IPF的GERD患者夜间食管酸暴露的特点。方法:选取2006年12月～2008年1月北京朝阳医院收治的16例IPF-GERD患者、32例GERD患者和16例健康志愿者(非GERD)。各组患者行24 h食管pH监测,对夜间8 h内(10pm-6am)的酸暴露程度,包括pH4的时间百分比、酸清除时间、反流次数、长反流(5 min)次数、最长反流时间等指标进行分析。结果:14例(87.5%)IPF-GERD患者存在夜间酸暴露,其程度高于非GERD组(P0.05),而与GERD患者无明显差异(P0.05)。IPF-GERD组患者前半夜pH4的时间百分比显著高于后半夜(12.2%±3.9%对1.1%±0.5%,P0.05),GERD组两者无明显差异(10.8%±2.7%对5.1%±1.8%,P0.05)。结论:大部分IPF-GERD患者存在夜间酸暴露,其主要发生于前半夜。     

酸敏感离子通道3在胃食管反流大鼠中的表达和意义

目的检测酸敏感离子通道3(ASIC3)在胃食管反流大鼠食管黏膜及背根神经节(DRG)中的表达变化,探讨其在胃食管反流病(GERD)发病中的作用。方法将Sprague-Dawley雄性大鼠随机分为实验组(G组)和对照组(S组)。实验组采用限制幽门及结扎胃底方法建立GERD大鼠模型。于造模后15 d处死两组大鼠,通过HE染色对大鼠食管黏膜进行组织病理学检测,通过蛋白质印迹法(Western blotting)和实时定量聚合酶链反应(RT-PCR)检测大鼠食管黏膜及DRG中ASIC3蛋白及mRNA表达变化。结果HE染色显示G组大鼠食管黏膜慢性炎症改变,S组大鼠食管黏膜无异常;Western blotting显示G组大鼠DRG中ASIC3蛋白表达高于S组(6.75±0.74 vs 5.07±0.72)(P0.05),食管黏膜中ASIC3蛋白表达高于S组(8.04±0.67 vs 7.31±0.740)(P0.05);RT-PCR同样显示,G组大鼠DRG中ASIC3 mRNA表达高于S组(0.00030±0.00003 vs 0.00013±0.00002)(P0.05),食管黏膜中ASIC3 mRNA表达高于S组(0.01073±0.00231 vs 0.00088±0.0007)(P0.05)。结论 ASIC3在DRG及食管黏膜上表达上调可能是导致GERD食管内脏高敏感的原因之一。     

Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms

OBJECTIVE: The association of gastroesophageal reflux disease (GERD) and respiratory symptoms is well known. The coexistence of ineffective esophageal motility (IEM, low-amplitude [< 30 mm Hg] or nontransmitted contractions in > or = 30% of 10 wet swallows in the distal esophagus) in patients with GERD has recently been demonstrated. Our aim was to determine the prevalence of IEM in patients with GERD-associated respiratory symptoms. METHODS: Manometry and pH studies of 98 consecutive patients with respiratory symptoms and abnormal reflux shown by pH-metry were reviewed. Symptoms were chronic cough (n = 43), asthma (n = 13), and laryngitis (n = 42). Sixty-six patients with heartburn with no extraesophageal manifestations were used as a control group. Total esophageal acid clearance (EAC) time was calculated for each patient. RESULTS: IEM was the most common motility abnormality seen in all groups of GERD patients. It was seen significantly more often in patients with chronic cough (41%) (p = 0.003) or asthma (53%) (p = 0.01), and numerically more often in patients with laryngitis (31%) than in patients with heartburn (19%). Diffuse esophageal spasm and nutcracker esophagus were rarely seen. Incidence of hypertensive or hypotensive lower esophageal sphincter was similar across all groups. The total EAC time was longer (median: 1.51 min/episode) (p = 0.01) in patients with GERD-associated respiratory symptoms than in patients with heartburn (median: 0.72 min/episode). CONCLUSIONS: IEM is the most prevalent motility abnormality in patients with GERD-associated respiratory symptoms. Coexistence of IEM with GER may place patients at high risk for respiratory symptoms due to the associated delayed esophageal acid clearance seen with this motility abnormality.     

Ineffective esophageal motility in gastroesophageal erosive reflux disease and in nonerosive reflux disease: are they different?

BACKGROUND: In GERD patients, ineffective esophageal motility (IEM), a hypocontractile disorder, is the most common motor abnormality. IEM has been associated with reflux in both the supine and upright position, prolonged esophageal clearance, and delayed of bolus transport. IEM has been equally present in erosive and in nonerosive GERD. GOAL: Considering that reflux has been found to be more severe in erosive GERD than in nonerosive GERD patients and that IEM delays esophageal clearance, our hypothesis is that patients with erosive GERD have more severe IEM than those with nonerosive disease. STUDY: A retrospective review of consecutive manometries of patients with the chief complaint of heartburn and a diagnosis of IEM were performed, and patients with both erosive and nonerosive GERD were selected. According to the number of ineffective contractions, IEM was stratified into three groups: 30% to 40%, mild; 50% to 60%, moderate; and greater than 60%, severe. We also registered the number of low amplitude, failed, and normal waves in each manometry of both groups. We evaluated 110 patients: 70 (64%) with erosive GERD and 40 (36%) with nonerosive GERD. The percentage of mild, moderate and severe IEM was similar in erosive and in nonerosive GERD patients, as well the number of low amplitude, failed or normal waves (P < 0.5). CONCLUSION: There were no differences between the severity of IEM in erosive and in nonerosive GERD patients.     

胃食管反流病患者的临床特征及其影响因素分析

目的分析胃食管反流病(GERD)患者的临床特征以及影响其发生的因素。方法选取深圳市龙岗区横岗人民医院消化内科2011年5月-2013年5月收治的GERD患者146例作为观察组,另选取148例非GERD患者为对照组,探讨其发病的危险因素。结果 GERD患者发生率最高的6项相关症状为反酸、烧心、上腹部不适、吞咽困难、胸痛、胸骨后不适;治疗前观察组Gerd Q得分显著高于对照组(10.63±2.87 vs 4.02±1.81,P0.05),Gerd Q得分自治疗2周后开始与治疗前比较,差异有显著统计学意义(P0.01);后期有消化道外症状的患者(72例)进行消化道外症状(EED)问卷分析,发现观察组自治疗后4周显著改善,差异有显著统计学意义(P0.01);单因素分析显示GERD影响因素包括:年龄、职业、BMI、腰围、辛辣饮食、高盐饮食、H.pylori感染、吸烟、饮酒、便秘。Logistic多元回归分析显示GERD的危险因素由大到小依次为辛辣饮食、年龄、便秘和职业(OR值分别为4.928、3.673、3.452、3.082)。结论 GERD的临床表现以反酸、烧心、上腹部不适等为主,也会表现出EED的症状;养成良好的饮食习惯、保持肠道畅通、戒烟戒酒、注意锻炼和放松等都能够有效预防和减少GERD的发生。