Objective: To analyze the clinical characteristics and pathogenesis of refractory gastroesophageal reflux disease(RGERD). Methods: The patients with acid regurgitation, heartburn and extraesophageal symptoms were enrolled in the study from November 2015 to September 2017 at Peking University Third Hospital. All the subjects filled the informed consent.Questionnaire, SCL-90, SAS and SDS scales were recorded. A 24 hour pH-impedance monitoring and esophageal high resonance manometry were carried out. According to the response to proton pump inhibitor(PPI), the patients were divided into RGERD and non-RGERD(NRGERD)groups. The clinical characteristics were compared between these two groups. Logistic regression was used to analyze the risk factors of RGERD. Results: One hundred and nineteen patients were finally enrolled in the study including 61 RGERD (51.3%) and 58 NRGERD patients (48.7%).The body mass index (BMI) and rates of, typical GER symptoms including acid regurgitation in RGERD patients were significantly lower than those in NRGERD patients (P<0.05).While the atypical GER symptoms such as poststernal discomfort or chest pain were more common in RGERD group (P<0.05).RGERD patients presented less acid reflux events and lower proximal segment reflux ratio than NRGERD patients. No obvious differences were found in the manometry metrics between these two groups. The scores of somatization, depression and hostility in RGERD patients by SCL-90 scales were significantly higher than those in NRGERD patients (P<0.05), and depression score was an independent risk factor for RGERD [OR=3.915 (95%CI 1.464-10.466), P =0.007]. Conclusions: RGERD patients present more atypical symptoms and pathological non-acid reflux.Depression is an independent risk factor for RGERD.
目的： 通过分析难治性胃食管反流病（RGERD）患者临床表现及相关检查特征，探讨其发病机制并指导临床诊疗决策。 方法： 纳入2015 年11月至2017 年9月在北京大学第三医院因反酸、烧心及食管外症状就诊的患者，采集临床资料及心理评分资料，包括：症状自评量表SCL-90，Zung氏焦虑量表SAS，Zung氏抑郁量表SDS，完成胃食管反流监测及食管高分辨测压。根据患者对质子泵抑制剂（PPI）治疗的反应，将患者分为RGERD 组及非难治性胃食管反流病（NRGERD）组，比较两组临床表现及相关检查特征，二分类logistic 回归分析RGERD 的独立危险因素。 结果： 共纳入119例患者，其中RGERD 61例（51.3%），NRGERD组58例（48.7%）。RGERD患者体重指数（BMI）、典型症状（反酸）比例显著低于NRGERD组（P<0.05）；但不典型症状（胸骨后不适或胸痛）的比例高于NRGERD组（P<0.05）。RGERD患者酸反流事件及近段反流比例显著低于NRGERD组，但病理性非酸反流事件和基线阻抗值较NRGERD组高（P<0.05）。RGERD 患者在食管高分辨测压基本参数及芝加哥分型的食管动力障碍与NRGERD 组差异无统计学意义。RGERD患者SCL-90评分中躯体化、抑郁、敌对得分显著高于NRGERD组（P值均<0.05），抑郁状态为RGERD的独立危险因素［OR= 3.915 （95%CI 1.464~10.466）， P=0.007］。 结论： RGERD患者非典型症状比例更高，病理性非酸反流增多。抑郁状态为其独立危险因素。.
Keywords: 24 hour pH-impedance monitoring; Esophageal high resolution manometry; Refractory gastroesophageal reflux disease.