NatlMed J China, November, 5, Vol 85, No (49. 4% ) The average DeMeester s score of the RE group was 9. (96. 5), significantly higher th

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1 NatlMed J China, November, 5, Vol 85, No145 (RE) (NERD ), ( GERD ) 6GERD,4 h ph RE 4 : RE ph (RE +, 5, 71% ), RE ph (RE -, 15, 1% ), NERD ph(nerd +, 77, 4914% ), NERD ph (NERD -, 79, 516% ) ;( SI) (NERD - SI +, 18, 18% )(NERD - SI -, 61, 771% ) [ / ( HAD ) ] (1) RE,NERD; RERE + NERDNERD +, ( ) RE ph NERD (71%4914% ),DeMeester[ 9. ( 96. 5)1. 9 (. 6) ];RE +NERD +,RE +DeMeester NERD +[ (95. )4. 1 (64. 4) ]() HAD4416% (9 /65), 619% (4 /65),/ NERD - NERD +, NERD - SI - NERD +RE NERD(NERDSI), ; ; Anx iety and depression rela ted to the sym ptom s of ga stroesophagea l reflux d isea se XU Zhijie, DUAN L iping, WANG Kun, X IA Zhiw ei, L IN Sanren1 D epartm ent of D igestive D isease, Third Hospital, Peking U niversity, B eijing 18, China Corresponding author: DUAN L iping, Em ail: duanlp81@ yahoo1com 1cn Abstract O bjectiveto compare the differences in the p sychological scale scoring among different subgroup s reflux esophagitis ( RE) and nonerosive reflux disease (NERD ) and to exp lore the influence of mental factors on the pathogenesis of RE and NERD. M ethodstwo hundred and six patients with typ ical heartburn and acid regurgitation underwent endoscopy and esophageal ph monitoring and then were divided into 4 group s: RE + group ( n = 5, 4. % ) with RE and positive ph monitoring results, RH - group ( n = 15,. % ) with RE and negative ph monitoring results, NERD + group ( n = 77, 4% ), with NERD and positive ph monitoring results, and NERD - group ( n = 79, 5. 6% ) with NERD and negative ph monitoring results that was redivided into subgroup s according to the symp tom index ( SI) : NERDSI + group ( n = 18,. 8% ) with positive symp tom index and NERD - SI - group ( n = 61, 77. % ) with negative SI. The demographic data and body mass index ( BM I) were investigated. The p sychological questionnaires: Symp tom Checklist 9 ( SCL9), and Hosp ital Anxiety and Dep ression Scale (HAD) were used. Results( 1 ) Male patients were dom inant in the RE group and RE + subgroup, while female patients were dom inant in the NERD group and NERD + subgroup. The values of BM I of the RE group and RE + subgroup were significantly higher than those of the NERD group and NERD + subgroup. ( ) The abnormal ph monitoring rate of the RE group was 7. %, significantly higher than that of the NERD group : 18 :, duanlp81@ yahoo1com1cn 转载

2 NatlMed J China, November, 5, Vol 85, No (49. 4% ) The average DeMeester s score of the RE group was 9. (96. 5), significantly higher than that of the NERD group 1. 8 (. 6). The average DeMeester s score of the RE + group was ( 95. ), significantly higher than that of the NERD + group 4. 1 ( 64. 4). ( ) 44. 6% ( 9 /65 ) of the patients p resented dep ression and 6. 9% (4 /65) had anxiety, most of them were in m ild or moderate degree. The scores of most item s of each mental scale were significantly higher in the NERD - patients than in the NERD + patients, especially in the NERD - SI - subgroup. Conclusion The symp tom s of RE + and NERD + patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and dep ression are related to the symp tom s of patients without objective evidence of esophageal mucosal injury and acid reflux (NERD - ), especially in the symp tom index negative subgroup. V isceral hypersensitivity and stress p lay an important role in the pathogenesis of gastroesophageal reflux. Key words Gastroesophageal reflux; Anxiety; Dep ression ( gastroesophageal reflux disease, GERD), [ 1, ], GERD, ( nonerosive reflux disease, NERD), ( reflux esophagitis, RE ), Barrett, NERD REBarrett NERD GERD, 4 h ph RENERD, GERD,GERD NERD 748, 6,4 h ph Genval GERD [ ] 94 ( 4516% ), 11 (5414% ),51 14(1876) Martinez [ 4 ] 6 : RE ( 5, 41% ),NERD(156, 7517% ) 4 h ph, RE, ph RE + (5, 71% ) ; RE - ( 15, 1% ), NERDNERD +(77, 4914% )NERD - ( 79, 516% ) ( SI) 4 h ph,,,> 5%,, NERD - NERD - SI +( 18, 18% )NERD - SI - (61, 771% ), RE Los Angeles [ 5 ] : A,< 15 cm; B,, > 15 cm; C, ; D, > 75% 4 h ph D igitrapper MK ph (Synectic Medical),,15 cm,(ph = 71pH = 11) 1,pH,pH ph (LES)5 cm 4 h,, ( EsopHogram TM Reflux Analysis Module, Version 1),: 4 h ph < 4 ph < 4 4 h ( 5 m in) 4 hph ( )

