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中华胃食管反流病电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 135 -138. doi: 10.3877/cma.j.issn.2095-8765.2023.03.005

论著

重度反流性食管炎合并消化性溃疡的临床特征分析
贺欢1, 孔文洁1, 高峰1,()   
  1. 1. 830001 乌鲁木齐,新疆维吾尔自治区人民医院消化科/新疆消化系统疾病临床医学研究中心
  • 收稿日期:2023-02-20 出版日期:2023-08-15
  • 通信作者: 高峰

Analysis of clinical characteristics of severe reflux esophagitis complicated with peptic ulcer in 334 patients

Huan He1, Wenjie Kong1, Feng Gao1,()   

  1. 1. Department of Gatroenterology,People's Hospital of Xinjiang Uygur Autonomous Region /Xinjiang Clinical Research Center for Digestive Diseases, Urumqi 830001,China
  • Received:2023-02-20 Published:2023-08-15
  • Corresponding author: Feng Gao
引用本文:

贺欢, 孔文洁, 高峰. 重度反流性食管炎合并消化性溃疡的临床特征分析[J]. 中华胃食管反流病电子杂志, 2023, 10(03): 135-138.

Huan He, Wenjie Kong, Feng Gao. Analysis of clinical characteristics of severe reflux esophagitis complicated with peptic ulcer in 334 patients[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2023, 10(03): 135-138.

目的

分析重度反流性食管炎合并消化性溃疡患者的临床和内镜检查特点。

方法

收集2015年 3月至 2021年2月新疆维吾尔自治区人民医院消化科收治的重度反流性食管炎患者的临床资料,分为合并消化性溃疡和无合并消化性溃疡2组,分析患者的性别、年龄、幽门螺杆菌感染状况。分析重度反流性食管炎合并消化性溃疡患者的溃疡部位和分期。

结果

重度反流性食管炎1866例患者中, 334例合并消化性溃疡,占重度反流性食管炎的17.90%,男女比例 4.39∶1, 与无合并消化性溃疡患者相比性别构成差异有统计学意义(P<0.01),年龄无统计学意义(P>0.05)。患者发病高峰年龄在 40~70岁,合并消化性溃疡中十二指肠球部溃疡260例(77.84%),消化性溃疡并上消化道梗阻108例(32.34%);活动期溃疡186处(53.76%)。重度反流性食管炎合并消化性溃疡幽门螺杆菌感染269例(80.54%),重度反流性食管炎无合并消化性溃疡幽门螺杆菌感染 735例(47.98%),差异有统计学意义(P<0.01)。

结论

重度反流性食管炎常合并消化性溃疡,且男性明显多于女性患者,发病高峰年龄在40~70岁,以十二指肠球部溃疡多见,多为活动期溃疡,常合并上消化道梗阻,幽门螺杆菌感染率高。

Objective

To analyze the clinical and endoscopic features of patients with severe reflux esophagitis complicated with peptic ulcer.

Methods

Data on severe reflux esophagitis diagnosed and treated in the Department of Gastroenterology of Xinjiang Uygur Autonomous Region People's Hospital from March 2015 to February 2021 were collected and divided into 2 groups,combined with peptic ulcer and without combined with peptic ulcer,and the patients' gender,age,and status of Helicobacter pylori infection were analyzed. The ulcer sites and stages of patients with severe reflux esophagitis combined with peptic ulcer were analyzed.

Results

Among 1866 patients with severe reflux esophagitis, 334 patients had combined peptic ulcers, accounting for 17.90% of the patients with severe reflux esophagitis, and the male-to-female ratio was 4.39∶1, which showed a certain difference in the gender composition compared with that of the patients with no combined peptic ulcers (P<0.01), and there was no significant difference in the age (P>0.05). The peak age of onset of the disease was between 40 and 70 years old. Among the combined peptic ulcers, there were 260 cases of duodenal bulb ulcers, accounting for 77.84%; 186 cases of active ulcers, accounting for 53.76%; 108 cases of peptic ulcers with upper gastrointestinal obstruction, accounting for 32.34%,and 269 cases of Helicobacter pylori infections in severe reflux esophagitis combined with peptic ulcers, accounting for 80.54%;735 cases of severe reflux esophagitis without combined peptic ulcers Helicobacter pylori infection, accounting for 47.98%;there was a certain difference between the two groups (P<0.01).

Conclusion

The prevalence rate of severe reflux esophagitis was significantly higher in males than in faremals. The peak age of patients is 40 to 70 years old. Ulcers in the duodenal bulb are common, mostly active ulcers, and are often combined with upper gastrointestinal obstruction and a high rate of H. pylori infection.

