Prevalence of Extraesophageal Symptoms in Patients With Gastroesophageal Reflux Disease: A Multicenter Questionnaire-based Study in Korea
Yang Won MinSeong Woo LimJun Haeng LeeHang Lak LeeOh Young LeeJae Myung ParkMyung‐Gyu ChoiPoong‐Lyul Rhee
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Many patients with gastroesophageal reflux disease (GERD) also present with extraesophageal symptoms (EESs). This study sought to determine the prevalence of concomitant EESs and to evaluate quality of life (QOL) impairment in a Korean population with GERD.This questionnaire-based study was carried out from 64 hospitals in Korea between October 2008 and March 2009. Patients with typical GERD symptoms of heartburn or acid regurgitation were recruited for study. Participants filled out questionnaire consisting of GerdQ questions and EES questions. All participants underwent endoscopy and were divided into patients with erosive reflux disease (ERD) and with non-erosive reflux disease (NERD).A total of 1,712 patients were included in this study. Of these, 697 (40.7%) patients had ERD and 1,015 (59.3%) NERD. The prevalence of EES was 90.3%. The most prevalent EES was epigastric burning (73.2%), followed by globus (51.8%), chest pain (48.4%), cough (32.0%), hoarseness (24.2%) and wheezing (17.3%). Individual EES was more prevalent in patients with ERD than in those with NERD. Regarding QOL, 701 patients (41.0%) had sleep disturbance and 676 (37.7%) had taken additional over-the-counter medication for heartburn and/or regurgitation, which were more prevalent in patients with ERD than in those with NERD (49.5% vs. 35.1% and 45.8% vs. 32.2%, respectively; all P < 0.001).The prevalence of EES is high in Korean patients with symptomatic GERD. Individual EES is more prevalent in patients with ERD than in those with NERD. QOL impairment is observed less frequently than previous studies.목적: 최근 아시아에서 시행된 미란 식도염에 관한 연구들에서 유병률은 증가하는 양상을 보이고 있다. 이번 연구에서는 국내 2-3차 병원에서 미란 식도염의 유병률을 조사하고, 관련 증상들을 분석하였다. 대상 및 방법: 2003년 5월부터 7월까지 소화기관련 증상으로 국내 24개 2-3차 병원에서 소화기내과 외래를 방문하여 증상기록지를 작성하고, 처음으로 상부 소화관 내시경검사를 받는 신환들을 대상으로 하였다. 결과: 4,275예의 환자들 중 506예(11.8%)에서 미란식도염이 관찰되었고, 주증상으로 전형적인 위식도역류질환(GERD) 증상을 호소할 때 미란 식도염의 유병률은 16.7%, 한 주에 2회 이상 또는 일상 생활에 영향을 줄 정도로 심한 전형적인 GERD 증상을 보일 때 미란 식도염의 유병률은 19.6%였다. 미란 식도염은 남자, 65세 이상의 여자, 한 주일에 두 번 이상 주증상으로 호소하는 전형적인 GERD 증상, 전형적인 GERD 증상의 개수가 증가할 경우에 유병률이 높았다. 그러나 GERD 증상의 강도와 미란 식도염의 유병률은 관계가 없었다. 가장 흔한 전형적인 GERD 증상은 위산 역류였고, 비전형적인 GERD 증상은 속쓰림이었다. 결론: 국내 2-3차 병원의 소화기내과 외래에 소화기 증상으로 방문하는 환자들에서 미란 식도염의 유병률은 11.8%였고, 전형적인 GERD 증상을 호소하는 경우가 그렇지 않은 경우에 비해 미란 식도염의 유병률이 높았다. 남자, 고령의 여자, 전형적인 GERD 증상의 개수, 한 주에 2회 이상의 빈도를 보이는 전형적인 GERD 증상의 유무가 미란 식도염으로 진단될 가능성을 높이는 독립적인 인자로 관찰되었다.