3 NatlMed J China, November, 5, Vol 85, No145 4 h ph ( )DeMeester (< 15, 15 ) > 5%, ( symp tom checklist 9, SCL 9) / ( hosp ital anxiety and dep ression scale, HAD ) SCL9 9,4,: (/9) (14 ) (/) ; SCL99( /), : HAD 14, 7, 7,,: 7, 8 1, 1114, 151 gx s, ( ) [M ( QR ) ] SPSS 11, Studentt; MannW hitney RE, 15 1; NERD, RE NERD, RE + NERD RE NERD,RE + 5,( 18 4, 1) 11RENERD : RE4 h ph NERD, 4 h ph < 4pH < 4 4 h DeMeester(1) 1RE +NERD +: RE +4 h ph < 4 ph < 4 4 h DeMeester NERD +(1) 1NERDSI +NERDSI: 4 h ph, NERDSI +4 h ph < 4 ph < 4 4 h DeMeester NERDSI, (1) 1 8 SCL 9, RE 6 /14 1RENERD4 h ph / ph < 4 () ( kg/m ) 4 h (m in) (6. 1. ) 11. (. 1) 6. 5 (6. 7) 118 (69) 5. 5 (1. 8) 16. (9. ) 67 (1) ph DeMeester ( ) 7. (5 /5) RE + /1 NERD 58 /98 NERD + /44 NERD5 / # ( ) (5. 7) 14. (. 5) (16. ) 4. (8. ) 1 (6) (7. 9) (7. 7) (6. 6) (115) (4. 8) (1. ) (1) # (17. 4) # (15. 7) # (18. 9) # (174) # (7. ) # (1. 1) ( ) 1. 5 (. 4). (. 5) 4 (45). (. ). (4. ) 1 (67) (71) ( ) (. 6) (77 /156) (64. 4) # ( ) NERDSI + 5 /1 5 1 ( ). 4 (. 5). (. 5) 5 (6. 5). (1. ). 5 (4. ) 1 (6) (. 7. 6) NERD SI / ( ) 1. 4 (. ). 1 (. 5) (45). (. ). (. 7) (9) ( ) :RE, P < 15;RE +, # P < 15; phgx s,m (QR )

4 NatlMed J China, November, 5, Vol 85, No HAD 18SCL9 51 (QR 5, 18),16 (QR 16, 1 ) ; 6 (QR 7, 84) ;115 (QR 16, 1) RENERD (), NERD - NERD +, NERD - SI - SI + SCL9, NERD - SI - NERD - SI +, 65HAD 6 (QR 6,14),619% ( 4 /65), (81%, /4) ;7 (QR 5,16), 4416% (9 /65 ), 611% ( 18 /9 ),415% ( 1 /9 ) SCL9, NERD - NERD +,,() NERD + NERD - SI + NERD - SI -,,NERD RE RE,GERD [, 6 ],, RENERD NERD [ 6 ] RENERD HAD [M (QR ) ] [M (QR ) ] RE (718) 4 (51) 7. (815) 4 (4414) NERD (515) (71) 7. (5. ) 5 (4515) NERD + 4. (515) 1 ( 51) 6. (6. ) 9 (419) NERD - 8. (615) 19 (5716) 7. (4. ) 16 (4815) NERD - SI (9. ) 5 (51) 715 (617) 5 (51) NERD - SI - 8. (6. ) 14 (619) 7. (5. ) 11 (4718) :NERD +, P < 15 NERDRE Pace [ 7 ] ph GERD 1,96% (8 /9)NERD5RE, 1 REBarrett, GERD, NERD RE Barret [ 8 ] NERD RE,NERD,RE, NERD RE [ 9, 1 ], NERD RENERD SCL9 [M (QR ) ] RE (918) 15 (14) 5 (7) 115 (18) 1 (715) 7 (8) 4 (715) 6 (8) () () (18) NERD (15) 9 (8) 115 (15) (8) 7 (815) 5 (9) () 4 (6) NERD (16) 14 (15) 114 (15) (615) (11) (7) 5 (815) 4 (1) 15 1 (1) NERD (44) (15) (1) (16) 1 (11) 915 (8) (6) (1) (9) (615) NERD - SI (68) 16 (16) 415 (8) (16) (1) 8 (9) 5 (618) 6 (715) 5 (615) 15 (41) (15) 4 (418) NERD - SI (715) 18 (14) 4 (1815) 116 (15) 1 (111) (9) (61) (115) 1 (1) (418) (418) 6 (7) :NERD +, P < 15

