Determinants of perception of heartburn and regurgitation
Determinants of perception of heartburn and regurgitation
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DOI：
10.1136/gut.2005.074690
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发表时间：
2006-03-01
期刊：
影响因子：
24.5
通讯作者：
Smout, AJPM
中科院分区：
文献类型：
--
作者：
Bredenoord, AJ;Weusten, BLAM;Smout, AJPM
背景和目的：目前尚不清楚为什么有些反流发作会引起症状，而另一些则不会。我们调查的决定因素的感知胃食管反流。方法：在32例患者的症状提示胃食管反流，24小时动态pH值和阻抗监测后停止抑酸治疗。在20例患者谁至少有一个有症状的反流发作，有症状和无症状的反流发作的特点进行了比较。结果：共检测到1807反流发作，其中203是有症状的。与无症状发作相比，有症状发作与较大的pH值下降（p < 0.001）、较低的最低pH值（p < 0.05）和较高的近端程度（p < 0.005）相关。有症状的反流发作的容量和酸清除时间较长（p < 0.05和p < 0.002）。症状发作前有较高的食管累积酸暴露时间（p < 0.05）。反流前发作的近端程度大于烧心前发作的近端程度; 14.8%的症状性反流发作为弱酸性。总共发生了426次纯气体反流事件，其中12次有症状。有症状的单纯气体反流较无症状的气体反流更容易伴有pH值下降（p < 0.05）。结论：当pH值下降较大、反流物近端范围较大、容量和酸清除延迟时，更容易诱发胃灼热和反流。食管的致敏作用发生在酸暴露之前。弱酸性反流是负责只有少数症状的患者停止治疗。与pH值下降相关的纯气体反流（“酸蒸汽”）可被视为胃灼热和反流。
Background and aim: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux.Methods: In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared.Results: A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p < 0.001), lower nadir pH (p < 0.05), and higher proximal extent (p < 0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p < 0.05 and p < 0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p < 0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p < 0.05).Conclusions: Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop ("acid vapour'') can be perceived as heartburn and regurgitation.