| Chapter I The occurrence rate and the correlation with symptoms of weakly acidic reflux in PPI resistant GERDBackground:The mechanism of PPI resistance is still unknown, some research show that weakly acidic reflux could induce GERD symptoms in recent years.Purpose:To observe the occurrence rate of weakly acidic reflux in PPI resistant GERD. To find the correlation between symptoms and weakly acidic reflux in PPI resistant GERD.Methods:To collect patients who were diagnosed as GERD and underwent24hour PH-impedance monitoring in Sir Run Run Shaw Hospital (SRRSH) during May2011to April2011. ALL patients still complain symptoms except standard PPI therapy for at least8weeks. ALL patients stop proton pump inhibitor (PPI) before the monitoring at least2weeks. To analyze their reports.Results:(1) A total of234patients are chose. Only181(77.4%) patients recorded symptoms during the study day and53(22.6%) patients had no symptoms during testing. Atotal of13155reflux episodes had been monitored,4273(32.5%) were acid reflux,7726(58.7%) were weakly acidic reflux,1156(8.8%) were weakly alkaline reflux.(2)181symptomatic patients recorded398GERD symptoms,155(38.9%) were typical symptoms and243(61.1%) were atypical symptoms.57(36.8%) symptoms were SI positive with total reflux episode in155typical symptoms, add up to220times symptoms (63.6%were related to acid reflux,16.8%were related to weakly acidic reflux,0.5%were related to weakly alkaline reflux,19.1%had no relation with reflux);82(33.7%) symptoms were SI positive with total reflux episode in243atypical symptoms, add up to1120times symptoms (31.1%were related to acid reflux,35.9%were related to weakly acidic reflux,4.2%were related to weakly alkaline reflux,28.8%had no relation with reflux). The difference between two groups has statistical significance(P<0.01).(3)In155typical symptoms,45(29.1%) were SI positive with acid reflux,7(4.5%) were SI positive with weakly acidic reflux,1(0.6%) were SI positive with weakly alkaline reflux,102(65.8%) were SI negative with any kinds of reflux; In243atypical symptoms,27(11.1%) were SI positive with acid reflux,27(11.1%) were SI positive with weakly acidic reflux,8(3.3%) were SI positive with weakly alkaline reflux,181(74.5%) were SI negative with any kinds of reflux. The difference between two groups has statistical significance (P<0.01).(4) In155typical symptoms,31(20.0%) were SAP positive with only acid reflux,12(7.8%) were SAP positive with only weakly acidic reflux,7(4.5%) were SAP positive with both acid reflux and weakly acidic reflux,0(0.0%) were SAP positive with weakly alkaline reflux,105(67.7%) were SAP negative with any kinds of reflux; In243atypical symptoms,18(7.4%) were SAP positive with only acid reflux,46(19.0%) were SAP positive with only weakly acidic reflux,28(11.5%) were SAP positive with both acid reflux and weakly acidic reflux,0(0.0%) were SAP positive with weakly alkaline reflux,140(67.7%) were SAP negative with any kinds of reflux. The difference between two groups has statistical significance (P<0.01).Conclusion:(1) Weakly acidic reflux episode is the main reflux episode in PPI resistant GERD.(2) There is higher correlation between weakly acidic reflux with atypical symptoms in PPI resistant GERD.Chapter II The features of symptomatic weakly acidic reflux in PPI resistant GERDBackground:Some researches show that only part of reflux episodes could induce symptoms. Then the features of the symptomatic weakly acidic reflux induce my concern.Purpose:To find the features of symptomatic weakly acidic reflux in PPI resistant GERD.Methods:31patients had at least one symptom which was SI positive with weakly acidic reflux in181symptomatic PPI resistant GERD patients. To chose15patients by randomization and to analyze their reports. Results:A total of709weakly acidic reflux episodes were recorded in15patients,103(14.5%) were related to symptoms,606(85.5%) had no relation with symptoms.(1) In103symptomatic weakly acidic reflux,40(38.8%) were fluid reflux,63(61.2%) were mixed reflux; In606asymptomatic weakly acidic reflux,409(67.5%) were fluid reflux,197(32.5%) were mixed reflux. The difference between two groups has statistical significance (P<0.01).(2) In103symptomatic weakly acidic reflux,14(13.6%) were distal reflux,89(86.4%) were proximal reflux; In606asymptomatic weakly acidic reflux,178(29.4%) were distal reflux,428(70.6%) were proximal reflux. The difference between two groups has statistical significance (P <0.01)Conclusion:Mixed reflux and proximal reflux of weakly acidic reflux could induce symptoms more easily in refractory GERD. |
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