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瞄准：在与的关系在一张健康一般人口决定胃的食道的倒流疾病(GERD ) 的流行和症状人口统计，在设拉子的生活方式和寻求健康的行为，南部的伊朗。方法：1978 的一个总数 > 使 35 年遭到并且谁指了 Gastroenterohepatology 研究中心完成了在与的关系为 GERD 由 27 个问题组成的一张问询表人口统计，生活方式和寻求健康的行为为五个月的一个时期在这研究被包括。问询表的有效性和可靠性是坚定的。结果：GERD 的流行是 15.4% ，它在女性(17.3%) 是更高的，在农村区域(19.8%) ，并且在有 50.25 年的吝啬的年龄的不识字的题目(21.5%) 和那些。流行在题目是显著地更低的油煎食物(14.8%) ，并且水果和蔬菜(14.6%) 。更多的症状在消费淹菜(22.1%) 的题目被注意，服阿司匹林(21%) 并且在有心理悲痛(27.2%) 和头疼(22%) 的题目。关联是统计上重要的在之间 GERD 和口臭，消化不良(30.6%) ，焦虑(19.5%) ，恶梦(23.9%) 和不安的海角(18.5%)(18.3%) 。他们寻求行为的健康证明有饮食(20%) 的重要限制，草药的药(19%) 的消费，使用普通的药(29.9%) 并且与医生(24.8%) 一起商量。GERD 症状的存在也是显著地与疾病(22.3%) 的以前的家庭历史有关。结论： GERD 在女性是更普通的，农村、不识字的题目并且与淹菜，头疼的出现，心理悲痛，消化不良，口臭，焦虑，恶梦和不安的海角的消费相关，并且 GERD 和阿司匹林吸入的家庭历史，但是关联与脂肪和纤维吸入的消费是否定的。
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2009年に日本消化器病学会より胃食道逆流症 (gastroesophageal reflux disease: GERD) 診療ガイドラインが発刊された. その後, 国内外からの多くの論文が報告され, GERD 診療に関する多くの進歩, 変化がみられた. 特に GERD 治療の第一選択薬であるプロトンポンプ阻害薬 (PPI) 抵抗性 GERD の病態, Barrett 食道に関する研究が多数報告され, これらの2012年6月までの文献エビデンスに基づく改定版が2015年10月に発刊された. 今回の改訂では, 新しくガイドライン作成の標準となりつつある GRADE system を用いて作成が行われている. 今回の改定の主な内容としては, 近年増加してきている PPI 抵抗性 GERD の定義 (標準量の PPI を8週間内服しても ① 食道粘膜傷害が治癒しない and/or ② 胃食道逆流症由来と考えられる症状が十分に改善しない状態) が示された. PPI 抵抗性 GERD に対する治療戦略としては PPI の変更, 消化管運動機能改善薬, 漢方薬, H2RA の追加投与が提案 (推奨度: 2, エビデンスレベル: C) され, また PPI 倍量分割投与が推奨 (推奨度: 1, エビデンスレベル: A) されている. GERD の長期治療戦略も変更され, 重症びらん性 GERD では症状の有無にかかわらず積極的な継続した維持療法が推奨 (推奨度: 1, エビデンスレベル: B) されているのに対して, 軽症びらん性 GERD および非びらん性 GERD では on demand 療法または継続的な維持療法が提案 (推奨度: 2, エビデンスレベル: B) されている. Barrett 食道に関しては, 国内外で定義が異なること, Barrett 食道の発症因子としては, 逆流性食道炎が重要であり, 酸逆流や胆汁逆流が関連している可能性が示されている. また懸念されている Barrett 食道からの発癌に関しては, 本邦からのエビデンスレベルの高い報告はなく, 正確な発癌頻度は不明であるが, 欧米と比較すると本邦の食道腺癌の増加は際立ったものでないことが報告されている.
