关键词: 胃食管反流, 体征和症状, 非典型症状, 食管pH监测, 高分辨率食管测压, 胃镜检查

Abstract: Background　Gastroesophageal reflux disease（GERD） is a common digestive system disease with high prevalence，complex and diverse clinical symptoms.Moreover，it shows an increasing trend in annual prevalence.Besides those who are diagnosed with GERD by the chief complaint of typical reflux symptoms，more and more patients are diagnosed by atypical symptoms.To provide guidance for clinical diagnosis and treatment，the differences between GERD patients with typical and atypical symptoms are needed to be further studied.Objective　To compare the differences in reflux characteristics and esophageal motility between GERD patients with typical and atypical symptoms，to fully explore the characteristics of GERD with atypical presentations to improve the understanding of this disease.Methods　We retrospectively enrolled GERD outpatients with typical and atypical presentations from Department of GI Medicine，Affiliated Hospital of Zunyi Medical University during from January 2015 to January 2017.All of them had pathological reflux detected by 24-h multichannel intraluminal impedance-pH monitoring（MII-pH），and had no other organic gastrointestinal disorders determined by high-resolution manometry（HRM） and gastroscopy.According to the main symptoms，the patients were divided into typical presentations group and atypical presentations group.We compared these two groups' baseline data，reflux characteristics〔number of reflux episodes（pH<4），number of reflux episodes > 5 min，percent total time pH<4〕，duration of GERD，esophageal motility parameters〔lower esophageal sphincter resting pressure（LESP），lower esophageal sphincter residual pressure（LESRP），upper esophageal sphincter resting pressure（UESP），upper esophageal sphincter residual pressure（UESRP），contractile front velocity（CFV），distal contractile integral（DCI），lower esophageal sphincter length（LESL）〕.Results　A total of 71 cases were enrolled，including 32 with typical presentations，and 39 with atypical presentations.Both groups showed no significant differences in mean age，sex ratio，mean weight and BMI，as well as gastroscopic findings（P>0.05）.The incidence of nonerosive reflux disease was higher than that of reflux esophagitis in both groups（P<0.05）.Compared with those with atypical presentations，patients with typical presentations had more mean number of reflux episodes（pH<4），greater percent total time pH<4，and shorter duration of GERD（P<0.05），but similar number of reflux episodes >5 min（P>0.05）.Moreover，patients with typical presentations also showed lower mean LESP，DCI and LESL，and higher mean UESP and UESRP（P<0.05），but similar mean LESRP and CFV（P>0.05）.Conclusion　GERD，either with typical or antitypical presentations，more easily occurs in individuals aged 40 to 60 years.The incidence of nonerosive reflux disease is significantly higher than that of reflux esophagitis in these patients.Those with atypical presentations have lower acid reflux degree and more significantly decreased UESP and UESRP，better LESP and esophageal peristalsis function，and longer duration of GERD.

Key words:  , Gastroesophageal reflux；Signs and symptoms；Atypical symptoms；Esophageal pH monitoring；High-resolution esophageal manometry；Gastroscopy