终末期肾病患者合并胃食管反流病的临床研究进展

胃食管反流病(GERD)是最常见的食管疾病之一。多项研究表明,终末期肾病(ERSD)患者GERD的患病率高于普通人群。目前对于ERSD患者特别是血液透析患者GERD的症状特点及严重程度的研究较少。ESRD患者常并发或伴发糖尿病、高血压等,而糖尿病神经病变可影响胃排空功能,钙拮抗剂和硝酸酯类药物可影响LES舒张功能。透析相关淀粉样变通过影响食管蠕动、食管下段括约肌张力和胃排空影响GERD的发生。ERSD患者中,相当比例的患者全身状况不佳,行胃镜风险较高,常常应用标准化量表或质子泵抑制剂诊断试验评估患者症状性GERD患病情况。ESRD及透析患者GERD的知晓率仍较低,部分患者自行服用碳酸氢钠等非一线药物控制症状。理论上对于ESRD及透析患者伴随的GERD进行早期诊断和治疗可能提高患者生活质量,并减少水钠摄入,改善血压及透析间期体重增加,降低心血管事件风险,具体的临床获益仍有待进一步研究证实。

Clinical Research Progress of the Gastroesophageal Reflux Disease in End Stage Renal Disease Patients

Gastroesophageal reflux disease (GRED) is one of the most common esophageal diseases. Researches show that the prevalence rate of GRED in patients with end-stage renal disease (ERSD) is higher than in ordinary people. Currently there is not much study on the characteristics of symptoms or severity of GRED among patients with ERSD, especially among hemodialysis patients. ESRD patients usually have diabetes mellitus (DM) and hypertension as complications. Decreased gastric emptying was proved to be related to DMneuropathy. Lower esophageal sphincter relaxations were considered to be caused by administration of Ca-antagonists and nitrites. GI motility dysfunction and complications have been observed in patients with amyloidosis. Many GERD patients have severe concomitant disease, so endoscopy examination could not be operated easily. Structured questionnaires are often used instead of endoscopy, to diagnose symptomatic GERD. Awareness of GERD and administration of PPIs remains low in hemodialysis patients. Early diagnosis and routine proton pump inhibitors treatment would provide clinical benefits, reduce GERD symptoms and improve the quality of life of these patients. Furthermore, relieving chronic heartburn may reduce sodium bicarbonate consumption and interdialytic weight gain. Further studies are required to elucidate the mechanisms that increase the rate of GERD in ESRD patients, especially those on hemodialysis.