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Objective To investigate the association between Hp infection and gastroesophageal reflux disease(GERD).Methods One hundred and two patients with GERD by endoscopy for the detection of Hp were divided into the group with Hp(+) and Hp(-).Comparison of the severe degree of reflux esophagitis by endoscopy and the rate of recurrence between the two groups were performed after eradication of the bacterria in 6 and 12 months.Results Detectable rate of severe GERD of Hp(+) and Hp(-) were 35.3% and 64.7% respectively.There was significant difference between the two groups.The total rate of recurrence after eradicating Hp 6 months,12 months in Hp(+) GERD was 66.1%,Hp(-) GERD was 43.3%,there was significant difference.Conclusion The prevalence of severe GERD in Hp(-) was higher than that in Hp(+).The rate of recurrence in Hp(+) GERD was high after eradicating Hp 12 months.Hp may has protective effect for GERD.
Esophagitis
Reflux esophagitis
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背景：胃食道逆流症（GERD）診療ガイドライン2015 ではGERD 診療においてPPI（protonpump inhibitor）が第一選択薬とされているが，症状の改善に十分満足していない患者の存在が問題となっている。目的：①従来のPPI による治療で満足していないGERD 患者，および②症状を有する新規GERD 患者を対象にカリウムイオン競合型アシッドブロッカーであるボノプラザンによる症状改善効果，およびQOL の改善効果を検討する。対象と方法：対象は①従来のPPI によるGERD 治療を8 週以上内服治療を行ったにもかかわらず，GERD 症状の改善効果に満足していない，いわゆるPPI 抵抗性GERD 患者37 例，および②上部消化管内視鏡検査を施行し，逆流性食道炎を認め，かつ症状を有する新規GERD患者159 例。①に対してはボノプラザンへの変更前後に，②に対してはボノプラザン投与前後に，症状はFSSG にて，QOL は出雲スコアを用いて評価した。結果：①PPI 抵抗性GERD 患者にPPI からボノプラザン20 mg/日に変更したところ，FSSG総合スコアは平均6.2 点低下（酸逆流関連症状3.6 点低下，運動不全症状2.6 点低下）を認め，いずれも統計学的に有意差を認めた。出雲スケールは，総合スコアで平均8.3 点低下（胸やけスコア1.8 点低下，胃の痛みスコア1.2 点低下，胃もたれスコア2.1 点低下，便秘スコア1.7点低下，下痢スコア1.5 点低下）を認め，いずれも統計学的に有意であった。②新規GERD 患者に対してボノプラザン20 mg/日を投与したところ，FSSG 総合スコアは平均6.8 点低下（酸逆流関連症状4.0 点低下，運動不全症状2.8 点低下）していた。出雲スケールは，総合スコアで平均9.5 点低下（胸やけスコア2.1 点低下，胃の痛みスコア2.2 点低下，胃もたれスコア1.7 点低下，便秘スコア1.4 点低下，下痢スコア2.1 点低下）を認めた。いずれのスコアも統計学的に有意であった。結論：ボノプラザンによるGERD 治療は，従来のPPI で満足していない症例にも新規患者に対しても有用である可能性が示された。
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Gastroesophageal reflux disease (GERD) is a common chronic condition in the United States, affecting as many as 40% of adults. Although questionnaire-based studies have found the prevalence of the disease to be equal in men and women, the relative prevalence of GERD in males and females has yet to be established by quantitative, clinical evaluation. Moreover, preliminary research suggests that there are gender differences in the pathology and symptomatology of GERD, and the increased prevalence of GERD in pregnancy may indicate that sex hormones play a role in the disease. Additional research is necessary to confirm these findings.
