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

摘要： 背景　胃食管反流病（GERD）是常见的消化系统疾病，患病率高、临床症状复杂多样，患病率有逐年增高的趋势。除因以典型反流症状为主诉就医确诊为GERD外，以不典型症状被诊断为本病的患者越来越多，因此需要进一步研究二者之间的差异，为临床诊治提供借鉴。目的　探讨典型症状与非典型症状GERD患者在基本资料、反流特点及食管动力学方面的差异，发现不典型症状GERD的特点，提高临床医生对不典型症状GERD的认识。方法　回顾性选取2015年1月—2017年1月就诊于遵义医科大学附属医院消化内科门诊患者为研究对象。患者均行24 h食管多通道腔内阻抗-pH监测（MII-pH）明确存在病理性反流，并同时行高分辨率食管测压（HRM）及胃镜排除其他胃肠器质性疾病。根据主要症状分为典型症状组和非典型症状组。比较两组患者的基本资料、反流特点〔pH<4总反流次数、长反流（>5 min）次数、pH<4时间百分比〕、病程及食管动力学参数〔下食管括约肌静息压（LESP）、下食管括约肌残余压（LESRP）、上食管括约肌静息压（UESP）、上食管括约肌残余压（UESRP）、收缩前沿速度（CFV）、远端收缩积分（DCI）、下食管括约肌长度（LESL）〕之间的差异。结果　符合入选标准的GERD患者共71例，其中典型症状组32例，非典型症状组39例。两组患者的年龄、性别、身高、体质量、体质指数及胃镜表现比较，差异均无统计学意义（P>0.05）；两组患者组内非糜烂性反流病（NERD）的发生率均高于反流性食管炎（RE）（P<0.05）。典型症状组pH<4总反流次数、pH<4时间百分比高于非典型症状组，病程短于非典型症状组（P<0.05）；两组长反流（>5 min）次数比较，差异无统计学意义（P>0.05）。典型症状组LESP、DCI、LESL低于非典型症状组，UESP、UESRP高于非典型症状组（P<0.05）；两组LESRP、CFV比较，差异无统计学意义（P>0.05）。结论　GERD的好发年龄为40~60岁，典型症状和非典型症状GERD患者的年龄无差异；GERD患者中NERD的发病率明显高于RE。非典型症状GERD患者反流程度低于典型症状GERD患者。非典型症状GERD患者UESP、UESRP下降的程度更为显著，但LESP及食管体部蠕动功能优于典型症状GERD患者，病程长于典型症状GERD患者。

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