5 NatlMed J China, November, 5, Vol 85, No145, Martinez [ 4 ], 5419% 4 h ph,nerd [, 6 ], 7517%,NERD (5% 7% ) [ ] REpH NERD,, RE +NERD +, RE +NERD + RENERD, RENERD NERD4914% (77 /156) ph,martinez( 5419% ), NERD NERD -, NERD + (4116%18% ), NERD + NERD -, 18%,,, ; 771%, ;, [, 6, 11 ], 4% /,, GERD,, [ 1 ],,RE, : Naliboff [ 1 ] ; Haug [ 14 ], NERD -, 4 h ph, NERD + NERD - SI + NERD - SI -,NERD - SI -, / NERD 911%, NERD - 771% (61 /79) NERD NERD - [, 6 ],,,,,, 5516%,11% [ 15 ], [ 16 ],,RE RE NERDNERD +RE NERD - NERD - SI -,,NERD, 4 h ph,,/ 1 Pan GZ, Xu GM, Guo HP, et al1 An ep idem iologic study on symptomatic GER in Beijing and Shanghai1 Chin J D ig, 1999, 19: 61,,, 1 1, 1999, 19: 61 Fass R1 Ep idem iology and pathophysiology of symp tomatic gastroesophageal reflux disease1 Am J Gastroenterol,, 98 ( Supp l ) : S71 Dent J, B run J, Frendrick AM, et al1 An evidence based appraisal of reflux disease managementthe Genval workshop report1 Gut, 1999, 44 ( Supp l ) : S1S161 4 Martinez SD, Malagon LB, Garewal HS, et al1 Nonerosive reflux disease ( NERD ) acid reflux and symp tom pattern1 A liment Pharmacol Ther,, 17: Lundell LR, Dent J, Bennett JR, et al1 Endoscop ic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification1 Gut, 1999, 45: Fass R, Tougas G1 Functional heartburn: the stimulus, the pain, and the brain1 Gut,, 51: Pace F, Bollani S, Molteni P, et al1 Natural history of gastro oesophageal reflux disease without oesophagitis ( NERD ) a reapp raisal 1 years on1 D ig L iver D is, 4, 6: Pace F, Porro GB1 Gastroesophageal reflux disease: a typ ical

6 NatlMed J China, November, 5, Vol 85, No spectrum disease ( a new conceptual framework is not needed) 1 Am J Gastroenterol, 4, 99: Peghini PL, Katz PO, B racyna NA, et al1 Nocturnal recovery of gastric acid secretion with twicedaily dosing of p roton pump inhibitors1 Am J Gastroenterol, 1998, 9: L ind T, Harelund T, Carlsson R, et al1 Heartburn without esophagitis: efficacy of omep razole therapy and features determ ining therapeutic response1 Scand J Gastroenterol, 1997, : D rossman DA1 The functional gastrointestinal disorder and the Rome II p rocess1 Gut, 1999, 45 ( Supp l II) : II1II51 1 Revicki DA, Crawley JA, Zodet MW, et al1 Comp lete resolution of heatburn symp tom and healthrelated quality of life in patients with gastrooesohageal reflux disease1 A liment Pharmacol Ther, 1999, 1: Naliboff BD, Mayer M, Fass R, et al1 The effect of life stress on symptom s of heartburn1 Psychosomatic Medicine, 4, 66: Haug TT, Mykletun A, DahlAA1 A re anxiety and dep ression related to gastrointestinal symp toms in the general population? Scand J Gastroenterol,, 7: W u W Y, L iu ML, L i CB, et al1 Clinical characteristics and p sychotropic therapy of dep ressive and anxious symptom s of patients with somatic diseases1 NatlMed J Chian, 1999, 79: ,,,1 1, 1999, 79: Shi SX, Lu Z, Zhu SY, et al1 Seeking behavior of patients with mental disorders and interfering factors1 Natl Med J China,, 8: 75781,,,1 1,, 8: (: 561) (:) Mental and Physical Health Across the L ife Span (,),,,,,, ;, 1% ;,,51 7 5, 8%, 51,,,16, :,,,,,, : 171, 1, 1%,1% 1,, 19, , : http: / /www. who. int/mental_health /evidence /atlas/,,,,, 4,1. 1 9,GDP5. 5% ;4,4, 1. 9/1, 1. 6/1,, (:)