中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
7期
517-520
,共4页
林琳%周丽雅%王晔%卢世芳%张耀朋%丁士刚%林三仁
林琳%週麗雅%王曄%盧世芳%張耀朋%丁士剛%林三仁
림림%주려아%왕엽%로세방%장요붕%정사강%림삼인
胃食管反流%流行病学%症状%胃镜
胃食管反流%流行病學%癥狀%胃鏡
위식관반류%류행병학%증상%위경
Gastroesophageal reflux%Epidemiology%Symptoms%Gastroscopes
目的 探讨以典型的反流症状诊断胃食管反流病(GERD)的临床意义.方法 于2012年5月9日至12月31日不间断纳入首次就诊于北京大学第三医院消化科门诊并接受问卷调查的患者(年龄≥16岁).患者首先完成包含人口学特征及胃食管反流病问卷(GerdQ)评分的自评式问卷,消化科医师根据患者的病情及意愿决定部分患者进行胃镜检查,分析问卷和胃镜结果.结果 本研究最终纳入18 987例患者(应答率91.5%),症状定义的GERD的检出率为13.6% (2 579/18 987).共4 357例(22.9%)患者接受了胃镜检查.胃镜结果:反流性食管炎、Barrett食管、消化性溃疡和恶性肿瘤的检出率分别为13.1% (572/4 357)、1.8% (78/4 357)、10.5% (456/4 357)和1.7%(75/4 357).存在典型反流症状者和无典型反流症状者比较,反流性食管炎的检出率分别为22.7%(216/951)和10.5% (356/3 406) (P <0.001),Barrett食管的检出率分别为2.7% (26/951)和1.5%(52/3 406) (P =0.013),消化性溃疡的检出率分别为6.8% (65/951)和11.5% (391/3 406) (P<0.001),恶性肿瘤的检出率分别为1.7%(16/951)和1.7% (59/3 406) (P =0.917).结论 GERD是我国消化科门诊患者就诊的主要病因之一,典型的反流症状对GERD的诊断具有一定的提示作用,但消化性溃疡和恶性肿瘤存在于相当一部分具有典型反流症状的患者中.存在典型反流症状的患者应联合胃镜检查以防漏诊器质性病变.
目的 探討以典型的反流癥狀診斷胃食管反流病(GERD)的臨床意義.方法 于2012年5月9日至12月31日不間斷納入首次就診于北京大學第三醫院消化科門診併接受問捲調查的患者(年齡≥16歲).患者首先完成包含人口學特徵及胃食管反流病問捲(GerdQ)評分的自評式問捲,消化科醫師根據患者的病情及意願決定部分患者進行胃鏡檢查,分析問捲和胃鏡結果.結果 本研究最終納入18 987例患者(應答率91.5%),癥狀定義的GERD的檢齣率為13.6% (2 579/18 987).共4 357例(22.9%)患者接受瞭胃鏡檢查.胃鏡結果:反流性食管炎、Barrett食管、消化性潰瘍和噁性腫瘤的檢齣率分彆為13.1% (572/4 357)、1.8% (78/4 357)、10.5% (456/4 357)和1.7%(75/4 357).存在典型反流癥狀者和無典型反流癥狀者比較,反流性食管炎的檢齣率分彆為22.7%(216/951)和10.5% (356/3 406) (P <0.001),Barrett食管的檢齣率分彆為2.7% (26/951)和1.5%(52/3 406) (P =0.013),消化性潰瘍的檢齣率分彆為6.8% (65/951)和11.5% (391/3 406) (P<0.001),噁性腫瘤的檢齣率分彆為1.7%(16/951)和1.7% (59/3 406) (P =0.917).結論 GERD是我國消化科門診患者就診的主要病因之一,典型的反流癥狀對GERD的診斷具有一定的提示作用,但消化性潰瘍和噁性腫瘤存在于相噹一部分具有典型反流癥狀的患者中.存在典型反流癥狀的患者應聯閤胃鏡檢查以防漏診器質性病變.
목적 탐토이전형적반류증상진단위식관반류병(GERD)적림상의의.방법 우2012년5월9일지12월31일불간단납입수차취진우북경대학제삼의원소화과문진병접수문권조사적환자(년령≥16세).환자수선완성포함인구학특정급위식관반류병문권(GerdQ)평분적자평식문권,소화과의사근거환자적병정급의원결정부분환자진행위경검사,분석문권화위경결과.결과 본연구최종납입18 987례환자(응답솔91.5%),증상정의적GERD적검출솔위13.6% (2 579/18 987).공4 357례(22.9%)환자접수료위경검사.위경결과:반류성식관염、Barrett식관、소화성궤양화악성종류적검출솔분별위13.1% (572/4 357)、1.8% (78/4 357)、10.5% (456/4 357)화1.7%(75/4 357).존재전형반류증상자화무전형반류증상자비교,반류성식관염적검출솔분별위22.7%(216/951)화10.5% (356/3 406) (P <0.001),Barrett식관적검출솔분별위2.7% (26/951)화1.5%(52/3 406) (P =0.013),소화성궤양적검출솔분별위6.8% (65/951)화11.5% (391/3 406) (P<0.001),악성종류적검출솔분별위1.7%(16/951)화1.7% (59/3 406) (P =0.917).결론 GERD시아국소화과문진환자취진적주요병인지일,전형적반류증상대GERD적진단구유일정적제시작용,단소화성궤양화악성종류존재우상당일부분구유전형반류증상적환자중.존재전형반류증상적환자응연합위경검사이방루진기질성병변.
Objective To explore the clinical significance of typical reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD).Methods Consecutive patients older than 16 years,who initially visited department of gastroenterology at clinic of Peking University Third Hospital from May 9,2012 to Dec 31,2012,were required to complete a self-reported GERD questionnaire.Upper endoscopy was performed in some selected patients.Results A total of 18 987 patients were enrolled with a response rate of 91.5%.The prevalence of symptom-defined GERD was 13.6% (2 579/18 987).A total of 4 357 (22.9%) patients underwent the upper endoscopy,and the diagnostic rates of reflux esophagitis,Barrett's esophagus,peptic ulcer disease,and upper gastrointestinal malignancy were 13.1% (572/4 357),1.8% (78/4 357),10.5% (456/4 357),and 1.7% (75/4 357),respectively.The incidence of reflux esophagitis was 22.7% (216/951) in patients with reflux symptoms and 10.5% (356/3 406) (P <0.001) in patients without reflux symptoms,2.7% (26/951) and 1.5 % (52/3 406),respectively (P =0.013) for Barrett's esophagus; 6.8% (65/951) and 11.5% (391/3 406),respectively (P<0.001) for peptic ulcer disease; 1.7% (16/951) and 1.7% (59/3 406),respectively (P =0.917) for upper gastrointestinal malignancy.Conclusions GERD is one of the major diseases at gastroenterology clinic.Typical reflux symptoms suggest a diagnosis of GERD.But some patients with peptic ulcer disease or upper gastrointestinal malignancy can also present typical reflux symptoms.Upper endoscopy is valuable to avoid the misdiagnosis of other disorders.