639例胃内胆汁反流与禁食时间相关性的临床观察

周银斌; 文良志; 刘凯军; 兰春慧; 沈小春; 杨莹莹; 陈东风

doi:10.16016/j.1000-5404.201712288

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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

临床医学 | 更新时间：2026-01-09

- 639例胃内胆汁反流与禁食时间相关性的临床观察
- Correlation between intragastric bile reflux and fasting time before gastroscopy: observation in 639 cases
- 第三军医大学学报 2018年40卷第10期页码：928-933
- 作者机构：
  
  400042 重庆，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
- 作者简介：
  
  [ 陈东风, E-mail: chendf1981@126.com CHEN Dongfeng, E-mail: chendf1981@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201712288
  中图分类号： R163;R181.32;R575.6
- 收稿：2017-12-30，
  
  修回：2018-02-08，
  
  纸质出版：2018-05-30
- 稿件说明：
移动端阅览
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.

Yinbin ZHOU, Liangzhi WEN, Kaijun LIU, et al. Correlation between intragastric bile reflux and fasting time before gastroscopy: observation in 639 cases[J]. Journal of Third Military Medical University, 2018, 40(10): 928-933.
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. DOI： 10.16016/j.1000-5404.201712288.

Yinbin ZHOU, Liangzhi WEN, Kaijun LIU, et al. Correlation between intragastric bile reflux and fasting time before gastroscopy: observation in 639 cases[J]. Journal of Third Military Medical University, 2018, 40(10): 928-933. DOI： 10.16016/j.1000-5404.201712288.

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

27例

=8.823，

=0.003)，2组间Ⅱ级及Ⅲ级反流人数差异无统计学意义(Ⅱ级χ

=0.02，

=0.89；Ⅲ级χ

=0.07，

=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(χ

=7.915，

=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(χ

=7.915，

=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 (

=324

fasting time 12~17 h) and afternoon group (

=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

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

0.05)

but the number of patients with grade Ⅱ and Ⅲ reflux showed no significant difference between the 2 groups (

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 (

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 (χ

=7.915

=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.

关键词

Keywords

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