胃食管反流病的检查要点

doi:10.3969/j.issn.1674-490X.2018.02.001

摘要/Abstract

摘要： 胃食管反流病(gastroesophageal reflux disease,GERD)患者的反流物(腐蚀性、刺激性和免疫反应性)不但可到达食管,还可进一步到达口腔、气道等相连的反流通道,继而引起相应部位症状、并发症乃至终末器官效应。GERD的典型症状如反酸、烧心等通常容易识别和治疗,但仍有约30%的患者症状顽固且药物治疗效果不佳。另外,GERD的不典型症状或食管外症状如慢性咽炎、咳嗽、哮喘、胸痛等危害性大,亦非常常见,但人们往往不会把这些症状与来源于胃肠道的胃食管反流这个病因相联系,而容易导致GERD的漏诊。故对于这类患者需要全面的GERD评估和检查以进一步确诊,有助于指导GERD的后续精准治疗。而熟练掌握PPI实验、胃镜、喉镜、造影、反流监测、高分辨率测压和胃蛋白酶检测等则是确立GERD诊断的关键。

关键词: 胃食管反流, 质子泵抑制剂, 胃镜, 反流监测, 高分辨率测压

Abstract: The refluxate(corrosive, irritative and immunoreactive)of gastroesophageal reflux disease(GERD)patient can not only reach the esophagus, but also reach the connected reflux passages, such as oral cavity and airway, and then cause symptoms, complications and terminal organ effects. The typical symptoms of GERD such as acid reflux, heartburn are usually easy to identify and treat, but there are still about 30% of the patients have persistent and proton pump inhibitor(PPI)intractable GERD symptoms. In addition, the atypical symptoms or extraesophageal symptoms of GERD such as chronic pharyngitis, cough, asthma, chest pain are not only very harmful but very common, however people often don’t associate these symptoms with gastroesophageal reflux which derives from the gastrointestinal tract as the etiology, thus easily lead to the misdiagnosis of GERD. The comprehensive examinations to confirm the diagnosis of GERD are needed for these patients, to help guidethe subsequent accurate treatment of GERD. The key to the accurate diagnosis of GERD is to master the PPI test, gastroscope, laryngoscope, contrast, reflux monitoring, high resolution pressure and pepsin test.

Key words: gastroesophageal reflux, proton pump inhibitor, gastroscopy, reflux monitoring, high resolution manometry

中图分类号:

胡志伟,吴继敏,汪忠镐. 胃食管反流病的检查要点[J]. 医学研究与教育, 2018, 35(2): 1-12.

参考文献

[1] 汪忠镐, 胡志伟. 胃食管反流病及其食管外反流:一个常被忽视的重大公共卫生问题[J]. 临床外科杂志, 2016, 24(1): 5-11. DOI:10.3969/j.issn.1005-6483.2016.01.001.
[2] EL-SERAG H B, SWEET S, WINCHESTER C C, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review[J].Gut,2014,63(6):871-880.DOI:10.1136/gutjnl-2012-304269.
[3] FOCK K M, TALLEY N, GOH K L, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett’s oesophagus[J]. Gut, 2016, 65(9): 1402-1415. DOI:10.1136/gutjnl-2016-311715.
[4] BROERS C, TACK J, PAUWELS A. Review article: gastro-oesophageal reflux disease in asthma and chronic obstructive pulmonary disease[J]. Aliment Pharmacol Ther, 2017. DOI:10.1111/apt.14416.
[5] CHANDRA K M, HARDING S M. Therapy Insight: treatment of gastroesophageal reflux in adults with chronic cough[J]. Nat Clin Pract Gastroenterol Hepatol,2007,4(11):604-613. DOI:ncpgasthep0955 [pii] 10.1038/ncpgasthep0955.
[6] BOHNHORST I, JAWAD S, LANGE B, et al. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease[J]. Am J Rhinol Allergy, 2015, 29(3): 70-74. DOI:10.2500/ajra.2015.29.4167.
[7] GROOME M, COTTON J P, BORLAND M, et al. Prevalence of laryngopharyngeal reflux in a population with gastroesophageal reflux[J]. Laryngoscope, 2007, 117(8): 1424-1428. DOI:10.1097/MLG.0b013e31806865cf00005537-200708000-00022 [pii].