表1 重度反流性食管炎合并消化性溃疡内镜特征(例)
表2 重度反流性食管炎合并消化性溃疡内镜特征(处)
1
Fujiwara Y,Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population[J].Gastroenterol,2009,44(6):518-534.
2
Iwakiri K,Kawami N,Sano H,et al.Mechanisms of excessive esophageal acid exposure in patients with reflux esophagitis[J].Dig Dis Sci,2009,54(8):1686-1692.
3
Lundell LR,Dent J,Bennett JR,et al. Endoscopic assessment of oesophagitis:clinical and functional correlates and further validation of the Los Angeles classification[J].Gut,1999,45(2):172-180.
4
Adachi K, Fujishiro H, Katsube T, et al. Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis[J].J Gastroenterol Hepatol,2001,16(11):1191-1196.
5
Dean C, Etienne D, Carpentier B, et al. Hiatal hernias[J].Surg Radiol Anat,2012,34(4):291-299.
6
中华医学会消化病学分会幽门螺杆菌学组.第六次全国幽门螺杆菌感染处理共识报告(非根除治疗部分)[J].中华消化杂志,2022,5(42):289-303.
7
Iwakiri K,Hayashi Y,Kotoyori M,et al.Transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism of gastroesophageal reflux but are not the cause of reflux disease[J].Dig Dis Sci,2005,50(6):1072-1077.
8
van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations[J].Gastroenterology,2000,119(6):1439-1446.
9
Trudgill NJ, Riley SA.Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers[J].Am J Gastroenterol,2001,96(9):2569-2574.
10
李兆申,王雯,许国铭,等.反流性食管炎1827例临床分析[J].中华内科杂志,2001,40(1):9-12.
11
中华消化杂志编委会. 消化性溃疡诊断与治疗规范(2016年,西安)[J].中华消化杂志,2016,36(8):508-513
12
Usai Satta P, Oppia F, Cabras F. Overview of pathophysiological features of GERD[J]. Minerva Gastroenterol Dietol a, 2017,63(3):184-197.
13
Zachariah RA,Goo T,Lee RH. Mechanism and pathophysiology of gastroesophageal reflux disease[J].Gastrointest Endosc Clin N Am,2020,30(2):209-226.
14
Menezes MA,Herbella FAM. Pathophysiology of Gastroesophageal Reflux Disease[J].World J Surg,2017,41(7): 1666-1671.
15
Sharma P,Yadlapati R. Pathophysiology and treatment options for gastroesophageal reflux disease:looking beyond acid[J].Ann N Y Acad Sci,2021,1486(1):3-14.
16
贺欢,高峰. 278例继发性重度反流性食管炎临床特征分析[J/OL].中华胃食管反流病电子杂志,2021, 8(2):77-80.
17
戴益琛,陈文柳,申爱华, 等.幽门狭窄的内镜下气囊扩张治疗[J].临床消化病杂志,2001,13(4):188-189.
18
Cherian PT, Cherian S, Singh P. Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy[J]. Gastrointest Endosc, 2007,66(3):491-497.
19
Ford AC,Delaney B,Forman D,et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients[J].Cochrane Database Syst Rev,2016,4(4):1-102.
20
Ho KY,Cheung TK,Wong BC.Gastroesophageal reflux disease in Asian countries: disorder of nature or nurture?[J]. J Gastroenterol Hepatol,2006,21(9):1362-1365.
21
Jie W, Qinghong X, Zhitao C. Association of Helicobacter pylori infection with gastroesophageal reflux disease[J]. J Int Med Res, 2019, 47(2):748-753.
22
Rokkas T, Ladas SD, Triantafyllou K, et al. The association between CagA status and the development of esophagitis after the eradication of Helicobacter pylori[J].Anm J Med,2001,110(9):703-707.
23
Koike T, Ohara S, Sekine H. Helicobacter pylori infection prevents erosive reflux esophagitis by decreasing gastric acid secretion[J].Gut,2001,49(3):330-334.
24
Fallone CA,Barkun AW,Friedman G. Is Helicobacter pylori eradication associated with gastroesophageal reflux disease?[J].Am J Gastroenterol, 2000,95(11):914-920.
25
Levine A,Milo T,Broide E. Influence of HP eradication on gastroesophageal reflux symptoms and epigastric pain in children and adolescent[J].Pediatrics, 2004, 113(1 Pt 1):54–58.
26
Schwizer W, Thumshirn M, Dent J, et al. Helicobacter pylori and symptomatic relapse of gastro-oesophageal reflflux disease: a randomised controlled trial[J].Lancet,2001,357(9270): 1738-1742.
27
Kountouras J, Zavos C, Polyzos SA, et al. Helicobacter pylori infection and gastroesophageal reflux disease-Barrett's esophagus sequence “dilemma”[J].Ann Gastroenterol,2015,28(1):153.
28
Raghunath A. Prevalence of Helicobacter pylori in patients with gastro-oesphageal reflux disease: systematic review[J].BMJ,2003,326(7392):737.
29
Kountouras J,Chatzopoulos D,Zavos C,et al. Helicobacter pylori infection might contribute to esophageal adenocarcinoma progress in subpopulations with gastroesophageal reflflux disease and Barrett's esophagus[J].Helicobacter,2012, 17(5):402-403.
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