CAJ | 학술논문

目的评价内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测和质子泵抑制剂(PPI)试验等方法对胃食管反流病(GERD)相关非心源性胸痛(NCCP)的诊断价值.方法因胸痛而接受冠状动脉造影的连续病例共255例中,符合本研究标准的NCCP患者27例纳入研究,对这些患者行问卷调查、内镜、24 h食管pH和胆汁监测后,予埃索美拉唑20 mg,2次/d,试验14 d.结果 27例NCCP中,若仅以存在糜烂性食管炎和(或)病理性酸反流诊断GERD相关NCCP有9例(33%);若以存在糜烂性食管炎和(或)病理性酸反流、症状指数阳性、病理性胆汁反流之其中1项诊断为GERD相关NCCP则有20例(74%).以后者为GERD相关NCCP的诊断标准,PPI试验的诊断敏感性75%、特异性86%,反流性疾病问卷(RDQ)敏感性35%、特异性86%.结论结合内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测等检查可提高GERD相关NCCP的诊断,PPI试验是临床上诊断GERD相关NCCP的首选方法.
목적 평개내경、24 h식관pH감측、증상지수、24 h식관담즙감측화질자빙억제제(PPI)시험등방법대위식관반류병(GERD)상관비심원성흉통(NCCP)적진단개치.방법 인흉통이접수관상동맥조영적련속병례공255례중,부합본연구표준적NCCP환자27례납입연구,대저사환자행문권조사、내경、24 h식관pH화담즙감측후,여애색미랍서20 mg,2차/d,시험14 d.결과 27례NCCP중,약부이존재미란성식관염화(혹)병이성산반류진단GERD상관NCCP유9례(33%);약이존재미란성식관염화(혹)병이성산반류、증상지수양성、병이성담즙반류지기중1항진단위GERD상관NCCP칙유20례(74%).이후자위GERD상관NCCP적진단표준,PPI시험적진단민감성75%、특이성86%,반류성질병문권(RDQ)민감성35%、특이성86%.결론 결합내경、24 h식관pH감측、증상지수、24 h식관담즙감측등검사가제고GERD상관NCCP적진단,PPI시험시림상상진단GERD상관NCCP적수선방법.
OMective To assess the values of endoscopy,24-hour esophageal pH monitoring,symptom index,24-hour esophageal bile monitoring,and proton pump inhibitor(PPI)trail in the diagnosis of gastroesophgeal reflux disease(GERD)-related noncardiac chest pain(NCCP).Methods 27 NCCP patients,selected from a consecutive sample of 255 patients who had received coronary angiography owing to chest pain,underwent upper endoscopy,and 24-hour esophageal pH and bile monitoring,then they took esomeprazole 20 mg orally twice dally for 14 days.Symptom score(SI)was used to measure the severity and frequency of chest pain before and after treatment.The patients also underwent an initial questionnaire survey including the general personal data and symptom characters,reflux diagnostic questionnaire(RDQ),self-rating anxiety scale(SAS)survey,and self-rating depression scale(SDS)survey.Results If only based on erosive esophagitis and/or abnormal 24-hour esophageal pH monitoring,9 of the 27 patients (33%)were classified as GERD-related NCCP.Otherwise,74%(20 of the 27 patients were classified as GERD-related NCCP based on erosive esophagitis and/or abnormal 24-hour esophageal pH monitoring,or positive SI or abnormal bile monitoring.15 of the 20 GERD patients(75%)had a significant symptom impmvement on PPI compared with 14%(1/7)of non-GERD pailents(P=0.009).The calculated sensitivity and specificity of the PPI trail was 75%and 86%respectively.The typical reflux symptoms presented more frequently among GERD patients than non-GERD patients[65%(13/20)vs 29%(2/7),P=0.185].There was no significant RDQ score difierence between the 2 groups(10±4 vs 8±4,P=0.411).The sensitivity and specificity of RDQ to GERD-related NCCP were 35%and 86%respectively.The SAS scores of GERD and non-GERD-related NCCP patients were both significantly higher than that of the normal controls(P=0.008 and P=0.011),while the SDS scores of the GERD and non-GERD-related NCCP patients were both similar to that of the normal controls(P=0.090 and P=0.113).Conclusion Combination of endoscopy,24-hour esophageal pH monitoring,SI,and 24-hour esophageal bile monitoring helped to improve the diagnosis of GERD-related NCCP.PPI trail is the first clinical diagnostic tool in the evaluation of GERD-related NCCP.