[8] 胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流病:胃食管气道反流的多学科研究和实践[J]. 中华胃食管反流病电子杂志, 2015(3): 165-170.
[9] 汪忠镐. 胃食反流与呼吸道疾病:胃食管喉气管综合征[M].2版. 北京:人民卫生出版社,2017:2-5.
[10] 汪忠镐, 刘建军, 陈秀, 等. 胃食管喉气管综合征(GELTS)的发现与命名——Stretta射频治疗胃食管反流病200例[J]. 临床误诊误治, 2007(5): 1-4. DOI:10.3969/j.issn.1002-3429.2007.05.001.
[11] KUO C L, CHEN Y T, SHIAO A S, et al. Acid reflux and head and neck cancer risk: A nationwide registry over 13 years[J]. Auris Nasus Larynx,2015,42(5):401-405. DOI:10.1016/j.anl.2015.03.008.
[12] SOUZA R F. From Reflux Esophagitis to Esophageal Adenocarcinoma[J]. Dig Dis, 2016, 34(5): 483-490. DOI:10.1159/000445225.
[13] ZHANG D, ZHOU J, CHEN B, et al. Gastroesophageal reflux and carcinoma of larynx or pharynx: a meta-analysis[J].Acta Otolaryngol,2014,134(10):982-989.DOI:10.3109/00016489.2014.927592.
[14] 郦振伟, 周水洪. 咽喉反流和喉癌前病变[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(8): 637-639.
[15] 吴俊标, 倪小佳, 陈设, 等. 我国质子泵抑制剂临床实践指南的概况与分析[J]. 中国药学杂志, 2017(18):1649-1654.
[16] 肖英莲, 李延青, 唐承薇, 等. 埃索美拉唑诊断性试验对胃食管反流病诊断价值的随机、双盲、多中心研究[J]. 中华消化杂志, 2008, 28(4): 233-236. DOI:10.3760/j.issn:0254-1432.2008.04.005.
[17] KATZ P O, GERSON L B, VELA M F. Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2013,108(3):308-328.DOI:10.1038/ajg.2012.444.
[18] 胡志伟, 吴继敏, 汪忠镐. 胃食管反流病的现状诊治难点及对策[J]. 中华医学杂志, 2016, 96(12): 988-992. DOI:10.3760/cma.j.issn.0376-2491.2016.12.021.
[19] ORANU A C, VAEZI M F. Noncardiac chest pain: gastroesophageal reflux disease[J]. Med Clin North Am, 2010, 94(2): 233-242. DOI:10.1016/j.mcna.2010.01.001.
[20] McCALLISTER J W, PARSONS J, MASTRONARDE J G. The relationship between gastroesophageal reflux and asthma: an update[J]. Ther Adv Respir Dis,2010,5(2):143-150.DOI:10.1177/1753465810384606.
[21] LIU C, WANG H, LIU K. Meta-analysis of the efficacy of proton pump inhibitors for the symptoms of laryngopharyngeal reflux[J]. Braz J Med Biol Res,2016,49(7). DOI:10.1590/1414-431X20165149.
[22] RASSAMEEHIRAN S, KLOMJIT S, HOSIRILUCK N, et al. Meta-analysis of the effect of proton pump inhibitors on obstructive sleep apnea symptoms and indices in patients with gastroesophageal reflux disease[J]. Proc(Bayl Univ Med Cent), 2016, 29(1): 3-6.
[23] INGEBRIGTSEN T S, MAROTT J L, VESTBO J, et al. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease[J]. Respirology,2015, 20(1): 101-107. DOI:10.1111/resp.12420.
[24] 胡志伟, 吴继敏, 汪忠镐. 胃食管反流病:知己知彼,百战不殆[J]. 临床外科杂志, 2017, 25(1): 8-14.
[25] SAVARINO E, ZENTILIN P, SAVARINO V. NERD: an umbrella term including heterogeneous subpopulations[J].Nat Rev Gastroenterol Hepatol,2013,10(6): 371-380. DOI:10.1038/nrgastro.2013.50.
[26] SAVARINO E, ZENTILIN P, SAVARINO V. Non-erosive reflux disease is more complex than negative endoscopy only[J]. Am J Gastroenterol, 2013, 108(10): 1657-1658. DOI:10.1038/ajg.2013.276.
