Correlation Analysis Of Intestinal Bacterial Overgrowth In Refractory Gastroesophageal Reflux Disease

Objective:Refractory gastroesophageal reflux disease(RGERD)is a kind of GERD with complicated clinical manifestations,which has the characteristics of recurrent symptoms,repeated medication,difficult clinical symptoms relief and repeated medical treatment,seriously affecting the quality of life of patients and bringing huge economic burden to patients,families and society.The prevalence of RGERD in China accounts for 20%-42%.The species or quantity of bacteria in the small intestine changes.When it reaches a certain level,it is called small intentional bacterial overgrowth(SIBO).Studies have linked SIBO to the long-term use of Proton pump inhibitiors(PPI).Because patients with RGERD have a long history of taking PPI medication,this study carried out a study on the correlation between methane hydrogen exhalation and RGERD,and made clear the correlation between intestinal bacterial overgrowth and RGERD patients,so as to provide theoretical basis for the diagnosis and treatment of RGERD in regulating intestinal flora.Methods:From June 2020 to December 2022,the data of outpatients or inpatients in the Department of Gastroenterology,No.3 Building of the First Affiliated Hospital of Kunming Medical University were analyzed,and 244 patients with gastroesophageal reflux were included,including 147 patients with non-refractory gastroesophageal reflux disease(NRGERD)and 60.25% patients with refractory gastroesophageal reflux disease(NRGERD).97 patients with RGERD(accounting for39.75%)were divided into groups according to Gerd Q,RDQ,RSI,SIBO,HP and other indicators,and the clinical data of each group were analyzed and counted to observe the relationship between Gerd Q,RDQ,RSI and related clinical symptoms and SIBO positive,negative,H2 value and CH4 value respectively.At the same time,the correlation between HP and SIBO and GERD and RGERD was observed.Results:1.The incidence of esophageal symptoms such as acid regurgitation,heartburn and nausea in patients with RGERD were 67.01%,62.89% and 49.48%,respectively,which were higher than those in patients with NRGERD(P < 0.05,P < 0.01,P < 0.01),indicating that the esophageal symptoms in patients with RGERD were more typical.The gastroscopic manifestations of RGERD/NRGERD patients are mainly LA-A and LA-B.2.The positive rate of CH4 in patients with RGERD was 52.50%,which was higher than that in patients with NRGERD.The value of 60 min CH4 in patients with RGERD was higher than that in patients with NRGERD,with statistical difference(P<0.05,P<0.05).It was found that when HP was negative,the SIBO positive rate of RGERD patients was 84.62%,which was higher than that of NRGERD patients,and the difference was statistically significant(P < 0.05),and there was a correlation between SIBO and RGERD(P < 0.05).When HP was positive,the positive rate of CH4 in RGERD patients was 56.52%,which was higher than that in NRGERD patients,and the difference was statistically significant(P<0.05).CH4 and 40 min H2were correlated with RGERD(P < 0.05,P < 0.05).Whether HP is positive or negative,the ROC of RGERD and NRGERD are predicted and analyzed by using CH4 values in different time periods.The area of ROC curve predicted by CH4 for RGERD in each time period is larger than that of NRGERD,and the CH4 values of RGERD patients in each time period are higher than or equal to that of NRGERD patients.3.In patients with RGERD,diarrhea was correlated with SIBO and H2(P < 0.05,P<0.05).In patients with NRGERD,chronic cough was correlated with SIBO(P<0.05),and noncardiac chest pain was correlated with SIBO and H2(P<0.01,P<0.05).In patients with RGERD,there was a correlation between H2 value and diarrhea in each time period(P<0.01,P<0.01,P<0.01,P<0.01,P<0.01,P<0.01,P<0.01).Conclusion:1.The symptoms of gastroesophageal reflux disease in RGERD patients are more typical.The gastroscopic manifestations of patients with RGERD and NRGERD are mainly LA-A and LA-B,which indicates that this kind of patients have mild esophageal mucosal injury.2.There is a certain correlation between CH4 value and patients with RGERD,which has a certain predictive value for patients with RGERD.3.In patients with RGERD,diarrhea is correlated with SIBO and H2.The results showed that SIBO could appear in patients with RGERD after long-term use of PPI preparation,and the clinical symptoms were related to diarrhea.