| Objective:1.Compare three diagnostic methods of gastroesophageal reflux disease(GERD): gastroesophageal reflux disease questionnaire(Gerd-Q)score,gastroscopy,proton pump inhibitor(PPI)experimental therapy,differences in the diagnosis of GERD in patients with upper gastrointestinal symptoms and consistency comparison with acid exposure time(AET)>4.2% criteria to explore the best way to diagnose GERD in the real world.2.Analyze the internal composition of three diagnostic results,namely Gerd-Q scale,gastroscopy and 24 h esophageal impediment-pH monitoring(24h MII-pH monitoring),and explore the limitations of different GERD diagnostic methods in clinical application.Methods:From April 2019 to December 2022,90 patients with upper gastrointestinal symptoms who visited the Geriatric Gastroenterology Department of Hebei General Hospital were enrolled.The general data were collected and Gerd-Q questionnaire,gastroscopy,PPI treatment and24 h MII-pH monitoring were performed.With AET > 4.2% as the gold standard for GERD diagnosis,90 subjects were divided into group A(pathological acid reflux group,n=37)and group B(physiological acid reflux group,n=53).To analyze the diagnostic efficacy of Gerd-Q scale,gastroscopy and PPI experimental treatment alone,in combination and in sequence in the real world,and to further analyze the internal composition of the diagnostic results of Gerd-Q scale,gastroscopy and 24 h MII-pH monitoring.Results:1.The drinking rate of group A was higher than that of group B(P <0.05).2.Compared with AET > 4.2%,Gerd-Q had diagnostic efficacy for GERD(P < 0.05),and the diagnostic results were consistent(P < 0.05),but the consistency was poor(Kappa value ≤0.4).The optimal cut-off value was 9,followed by 8,and the corresponding sensitivity and specificity were 73.0% and 64.2%,81.0% and 47.2%,respectively.3.Compared with AET > 4.2%,RE showed by gastroscopy had diagnostic efficacy for GERD(P < 0.05),with a sensitivity of 45.9% and a specificity of 88.7%.The diagnostic results were moderately consistent in "Gerd-Q≥8 points and PPI experimental treatment positive population"(0.4< Kappa value ≤0.6).In "Gerd-Q < 8 and PPI experimental treatment positive population",the consistency was good(Kappa value > 0.6),and the sensitivity and specificity were 100.0% and 87.5%.Among all combined diagnostic models,gastroscopy combined with Gerd-Q scale had the largest AUC for GERD,when the critical value was 0.582,the sensitivity and specificity were 54.1% and 92.5%.It was better than gastroscopy alone or gastroscopy combined with PPI experimental treatment(P < 0.05).Sequence diagnostic analysis showed that the sensitivity and specificity of gastroscopy in the diagnosis of GERD in the population with Gerd-Q < 8 and positive PPI experimental treatment were100.0% and 100%,respectively.4.There was no diagnostic efficacy of PPI test positive alone,combination and sequence in GERD diagnosis(P > 0.05).5.The Gerd-Q scale structure: scores 3～7 were mainly asymptomatic,scores 8～10 and 11～18 were mainly mild and moderate symptoms.The comparison among the three groups and post hoc multiple comparisons showed that there were significant differences between the 3～7 group and the other two groups(P < 0.05/3).The number of patients in group A was 7,10 and 20,respectively.The comparison among the three groups and post hoc multiple comparisons showed that there was a significant difference between the 3～7 group and the 11～18 group(P < 0.05/3).6.Gastroscopic structure,NERD accounted for 74.4%,of which 60%were female,70% were group B,and 64% were PPI trial treatment-negative.The rate of group A in RE was higher than that in NERD,and the difference was statistically significant(P < 0.05).NERD and grade LA-A,B,and C RE,the comparison among the four groups and post hoc multiple comparisons showed that the Hill rate of grade III+IV of NERD was lower than that of grade LA-B or LA-C RE,and the difference was statistically significant(P < 0.05/6).The grade III+IV Hill rate of group B was lower than that of group A,and the difference was statistically significant(P < 0.05).Endoscopic grade IV Hill 100% was group A.7.The pH monitoring structure showed that the prevalence of GERD increased in the first 60 years of life and then began to decrease.The rate of group A in 45～49 years old was higher than that in 35～44 years old,and the difference was statistically significant(P < 0.05).In patients < 55 years old,the male rate in group A was higher than that in group B,and the difference was statistically significant(P < 0.05).In group A,the female rate of ≥55 years old was higher than that of < 55 years old,and the difference was statistically significant(P < 0.05).In 40～44 years old,45～49 years old,50～54 years old and 55～59 years old,the nausea symptom rate in group B was higher in 50～54 years old or 40～44 years old than in 55-59 years old,and the difference was statistically significant(P <0.05/4).Conclusions:1.The drinking rate of pathological acid reflux is higher than that of physiological acid reflux.2.In the diagnosis of pathological acid reflux,Gerd-Q scale has high sensitivity and gastroscopy has high specificity.Gerd-Q scale combined with gastroscopy has good diagnostic efficacy.The diagnostic efficacy of PPI test is poor.3.For patients with atypical esophageal and extra-esophageal symptoms,positive PPI test and gastroscopy showing grade LA-B or above RE have better diagnostic efficacy for pathological acid reflux.4.Gerd-Q can be used to assess the severity of GERD symptoms and predict pathological acid reflux.5.Endoscopic findings of RE were mostly pathological acid reflux.Grade III+IV Hill is correlated with the severity of RE and can predict pathological acid reflux.All grade IV Hill were pathologic acid reflux.6.Pathological acid reflux in young and middle-aged patients was mostly male.Most women with pathological acid reflux are postmenopausal.Physiological acid reflux with nausea is mostly in young and middle-aged people. |
PDF Full Text Request