[27] SAVARINO Z, DUOWU, HE J, et al. Epidemiology of symptom-defined gastroesophageal reflux disease and reflux esophagitis: the systematic investigation of gastrointestinal diseases in China(SILC)[J]. Scand J Gastroentero, 2011, 46(2): 133-141.
[28] BAI Y, DU Y, ZOU D, et al. Gastroesophageal Reflux Disease Questionnaire(GerdQ)in real-world practice: a national multicenter survey on 8065 patients[J]. Journal of Gastroenterology & Hepatology, 2013, 28(4): 626-631.
[29] PIQUE N, PONCE M, GARRIGUES V, et al. Prevalence of severe esophagitis in Spain. Results of the PRESS study(Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional study)[J]. United European Gastroenterology Journal, 2016, 4(2): 229-235. DOI:10.1177/2050640615595916.
[30] KAUL B, PETERSEN H, MYRVOLD H E, et al. Hiatus hernia in gastroesophageal reflux disease[J]. Scand J Gastroenterol,1986, 21(1): 31-34.
[31] AVIDAN B, SONNENBERG A, SCHNELL T G, et al. Hiatal hernia size, Barrett’s length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma[J]. Am J Gastroenterol, 2002, 97(8): 1930-1936. DOI:10.1111/j.1572-0241.2002.05902.x.
[32] WIENBECK M, BARNERT J. Epidemiology of reflux disease and reflux esophagitis[J]. Scand J Gastroenterol Suppl,1989, 24(sup 156): 7-13.
[33] HYUN J J, KIM J H, YEON J E, et al. Short segment hiatal hernia: is it a clinically significant entity?[J].J Neurogastroenterol Motil, 2010,16(1): 35-39. DOI:10.5056/jnm.2010.16.1.35.
[34] 胡志伟, 汪忠镐, 吴继敏,等. 反流性食管炎严重程度与高分辨率测压的食管动力学关系[J]. 中华医学杂志,2017,97(42): 3306-3311. DOI:10.3760/cma.j.issn.0376-2491.2016.12.021.
[35] BIANCHI L K, PANDOLFINO J E, GOELZ K, et al. Esophagogastric junction(EGJ)morphology predicts susceptibility to exercise-induced reflux[J]. Gastroenterology, 2004, 99(8): 1430.
[36] PATTI M G, GOLDBERG H I, ARCERITO M, et al. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury[J]. Am J Surg, 1996, 171(1): 182-186. DOI:10.1016/S0002-9610(99)80096-8.
[37] 胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流病合并食管裂孔疝及哮喘症状的腹腔镜外科治疗[J]. 中华疝和腹壁外科杂志(电子版), 2014(5): 396-402.
[38] PENG S, XIAO Y L, CUI Y, et al. High-dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia[J]. J Gastroenterol Hepatol, 2012, 27(5): 893-898. DOI:10.1111/j.1440-1746.2011.06969.x.
[39] KOHN G P, PRICE R R, DEMEESTER S R, et al. Guidelines for the management of hiatal hernia[J]. Surg Endosc, 2013, 27(12): 4409-4428. DOI:10.1007/s00464-013-3173-3.
[40] AVIDAN B, SONNENBERG A, SCHNELL T G, et al. Hiatal hernia and acid reflux frequency predict presence and length of Barrett’s esophagus[J]. Dig Dis Sci, 2002,47(2): 256-264.
[41] WESTON A P, BADR A S, HASSANEIN R S. Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett’s multifocal high-grade dysplasia or adenocarcinoma[J]. Am J Gastroenterol,1999, 94(12): 3413-3419. DOI:10.1111/j.1572-0241.1999.01602.x.
[42] KRISHNAN K, PANDOLFINO J E, KAHRILAS P J, et al. Increased Risk for Persistent Intestinal Metaplasia in Patients With Barrett’s Esophagus and Uncontrolled Reflux Exposure Before Radiofrequency Ablation[J]. Gastroenterology,2012,143:576-581. DOI:S0016-5085(12)00686-5 [pii] 10.1053/j.gastro.2012.05.005.
[43] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组. 咽喉反流性疾病诊断与治疗专家共识(2015年)[J]. 中华耳鼻咽喉头颈外科杂志,2016, 51(5): 324-326. DOI:10.3760/cma.j.issn.1673-0860.2016.05.002.
