CAJ | 학술논문

目的调查消化专科就诊人群症状谱的特点,以及胃食管反流病(GERD)合并功能性肠病(FBD)的比例.方法 2011年4-6月对就诊北京大学人民医院消化科门诊的患者进行问卷调查,记录患者一般信息及主诉；利用反流性疾病问卷(RDQ量表)对典型反流症状进行评分,以RDQ评分≥12分诊断GERD,并结合胃镜结果和对质子泵抑制剂治疗的反应来区分反流性食管炎(RE)和非糜烂性反流病(NERD).同时询问患者是否存在腹痛、腹胀、腹泻及便秘等症状,病程≥6个月考虑为慢性病程.按RomeⅢ标准判断是否患有FBD.结果资料可利用的患者为1074例.具有胃食管反流症状者(RDQ评分＞0分)为351例(32.7％),诊断GERD107例(10.0％).具有慢性腹痛、腹胀、腹泻、便秘等任一种症状者404例(37.6％)；诊断肠易激综合征(IBS) 63例,功能性便秘(FC)40例,功能性腹泻28例,功能性腹胀75例,即FBD共计206例(19.2％).胃食管反流典型症状的RDQ评分越高,合并其他胃食管反流相关的食管表现及食管外表现的比例越高,合并慢性腹胀、慢性便秘及IBS、FC的比例也增高(P值均＜0.05).GERD患者合并慢性腹胀、慢性便秘的比例均高于非GERD者[25.2％ (27/107)比16.6％ (160/966),14.0％(15/107)比7.1％(69/966),P值均＜0.05]；26.2％ (28/107) GERD患者合并FBD,其中GERD合并IBS和FC的比例均高于非GERD者[10.3％ (11/107)比5.4％ (52/966),7.5％ (8/107)比3.3％ (32/966),P值均＜0.05].与RE相比,NERD合并多种FBD的比例较高,但差异无统计学意义(P＞0.05).结论 GERD患者常伴有慢性腹胀、慢性便秘等,易合并IBS及FC,且随着GERD症状加重,其重叠比例有增高的趋势.
목적 조사소화전과취진인군증상보적특점,이급위식관반류병(GERD)합병공능성장병(FBD)적비례.방법 2011년4-6월대취진북경대학인민의원소화과문진적환자진행문권조사,기록환자일반신식급주소；이용반류성질병문권(RDQ량표)대전형반류증상진행평분,이RDQ평분≥12분진단GERD,병결합위경결과화대질자빙억제제치료적반응래구분반류성식관염(RE)화비미란성반류병(NERD).동시순문환자시부존재복통、복창、복사급편비등증상,병정≥6개월고필위만성병정.안RomeⅢ표준판단시부환유FBD.결과 자료가이용적환자위1074례.구유위식관반류증상자(RDQ평분＞0분)위351례(32.7％),진단GERD107례(10.0％).구유만성복통、복창、복사、편비등임일충증상자404례(37.6％)；진단장역격종합정(IBS) 63례,공능성편비(FC)40례,공능성복사28례,공능성복창75례,즉FBD공계206례(19.2％).위식관반류전형증상적RDQ평분월고,합병기타위식관반류상관적식관표현급식관외표현적비례월고,합병만성복창、만성편비급IBS、FC적비례야증고(P치균＜0.05).GERD환자합병만성복창、만성편비적비례균고우비GERD자[25.2％ (27/107)비16.6％ (160/966),14.0％(15/107)비7.1％(69/966),P치균＜0.05]；26.2％ (28/107) GERD환자합병FBD,기중GERD합병IBS화FC적비례균고우비GERD자[10.3％ (11/107)비5.4％ (52/966),7.5％ (8/107)비3.3％ (32/966),P치균＜0.05].여RE상비,NERD합병다충FBD적비례교고,단차이무통계학의의(P＞0.05).결론 GERD환자상반유만성복창、만성편비등,역합병IBS급FC,차수착GERD증상가중,기중첩비례유증고적추세.
Objective To analyze the common symptoms in our gastrointestinal (GI) clinic of a general hospital and the prevalence of gastroesophageal reflux disease (GERD) combined with functional bowel diseases (FBD) was also investigated.Methods Data of out-patients who visited GI clinic from April to June,2011 were collected,including demographic information and chief complaints.A validated Chinese Reflux Disease Questionnaire (RDQ) was used to assess the frequency and severity of typical gastroesophageal reflux (GER) symptoms.Reflux esophagitis (RE) and non-erosive gastroesophageal reflux disease (NERD) werc differentiated according to RDQ scores,endoscopic diagnosis,and response to proton pump inhibitors (PPIs).FBD was diagnosed based on Rome Ⅲ criteria.Results Totally 1074 patients (98.3％) had completed the questionnaires.A total of 107 patients(10％) were diagnosed as GERD among 351 patients(32.7％) who had GER symptoms.A total of 404 cases (37.6％)presented symptoms of chronic abdominal pain/bloating,chronic diarrhea/constipation.Totally 206 cases (19.2％) of FBD were diagnosed,including 63 irritable bowl disease (IBS),40 functional constipation and others.RDQ scores were positively correlated with the prevalence of other atypical GER symptoms,as well as chronic bloating,constipation,the incidence of IBS and functional constipation (FC) (P ＜ 0.05).Further,the incidences of chronic bloating[25.2％ (27/107)],chronic constipation[14.0％ (15/107)],IBS [10.3％ (11/107)] and FC[7.5％ (8/107)] in GERD patients were higher than those in non-GERD patients [16.6％(160/966),7.1％ (69/966),5.4％ (52/966),3.3％ (32/966),all P ＜0.05].Higher rate of NERD than RE overlapping with FBD was found,but without statistic significance.Conclusions GERD frequently represents with chronic bloating and constipation,usually overlaps with IBS and FC.The severity of GERD symptoms is associated with higher rate of overlapping with FBDs.