胃食管反流病与Barrett食管患者的临床、形态学特征及功能参数。

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Terapevticheskii Arkhiv Pub Date : 2025-08-28 DOI:10.26442/00403660.2025.08.203299

A S Trukhmanov, A V Paraskevova, O A Storonova, A B Ponomarev, A A Makushina, V T Ivashkin

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引用次数: 0

摘要

目的：通过分析胃食管反流病（GERD）患者的临床表现和形态功能诊断结果，探讨预防食管上皮肠上皮化生（IM）发生发展的治疗策略。材料和方法：本研究纳入50例诊断为胃食管反流的受试者。经食管胃十二指肠镜活检及随后食管黏膜形态学检查后，分为两组：胃食管反流合并IM （Barrett食管）患者（n = 19）和无IM的胃食管反流患者（n = 31）。所有参与者都进行了高分辨率食管测压和24小时阻抗pH监测。结果：研究发现，与没有IM的GERD患者相比，合并IM的GERD患者出现强烈烧心和吞咽困难的主诉更为频繁。测压结果显示，胃食管反流合并IM患者食管下括约肌静息压（15.1 [1.3;36.4]mmHg）低于无IM的胃食管反流患者（20.3 [5.5;42.1]mmHg）。差异有统计学意义（p = 0.002）。在胃食管反流和IM患者中，食管运动效果较差；这意味着食管远端可收缩积分减少到276.5 [0.2；无IM的胃食管反流患者则高得多：942.5 [47.3]；3759.7] mmHg × s × cm。吞咽困难与食管运动功能降低有关。在合并IM的胃食管反流患者中，与未合并IM的患者相比，胃酸倒流发生率更高（72.5例[53.5;91.5]vs 54.2例[29.9;78.3];p = 0.036）。食管pH < 4.0的时间比例更高（14.5 [9.7;19.3]vs 10.3 [5.6; 14.9]; p = 0.028）， DeMeester指数值更高（35.4 [1.9;114.5]vs 15.1 [0.2; 47.7]; p = 0.004）。结论：胃食管反流是一种多因素疾病，以上消化道运动功能受损为主要病因。酸性反流可能影响肠型上皮化生的发生。

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[Clinical and morphological features and functional parameters in patients with gastroesophageal reflux disease and Barrett's esophagus].

Aim: To develop a treatment strategy based on the analysis of clinical manifestations and the results of morphofunctional diagnostics for patients with gastroesophageal reflux disease (GERD) aimed at preventing the development and progression of intestinal metaplasia (IM) of the esophageal epithelium.

Materials and methods: The study included 50 subjects diagnosed with GERD. After esophagogastroduodenoscopy with biopsy and subsequent morphological examination of the esophageal mucosa, two groups were formed: patients with GERD complicated by IM, also known as Barrett's esophagus (n = 19), patients with GERD without IM (n = 31). All participants underwent high-resolution esophageal manometry and 24-hour impedance pH monitoring.

Results: The study found that in patients with GERD complicated by IM, complaints of intense heartburn and difficulty swallowing occurred more often than in patients with GERD without IM. According to manometry, the resting pressure of the lower esophageal sphincter in patients with GERD and IM (15.1 [1.3; 36.4] mmHg) was lower than in patients with GERD without IM (20.3 [5.5; 42.1] mmHg). This difference was statistically significant (p = 0.002). In patients with GERD and IM, esophageal motility is less effective; this was translated in a decrease in the distal contractile integral of the esophagus to 276.5 [0.2; 567.7] mmHg × s × cm, while in patients with GERD without IM, it was much higher: 942.5 [47.3; 3759.7] mmHg × s × cm. Difficulties in swallowing were associated with a reduced effectiveness of esophageal motility. In patients with GERD complicated by IM, more acid gastroesophageal refluxes were observed compared to patients without IM (72.5 [53.5; 91.5] vs 54.2 [29.9; 78.3]; p = 0.036). They also have a greater percentage of time with pH < 4.0 in the esophagus (14.5 [9.7; 19.3] vs 10.3 [5.6; 14.9]; p = 0.028) and higher DeMeester index values (35.4 [1.9; 114.5] vs 15.1 [0.2; 47.7]; p = 0.004).

Conclusion: GERD is a multifactorial disease with a primary impairment of the motor function of the upper gastrointestinal tract. The acidic reflux may affect the development of the intestinal type of epithelial metaplasia.

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来源期刊

Terapevticheskii Arkhiv 医学-医学：内科

CiteScore

1.40

自引率

33.30%

发文量

171

审稿时长

3-8 weeks

期刊介绍： Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.