[44] VARDAR R, VARIS A, BAYRAKCI B, et al. Relationship between history, laryngoscopy and esophagogastroduodenoscopy for diagnosis of laryngopharyngeal reflux in patients with typical GERD[J]. Eur Arch Otorhinolaryngol,2012, 269(1): 187-191. DOI:10.1007/s00405-011-1748-y.
[45] 许道嵩, 赵宇靖. 吸水试验在胃食管返流X线诊断中的应用[J]. 临床放射学杂志, 2000, 19(1): 50-52.
[46] 方京龙. X线钡餐造影对胃食管反流病的诊断价值[J]. 中国医药科学, 2014(13): 112-114.
[47] 毛朝亮, 周力. X线钡剂造影和胃镜对食管裂孔疝诊断的对比研究[J]. 贵阳医学院学报, 2012, 37(3): 291-293.
[48] BAR-SEVER Z. Scintigraphic evaluation of gastroesophageal reflux and pulmonary aspiration in children[J]. Semin Nucl Med, 2017, 47(3): 275-285. DOI:10.1053/j.semnuclmed.2016.12.001.
[49] 胡荣剑, 潘纪戍, 焦晟, 等. 食管裂孔疝的多层螺旋CT表现(附140例国人正常食管裂孔宽径的测量结果)[J]. 中华放射学杂志,2007, 41(5): 502-506.
[50] 张超, 刘殿刚, 高翔, 等. 动态食管监测在胃食管反流病诊断中的应用与进展[J]. 临床误诊误治,2017, 30(1): 106-112.
[51] SAVARINO E, TUTUIAN R, ZENTILIN P, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy[J]. Am J Gastroenterol, 2010, 105(5): 1053-1061. DOI:ajg2009670[pii] 10.1038/ajg.2009.670.
[52] PATEL A, SAYUK G S, GYAWALI C P. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease[J]. Clin Gastroenterol Hepatol, 2015, 13(5): 884-891. DOI:10.1016/j.cgh.2014.08.029.
[53] ANG D, ANG T L, TEO E K, et al. Is impedance pH monitoring superior to the conventional 24-h pH meter in the evaluation of patients with laryngorespiratory symptoms suspected to be due to gastroesophageal reflux disease?[J]. Journal of Digestive Diseases, 2011, 12(5): 341-348. DOI:10.1111/j.1751-2980.2011.00519.x.
[54] PRAKASH C, CLOUSE R E. Value of extended recording time with wireless pH monitoring in evaluating gastroesophageal reflux disease[J]. Clin Gastroenterol Hepatol,2005, 3(4): 329-334. DOI:S1542356505000212 [pii].
[55] AYAZI S, LIPHAM J C, HAGEN J A, et al. A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold[J]. J Gastrointest Surg, 2009, 13(8): 1422-1429. DOI:10.1007/s11605-009-0915-6.
[56] ZHANG C, HU Z W, YAN C, et al. Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale[J]. World J Gastroenterol, 2017, 23(19): 3546-3555. DOI:10.3748/wjg.v23.i19.3546.
[57] MAZZOLENI G, VAILATI C, LISMA D G, et al. Correlation between oropharyngeal pH-monitoring and esophageal pH-impedance monitoring in patients with suspected GERD-related extra-esophageal symptoms[J]. Neurogastroenterol Motil,2014, 26(11): 1557-1564. DOI:10.1111/nmo.12422.
[58] SUBRAMANIAN C R, TRIADAFILOPOULOS G. Refractory gastroesophageal Reflux disease[J]. Gastroenterology Report, 2015, 3(1): 41-53. DOI:10.1093/gastro/gou061.
[59] TUTUIAN R, CASTELL D O. Clinical application of impedance-manometry for motility testing and impedance-pH for reflux monitoring[J]. Business Briefing: US Gastroenterology Review, 2005:1-5.
[60] FRAZZONI M, CONIGLIARO R, MELOTTI G. Reflux parameters as modified by laparoscopic fundoplication in 40 patients with heartburn/regurgitation persisting despite PPI therapy: A study using impedance-pH monitoring[J]. Digest Dis Sci, 2011, 56(4): 1099-1106. DOI:10.1007/s10620-010-1381-4.
