摘要
目的：本研究旨在根据不同的诊断技术评估质子泵抑制剂（PPI）对胃食管反流病（GERD）表型和功能性烧心（FH）的反应率：这是一项回顾性、非介入性、单中心研究，提供的是现实生活中的数据。在 1233 名患者中，有 510 名患者同意回答，并通过一份包含 28 个问题的有效问卷进行了评估。患者被分为第一组（54 人）仅根据病史进行诊断；第二组（151 人）根据病史和上消化道内窥镜检查进行诊断；第三组（305 人）根据病史、上消化道内窥镜检查、高分辨率测压和食道内 24 小时动态 pH 值阻抗监测进行诊断。根据最终诊断结果，患者被分为 5 种表型：侵蚀性食管炎（EE）（117 人）、非侵蚀性反流病（NERD）（94 人）、FH（58 人）、反流过敏（RH）（16 人）和巴雷特食管（BE）（20 人）。治疗 8 周后，反应率低于 50%，则视为无应答，需服用双倍剂量。典型症状改善率超过 80% 即为非常好的反应：所有患者对胃灼热和反胃的反应率分别为 85.3% 和 82.2%。第一组患者的胃灼热和反流反应率分别为 79.6% 和 70.4%；第二组分别为 91.4% 和 85.4%；第三组分别为 83.3% 和 82.6%。BE 患者的胃灼热和反流反应率分别为 90% 和 90%，EE 患者的胃灼热和反流反应率分别为 88% 和 87.2%，NERD 患者的胃灼热和反流反应率分别为 85.2% 和 85.1%，RH 患者的胃灼热和反流反应率分别为 68.8% 和 62.5%，FH 患者的胃灼热和反流反应率分别为 72.4% 和 74.1%。烧心和反流的应答率分别为：BE 40%、EE 41.4%、NERD 18.8%、RH 24.1%、FH 15.5%：所有胃食管反流患者的 PPI 反应率均高于西方人群。超过三分之一的患者对烧心和反胃都表现出了很好的反应率。通过所有诊断方式确诊的患者的应答率低于仅通过病史和胃食管返流确诊的患者。Aims: The purpose of this study was to evaluate proton pump inhibitor (PPI) response rates for gastroesophageal reflux disease (GERD) phenotypes and functional heartburn (FH) according to the different diagnostic techniques.
Methods: This was a retrospective, noninterventional, single-center study, presenting real-life data. Among 1,233 patients, 510 patients agreed to respond and were evaluated via a validated questionnaire consisting of 28 questions. Patients were classified into: Group I (n=54) if the diagnosis was based only on history, Group II (n=151) if diagnosis was documented on history and upper gastrointestinal endoscopy (UGE), and Group III (n=305) if diagnosis was based on history, UGE, high-resolution manometry and intraesophageal 24-h ambulatory pH-impedance monitoring. Patients were classified into 5 phenotypes (according to the final diagnosis): erosive esophagitis (EE) (n=117), non-erosive reflux disease (NERD) (n=94), FH (n=58), reflux hypersensitivity (RH) (n=16) and Barrett esophagus (BE) (n=20). A response rate under 50% was accepted as being nonresponsive with double doses after 8 weeks of treatment. A very good response was defined as being over 80% improvement of typical symptoms.
Results: The response rates for heartburn and regurgitation of all the patients were 85.3% and 82.2%, respectively. The heartburn and regurgitation response rates of Group I patients were 79.6% and 70.4%; 91.4% and 85.4% for Group II; whereas 83.3% and 82.6% for Group III. The heartburn and regurgitation response rates of BE were 90% and 90%, for EE 88% and 87.2%, for NERD 85.2% and 85.1%, for RH 68.8% and 62.5% and for FH 72.4% and 74.1%. Response rates for both heartburn and regurgination were 40% in BE, 41.4% in EE, 18.8% in NERD, 24.1% in RH and 15.5% in FH.
Conclusions: We demonstrated higher PPI response rates than Western populations in all the GERD patients. More than 1/3 of the patients exhibited very good response rates for both heartburn and regurgitation. The response rates of patients who were diagnosed via all the diagnostic modalities are lower than those who were diagnosed via only history and UGE.
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