Clinical And Experimental Study On Gastroesophageal Reflux Disease

Gastroesophageal reflux disease(GERD) means the symptoms including heartburn and regurgitation, or histionic lesions caused by reflux of overmuch intragastric acid and duodenal juice's to esophagus, usually complicated with reflux esophagitis(RE), and sometimes leading to severe complications such as Barrett's esophagus(BE) and esophageal adcnocarcinoma. lipidemiological mxcstigution in Beijing and Shanghai showed that the symptomatic incidence of GER is 8.97%. the morbidity of GERD is 5.77%, and the incidence of RE is 1.92%. The incidence of BE and EA has been greatly increased over the past several decades. But the etiology and pathogenesis of GERD, RE, BE and EA remains unclear, which influenced the diagnosis of them to some degree.Clinical Study We investigated the status of DGR in the occurrence of chronic gastritis, GER and DGER in the occurrence of RE, and investigated the occurrence of GER and DGER in the patients performed different kind of gastrectomies. At the same time, we studied the relationship between pH and bile reflux in the stomach and esophagus, in order to discuss whether the monitoring of bile reflux could be substituted by the monitoring of acid.Experimental Study In this Experiment, in oder to find out the actions of the genes of PCNA and p53 in the genesis of RE, BE and EA, we studied the expression of the two genes in the level of protein synthesization by immunohistochemical staining and of mRNA transcription by digoxigenin labeling in situ hybridization technique. 1. To monitor bile reflux for patients with chronic gastritisThe aim of this part is to study the bile reflux in patients with different kind of chronic gastritis. Method Using ambulatory bilirubin monitoring techniques toassess the changes of intragastic bile reflux during 24h in 45 subjects(including 17 patients with chronic superficial gastritis, 21 with chronic erosive gastritis and 7 with chronic atrophic gastritis). Result Total time of intragastric bile reflux(%) was significantly greater for patients with chronic atrophic gastritis (16.2 ± 18.0) and chronic erosive gastritis (14.2 ± 12.1) than that for patients with chronic superficial gastritis (5.3 ± 14.1) (73<0.01). Conclusion Inlragastrie bile reflux is correlated \ulh chronic erosive gastritis and atrophic gastritis.2. Simultaneously monitoring acid and bile reflux for 85 patients with reflux esophagitisThe aim of this part is to study the incidence of acid and bile reflux in patients with reflux esophagitis(RE) and to evaluate the significance of detecting bile reflux in diagnosing RE. Methods Using ambulatory 24h pH monitoring bilirubin monitoring techniques, we simultaneously assessed the changes of intraesophgeal pH and bile reflux during 24h in 105 subjects(including 85 patients with RL and 21) volunteers;. Results The time of esophageal acid exposure(pH<4) for RF patients was significantly greater than that for controls. Bile reflux, represented by total percentage time of bilirubin absorbance>0.14, was significantly greater for RE patients than that for controls. Neither acid nor bile reflux had difference between male and female. 62.4% of RE patients had both acid and bile reflux, 30.6% only had acid reflux, 3.5% only had bile reflux, and 3.5% had no reflux. Conclusion Both acid and bile reflux were very common in RE patients and both may played a role in the development of RE. Simultaneously monitoring acid and bile reflux is very important to diagnose RE.3. Simultaneously monitoring acid and bile in esophagus for patients with total or partial gastrectomyThe aim of this part is to study the acid and bile reflux in patients performed different kind of gastrectomies. Methods Using ambulatory acid and bilirubin monitoring techniques to assess the changes of introesophageal acid and bile reflux during 24h in 57 subjects performed different kinds of gastrectomies(including A~D 4 groups, Group A had 15 patients with proximal partial gastrectomy, Group B had 9 patients with Billroth I gastrectomy. Group C had 24 patients with Bill...