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瞄准：为了分析胃的食道的倒流疾病(GERD ) 的流行，与糖尿病(DM ) 并且到在病人联系了症状发现在糖尿病性神经病和 GERD 症状的流行之间的关系。方法：在这未来的问询表研究， 150 连续类型出席内分泌的诊所的 2 个糖尿病的病人被注册。一位年轻医生帮助了病人理解这些问题。病人们被向了解 GERD 的五很经常的症状的存在那包括的心痛(至少 1/wk ) ，流回，胸痛，声音的嘶哑和长期的咳嗽。有咽峡炎的过去的病历的病人， COPD，气喘，咳嗽从调查由于在糖尿病和明显的精神病学的混乱的发作以前的 ACEI 或先存在的 GERD 被排除。我们进一步基于外部神经病的存在或缺席把病人划分了成二个组。从 150 个病人， 46 有神经病，而 104 个病人没有神经病。数据被表示为吝啬的 +/- SD，并且在那个组在彻底的病人的每个范畴和百分比病人数。在组之间的常态分配与学生 t 相比，在组之间的流行率与为意义的 Chi 平方测试相比。结果：糖尿病的平均持续时间是 9.2 年和这的平均 HbA1c 水平组织的 12 +/- 是 7.7%+/-2.0% 。吝啬的重量和 BMI 是 198 +/- 54 磅。并且 32 +/- 7.2 kg/m2。百分之四十(61/150 ) 病人们报导(45/150 ) GERD 的至少一症状和百分之三十报导了每周一次至少有心痛。没有神经病， GERD 症状的流行比病人在有神经病的病人是更高的(58.7% 对 32.7% ， P < 0.01 ) 。没有神经病，心痛，胸痛和长期的咳嗽的流行比在病人在有神经病的病人也是更高的(43.5% 对 24% ；10.9% 对 4.8% 和 17.8% 对 6.7% 分别地， P < 0.05 ) 。结论：在类型 2 DM 的 GERD 症状的流行比在一般人口高。我们的数据建议 DM 神经病可以是为开发 GERD 症状的一个重要联系因素。
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瞄准：精确地在一般实践估计 GERD 症状的流行。方法：4139 个连续病人(有 43 年的吝啬的年龄的 2025 个男人和 2114 个女人) 首先在 Toho 大学 Omori 医院出席了一般的药和紧急情况照顾的门诊病人部门，被要求不管他们的主诉对 F 规模问询表作出回应。问询表是一台自我报告仪器，用一种简单、容易理解的语言写，包含 12 个问题。结果：4139 个题目， 1554 个病人(37.6%) 根据他们的 F 规模分数作为 GERD 被识别(> 7 ) 。然而，仅仅为典型 GERD 症状有 45 咨询(1.1%) 。尽管 GERD 症状在所有年龄的成年人是普通的， GERD 的流行在 20-29 年年龄组是最高的，年龄组 70-79 年为男性和女性有最低流行。结论：尽管有高率，在我们的主要照顾人口显示 GERD，仅仅， 1.1% 门诊病人与 GERD 症状的主诉出席了我们的医院。因为大约三分之一个个 GERD 病人被不正常的症状影响，一般医生需要关于外推小心这些结果到有除典型 GERD 症状以外的主诉的病人。
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Aim: The aim of this study was to investigate the role of bile and acid reflux in the pathogenesis of reflux oesophagitis (RE) in children. Methods: A total of 44 patients aged 5–17 years with gastro‐oesophageal reflux symptoms were enrolled. Simultaneous 24‐h oesophageal Bilitec 2000 (Medtronic Instruments, Minneapolis, MN, USA) bilirubin monitoring and pH monitoring, in biopsy of oesophageal mucosa by gastro‐endoscopy, were performed in all patients. Results: According to the diagnostic criteria of pathological acid reflux and pathological bile reflux, 10 of 44 cases (22.7%) had acid reflux, 10 (22.7%) had isolated bile reflux, 16 (36.4%) had mixed acid and bile reflux, and the other eight (18.2%) had no reflux. Significant difference was observed in the ratio of different patterns of reflux between the RE group (26 cases) and the non‐erosive reflux disease (NERD) group (18 cases) (χ 2 = 9.096, P < 0.01). All the parameters of acid reflux in the RE group were higher significantly than that in the NERD group ( P < 0.05 or P < 0.01). A total of 20 out of 26 cases (76.9%) with RE had oesophageal acid reflux as against six out of 18 cases (33.3%) in patients with NERD ( P < 0.01). The difference of each parameter of bile reflux had not reached significance between the two groups. Conclusions: Mixed reflux is the predominant form of reflux in the causation of oesophageal mucosal injury in children. Isolated bile reflux also plays a role in the development of RE, although only in patients without acid reflux.
Nerd
Bile reflux
Pathogenesis
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