| Objective Retrospective analysis of the patients with atypical GERD among asthma patients in gastroenterology department from 2016 to 2017.Investigate the application value of GerdQ and MII-pH in atypical GERD patients,to provide effective solutions for the diagnosis of atypical GERD patients.To ensure the patients were diagnosed and treated in time.Methods:98 patients with atypical GERD among asthma patients in gastroenterology department from March 2016 to December 2017 in our hospital were retrospectively analyzed.All patients had recurrent asthma for 3 months,and the main clinical manifestation was asthma,and conforms to the clinical definition of bronchial asthma.Gastroscopy showed no obvious damage to the mucosa of the esophagus.According to the results of the M?-pH,51 cases of the patients were consistent with the diagnosis of gastroesophageal reflux,to the GERD positive group.The remaining patients were GERD negative group.The clinical data of hospitalized patients were complete.All patients underwent esophageal dynamic monitoring,M?-pH,GerdQ and electronic gastroscopy during hospitalization.According to the results of gastroscopy,tissues should be taken for pathological examination if necessary.Results:1.The detection rates of M?-pH,Esophageal multi-channel intraluminal impedance monitoring,distal pH monitoring and proximal pH monitoring for pathological reflux were 52.04%,40.82%,28.57%and 9.18%respectively,and the detection rates of different detection protocols were significantly different(X2=3.964,5.342 and 9.427,P<0.05).Through the MII-pH monitoring of the distal reflux,the results showed that the number of total reflux and the number of acid reflux in the GERD positive group were significantly higher than those of the GERD negative group(P<0.05),but there was no significant difference in the contrast between the weak acid reflux and the weak alkali reflux in the two groups(P>0.05).Through the MII-pH monitoring of the proximal reflux,the results showed that the number of weak acid reflux,total reflux and acid reflux in GERD positive group were significantly higher than those of GERD negative group(P<0.05),but there was no significant difference in the number of weak alkali reflux in the two groups(P>0.05).4.Through the M?-pH monitoring of the proximal reflux,the results showed that the number of fluid reflux in the GERD positive group was significantly higher than that of the GERD negative group(P<0.05),but there was no significant difference in the number of gas and mixed reflux in the two groups(P>0.05).5.The gas,mixture and liquid reflux in the GERD positive group were 28.79%,33.86%and 37.35%,respectively,and in the GERD negative group were 24.34%,34.90%and 40.76%.Chi square test showed significant difference in reflux ratio between different groups(X2=14.246,P<0.05).The acid,weak acid and weak alkali reflux in the GERD positive group were 44.65%,41.72%and 13.63%,respectively.The weak acid,acid and weak base reflux in the GERD negative group were 71.54%,21.53%and 6.93%,respectively.Chi square test showed significant difference in reflux ratio between different groups(X2=21.624,P<0.05).The proportion of proximal reflux in the GERD positive group and the negative group were 42.45%and 30.74%,respectively,and the difference between the two groups was statistically significant(X2=16.842,P<0.05).6.The score of total score,C1,B2 and C2 in the GERD positive group were significantly higher than those in the GERD negative group(P<0.05),but there was no significant difference in the scores of A2,B1 and A1 in the two groups(P>0.05).7.The Youden index was 0.460 when the critical value was 8,and the specificity,sensitivity,positive predictive value and negative predictive value were 61.70%,84.31%,70.49%and 78.38%.Now the diagnostic value of GerdQ was the highest and the area under the curve was 0.746.8.For asthma GERD,the positive rate of M?-pH monitoring was 52.04%,and GerdQ score was 43.88%.The difference of positive diagnostic rate between the two diagnostic schemes was statistically significant(X2=7.627,p<0.05).Conclusions 1.MII-pH monitoring could increase the detection rate of atypical GERD among asthma.The GERD positive and negative groups among asthmatic were mainly acid reflux and weak acid reflux.The number of acid reflux in asthmatic GERD positive group was significantly higher than that in negative group.Acid reflux could play an important role in GERD patients among asthma.The number of proximal reflux in GERD positive group among asthmatic was significantly higher than that in negative group,which could be an important evaluation index for reflux degree proximal reflux.4.The GredQ score of the GERD positive group among asthmatic was significantly higher than that of the negative group.For patients with partial rejection,intolerance test or hospital unable to carry out MII-pH,GredQ questionnaire could be used for investigation.Although the positive rate of diagnosis was not as good as that of MII-pH,it cold be used as an auxiliary diagnostic program for GERD among asthma. |
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