[1]周银斌,文良志,刘凯军,等.639例胃内胆汁反流与禁食时间相关性的临床观察[J].第三军医大学学报,2018,40(10):928-933.
 ZHOU Yinbin,WEN Liangzhi,LIU Kaijun,et al.Correlation between intragastric bile reflux and fasting time before gastroscopy: observation in 639 cases[J].J Third Mil Med Univ,2018,40(10):928-933.
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639例胃内胆汁反流与禁食时间相关性的临床观察(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第10期
页码:
928-933
栏目:
临床医学
出版日期:
2018-05-30

文章信息/Info

Title:
Correlation between intragastric bile reflux and fasting time before gastroscopy: observation in 639 cases
作者:
周银斌文良志刘凯军兰春慧沈小春杨莹莹陈东风
陆军军医大学(第三军医大学)第三附属医院(野战外科研究所)消化内科
Author(s):
ZHOU Yinbin WEN Liangzhi LIU Kaijun LAN Chunhui SHEN Xiaochun YANG Yingying CHEN Dongfeng

Department of Gastroenterology, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
无痛胃镜检查胆汁反流现象胆汁反流指数胆汁反流性胃炎禁食时间
Keywords:
painless gastroscopy bile reflux bile reflux index bile reflux gastritis fasting time
分类号:
R163;R181.32;R575.6
文献标志码:
A
摘要:

目的    观察胃镜检查时胃内胆汁反流与禁食时间的关系,探讨胃镜下诊断病理性胆汁反流的最佳禁食时间。方法    将2016年1~6月我院因上消化道症状就诊的639例患者纳入本研究,根据胃镜检查前禁食时间长短分为上午组(禁食12~17 h)和下午组(禁食18~24 h)。比较2组患者胃内胆汁反流程度与禁食时间的关系,根据胆汁反流指数(bile reflux index,BRI)及胃内胆汁反流严重程度判断是否为病理性反流,探讨胃镜检查诊断胆汁反流性胃炎的合理禁食时间。结果    纳入639例患者,其中上午组55例(16.98%, 55/324)、下午组75例(23.81%,75/315)发生胆汁反流。下午组Ⅰ级胆汁反流发生例数显著高于上午组(50例 vs 27例,χ2=8.823,P=0.003),2组间Ⅱ级及Ⅲ级反流人数差异无统计学意义(Ⅱ级χ2=0.02,P=0.89;Ⅲ级χ2=0.07,P=0.89)。上午组有35例BRI≥14,下午组有29例BRI≥14。结合内镜下胆汁反流分级及BRI值,上午组确定为病理性胆汁反流人数显著高于下午组(χ2=7.915,P=0.005)。根据BRI值,上午组发生反流患者中Ⅰ级有20例为生理性,7例为病理性,Ⅱ级和Ⅲ级则全部为病理性;下午组Ⅰ级中有45例为生理性反流,5例为病理性反流,Ⅱ级中有1例为生理性反流,16例为病理性反流,Ⅲ级则全部为病理性反流。下午组发生生理性胆汁反流人数多于上午组(χ2=7.915,P=0.005)。自禁食12 h起,按照每小时出现胆汁反流人数分组,结合BRI值鉴别生理性和病理性胆汁反流,患者禁食时间过长(下午组)被误诊为病理性胆汁反流可能性更大。结论    患者禁食时间过长易被误诊为病理性胆汁反流,内镜检查时间在禁食12~14 h内完成最为合适。

Abstract:

Objective     To determine the optimal fasting time before gastroscopy for diagnosis of pathological bile reflux. Methods    This study was conducted among 639 patients undergoing gastroscopy for digestive symptoms in our hospital from January to June, 2016. According to the fasting time, the patients were divided into morning group (n=324, fasting time 12~17 h) and afternoon group (n=315, fasting time 18~24 h). The incidence and severity of gastric bile reflux was compared between the 2 groups to analyze the association between gastric bile reflux and fasting time. The nature of bile reflux (pathological vs physiological) was determined based on the bile reflux index (BRI) and the severity of bile reflux. Results    Among the 639 patients, intragastric bile reflux occurred in 55 (16.98%) patients in the morning group and in 75 (23.81%) patients in the afternoon group. The number of patients with grade Ⅰ bile reflux was significantly smaller in the morning group than in the afternoon group (27 vs 50, P<0.05), but the number of patients with grade Ⅱ and Ⅲ reflux showed no significant difference between the 2 groups (P>0.05). Thirty-five patients in the morning group had a BRI of no less than 14, as compared to the number of 29 in the afternoon group. Based on the results of endoscopic grading and BRI, a diagnosis of pathological bile reflux was made in significantly more patients in the morning group than in the afternoon group (P<0.05). In the morning group, grade Ⅰ bile reflux was defined as physiological based on the BRI value in 20 patients and as pathological in 7 patients, and all the patients with grade Ⅱ and Ⅲ bile reflux were diagnosed to have a pathological condition. In the afternoon group, grade I bile reflux was physiological in 45 cases and pathological in 5 cases; grade Ⅱ bile reflux was physiological in 1 case and pathological in 16 cases; grade Ⅲ bile reflux was pathological in all the cases. The incidence of physiological bile reflux was significantly higher in the afternoon group than in the morning group (χ2=7.915, P=0.005). In patients fasted for over 12 h, a longer fasting time was associated with a greater chance of misdiagnosis of physiological bile reflux as pathological bile reflux. Conclusion    In patients with prolonged fasting (18~24 h) before gastroscopy, physiological bile reflux is likely to be misdiagnosed as pathological bile reflux, and a fasting time of 12~14 h before gastroscopy can be optimal.

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更新日期/Last Update: 2018-05-30