[61] KOHATA Y, FUJIWARA Y, MACHIDA H, et al. Pathogenesis of proton-pump inhibitor-refractory non-erosive reflux disease according to multichannel intraluminal impedance-pH monitoring[J]. J Gastroenterol Hepatol, 2012, 27(Suppl 3): 58-62. DOI:10.1111/j.1440-1746.2012.07074.x.
[62] ZERBIB F, ROMAN S, BRULEY DES VARANNES S, et al. Normal values of pharyngeal and esophageal 24-hour pH impedance in individuals on and off therapy and interobserver reproducibility[J]. Clin Gastroenterol Hepatol, 2013, 11(4): 366-372. DOI:10.1016/j.cgh.2012.10.041S1542-3565(12)01309-2 [pii].
[63] MAINIE I, TUTUIAN R, SHAY S, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance-pH monitoring[J]. Gut, 2006, 55(10): 1398-1402. DOI:10.1136/gut.2005.087668.
[64] SIFRIM D, CASTELL D, DENT J, et al. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux[J]. Gut, 2004, 53(7): 1024-1031.
[65] WIENER G J, RICHTER J E, COPPER J B, et al. The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring[J]. Am J Gastroenterol,1988, 83(4): 358-361.
[66] WEUSTEN B L, ROELOFS J M, AKKERMANS L M, et al. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data[J]. Gastroenterology, 1994, 107(6): 1741-1745. DOI:S0016508594003707 [pii].
[67] BREUMELHOF R, SMOUT A J. The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH recording[J]. Am J Gastroenterol, 1991, 86(2): 160-164.
[68] KHAN M Q, ALARAJ A, ALSOHAIBANI F, et al. Diagnostic Utility of Impedance-pH Monitoring in Refractory Non-erosive Reflux Disease[J]. J Neurogastroenterol Motil, 2014, 20(4): 497-505. DOI:10.5056/jnm.20.49710.5056/jnm14038.
[69] LOOTS C M, BENNINGA M A, DAVIDSON G P, et al. Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux[J]. J Pediatr,2009, 154(2): 248-252. DOI:S0022-3476(08)00700-2 [pii] 10.1016/j.jpeds.2008.08.019.
[70] KESSING B F, BREDENOORD A J, WEIJENBORG P W, et al. Esophageal acid exposure decreases intraluminal baseline impedance levels[J]. Am J Gastroenterol, 2011, 106(12): 2093-2097. DOI:10.1038/ajg.2011.276.
[71] YAMASAKI T, FASS R. Reflux Hypersensitivity: A New Functional Esophageal Disorder[J]. J Neurogastroenterol Motil, 2017, 23(4): 495-503. DOI:10.5056/jnm17097.
[72] PAVIC I, BABIC I, CEPIN B J, et al. The importance of combined 24-hour multichannel intraluminal impedance-pH monitoring in the evaluation of children with suspected laryngopharyngeal reflux[J]. Clin Otolaryngol, 2017, 42(3): 544-549. DOI:10.1111/coa.12766.
[73] SUZUKI T, SEKI Y, OKAMOTO Y, et al. Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms[J]. Surg Endosc, 2017,32(5):2409-2919. DOI:10.1007/s00464-017-5940-z.
[74] ZHANG C, WU J, HU Z, et al. Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring[J]. PLoS One, 2016, 11(8): e0160139. DOI:10.1371/journal.pone.0160139.
[75] HERREGODS T V, PAUWELS A, JAFARI J, et al. Ambulatory pH-impedance-pressure monitoring as a diagnostic tool for the reflux-cough syndrome[J]. Dis Esophagus, 2018,31(1):1-7. DOI:10.1093/dote/dox118.
[76] TENCA A, DE BORTOLI N, MAURO A, et al. Esophageal chemical clearance and baseline impedance values in patients with chronic autoimmune atrophic gastritis and gastro-esophageal reflux disease[J]. Dig Liver Dis, 2017,49(9):978-983. DOI:10.1016/j.dld.2017.04.005.
[77] SALVADOR R, DUBECZ A, POLOMSKY M, et al. A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry[J]. Journal of the American College of Surgeons, 2009, 208(6): 1035-1044.
