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目的 探讨十二指肠胃食管反流 (DGER)的诊断方法和胆汁反流在胃食管反流病(GERD)中的临床意义。方法 用便携式 pH监测仪及胆红素监测仪 (Bilitec 2 0 0 0 )对 2 0例健康人及 5 2例有烧心、反酸等症状的患者行 2 4h食管腔内 pH和胆红素同步监测 ,以光吸收值≥ 0 .14作为发生胆汁反流的阈值 ,计算 2 4h反流总时间 %等指标。并对 15例酸和胆汁混合反流者用铝碳酸镁加西沙必利治疗 4周 ,然后复查两项监测。结果 2 0例健康人中未发现病理性酸反流 ,5 2例患者中有 4 7例 (包括食管炎 12例 )存在病理性酸反流 ,诊为GERD。胆汁反流总时间 %在健康人组及反流症状组分别为( 0 .4 7± 0 .71) %及 ( 2 .67± 3 .2 3 ) % (P <0 .0 5 ) ,在食管炎及非食管炎者分别为 ( 5 .4 1± 4 .93 ) %及 ( 1.68± 1.76) % (P <0 .0 5 )。 4 7例GERD中 15例 ( 3 2 % )为酸及胆汁混合反流 ,另 3 2例为单纯酸反流 ,前者有食管炎 8例而后者仅为 4例 (P <0 .0 5 )。 15例混合反流经治疗后酸和胆汁反流总时间 %均明显降低 ,8例食管炎中有 7例炎症消退 ,1例减轻。结论 Bilitec 2 0 0 0是评价DGER的有用工具 ,3 2 %的GERD存在酸和胆汁混合反流 ;胆汁反流在GERD食管黏膜损害中起重要作用。
Objective To investigate the diagnostic value of gastroesophageal reflux (DGER) and the clinical significance of bile reflux in gastroesophageal reflux disease (GERD). Methods Twenty-two healthy volunteers and 52 patients with symptomatic heartburn and acid reflux were treated with a portable pH monitor and a bilirubin monitor (Bilitec 2000) for 24 h with intragastric pH and bilirubin Simultaneous monitoring, light absorption value ≥ 0.14 as the threshold for the occurrence of bile reflux, calculate the total reflux time 2 4h and other indicators. And 15 cases of acid and bile mixed reflux with aluminum magnesium carbonate plus cisapride for 4 weeks, and then review the two monitoring. Results No pathologic acid reflux was found in 20 healthy subjects. Pathological acid reflux occurred in 47 of 52 patients (including esophagitis 12) and was diagnosed as GERD. The total time of bile reflux was (0. 47 ± 0.71)% and (2.67 ± 3.23)% (P <0. 05) in healthy and reflux group respectively Esophagitis and non-esophagitis were (5.41 ± 4.93)% and (1.68 ± 1.76)% (P <0.05), respectively. Of the 77 patients with GERD, 15 (32%) had mixed reflux of acid and bile, and the other 32 patients had simple acid reflux. The former had 8 cases of esophagitis and the latter 4 cases (P <0. 05) . The total time of acid reflux and bile reflux were significantly decreased after 15 cases of mixed reflux were treated. Among 8 cases of esophagitis, 7 cases of inflammation subsided and 1 case was relieved. Conclusions Bilitec 2000 is a useful tool for evaluating DGER. Mixed reflux of acid and bile exists in 32% of GERD and bile reflux plays an important role in the damage of esophageal mucosa in GERD.