[78] CASTELL J A, DALTON C B, CASTELL D O. Pharyngeal and upper esophageal sphincter manometry in humans[J]. Am J Physiol, 1990, 258(2 Pt 1): G173-178.
[79] WILSON J A, PRYDE A, CECILIA A, et al. Normal pharyngoesophageal motility. A study of 50 healthy subjects[J]. Dig Dis Sci, 1989, 34(10): 1590-1599.
[80] GOYAL R K, COBB B W. Motility of the pharynx, esophagus and esophageal sphincters[M] //JOHNSON L R. Physiology of the astrointestinal Tract. New York: Raven Press, 1981: 359-391.
[81] ZHU G C, GAO X, WANG Z G, et al. Experimental study for the mechanism of gastroesophageal-reflux-associated asthma[J]. Dis Esophagus, 2014, 27(4): 318-324. DOI:10.1111/dote.12108.
[82] WANG Z, HU Z, WU J, et al. Insult of gastroesophageal reflux on airway: clinical significance of pharyngeal nozzle[J]. Frontiers of medicine, 2014, 9(1): 117-122. DOI:10.1007/s11684-014-0343-1.
[83] BREDENOORD A J, WEUSTEN B L, TIMMER R, et al. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux[J]. Gastroenterology, 2006, 130(2): 334-340. DOI:S0016-5085(05)02234-1[pii] 10.1053/j.gastro.2005.10.053.
[84] SAVARINO E, GEMIGNANI L, POHL D, et al. Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease[J]. Aliment Pharmacol Ther, 2011, 34(4): 476-486. DOI:10.1111/j.1365-2036.2011.04742.x.
[85] HO K Y, KANG J Y. Reflux esophagitis patients in Singapore have motor and acid exposure abnormalities similar to patients in the Western hemisphere[J]. Am J Gastroenterol, 1999, 94(5): 1186-1191. DOI:10.1111/j.1572-0241.1999.01063.x.
[86] QUIGLEY E M. Gastro-oesophageal reflux disease-spectrum or continuum?[J]. QJM, 1997, 90(1): 75-78.
[87] KHAJANCHEE Y S, CASSERA M A, SWANSTROM L L, et al. Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy[J]. Dis Esophagus, 2012. DOI:10.1111/j.1442-2050.2011.01314.x.
[88] FORNARI F, BLONDEAU K, DURAND L, et al. Relevance of mild ineffective oesophageal motility(IOM)and potential pharmacological reversibility of severe IOM in patients with gastro-oesophageal reflux disease[J]. Aliment Pharmacol Ther,2007,26(10): 1345-1354. DOI:APT3525 10.1111/j.1365-2036.2007.03525.x.
[89] LEE J, ANGGIANSAH A, ANGGIANSAH R, et al. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease[J]. Clin Gastroenterol Hepatol,2007,5(12): 1392-1398. DOI:S1542-3565(07)00769-010.1016/j.cgh.2007.08.011.
[90] SIMREN M, SILNY J, HOLLOWAY R, et al. Relevance of ineffective oesophageal motility during oesophageal acid clearance[J]. Gut,2003,52(6): 784-790.
[91] WU J C, CHEUNG C M, WONG V W, et al. Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis[J]. Clin Gastroenterol Hepatol,2007,5(6): 690-695. DOI:S1542-3565(07)00216-910.1016/j.cgh.2007.02.023.
[92] 高岩, 尚占民. 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[J]. 中国实用内科杂志,2008,28(3): 205-207.
[93] 史伟东, 苏秉忠. 无效食管动力对胃食管反流病食管外并发症发病机制及临床意义[J]. 内蒙古医学杂志,2012,44(6): 644-646.
[94] EHERER A. Management of gastroesophageal reflux disease: lifestyle modification and alternative approaches[J]. Dig Dis,2014,32(1/2): 149-151. DOI:10.1159/000357181.
[95] DU X, WANG F, HU Z,et al. The diagnostic value of pepsin detection in saliva for gastro-esophageal reflux disease: a preliminary study from China[J]. BMC Gastroenterol,2017,17(1): 107. DOI:10.1186/s12876-017-0667-9.
[96] 杜兴, 胡志伟, 汪忠镐,等. 胃蛋白酶检测在反流性疾病中的研究进展[J]. 临床误诊误治,2017,30(10):107-112.