Reflux esophagitis Diagnosis
Diagnosis for Reflux esophagitis is based by medical history and clinical feature. Following tests is used to Reflux esophagitis confirm Diagnosis.
1. esophageal acid drop test (acid perfusion test). In patients with seat check by nasal gastric tube placed. When the pipe end up to 30 ~ 35cm, the first instillation of normal saline per minute of about 10ml, the calendar for 15 minutes. Such as in patients with non - special does not apply, for with 0.1N hydrochloric acid, flow rate is the same 30-minute drip, drop acid in the process, the attack substernal pain or burning sensation is a positive response, and drop acid more than 15 minutes the first time. If the repeat Second both positive and mitigation by the instillation of normal saline may determine acid GER, test sensitivity and specificity of 80%.
2. Determination of esophageal intraluminal pH. A pH electrode placed in the cavity, and gradually into the esophagus, the LES and placed about 5cm above the main Office. Under normal circumstances, the low intragastric pH. Told patient at this time from supine position and abdominal pain for the Department to increase pressure on the action, such as closed, cover the nose, deep breath or with bent knees, blowing his nose and force 3 to 4 times. If esophageal pH decreased to under 4 times to explain the existence of GER. also can be injected into the stomach cavity that 0.1N hydrochloric acid 300ml, 15 minutes after hydrochloride injection and before injection, respectively, told patient supination and increased abdominal movements. Patient with GER is decreased intraluminal after injection hydrochloric acid into the esophagus. In recent years, 24-hour esophageal pH monitoring has become the determination of whether the acid GER standards, including determination of esophageal pH <4 the percentage of supine and standing position when the pH <4 percentage, pH <4 the number, pH <4 for 5 minutes or more the number and the longest duration and so on. my normal 24-hour esophageal pH monitoring of pH <4 of 6 percent in the following time, continuing for more than five minutes the number of ≤ 3 times the longest duration of reflux for 18 minutes. These parameters can be help determine whether or not acid reflux, and help to clear chest pain and lung disease and the relationship between acid reflux.
3. intraluminal esophageal manometry. Usually filled with water perfusion catheter system for intraluminal esophageal pressure measured to estimate the LES and esophageal function. Manometry, the pressure catheter inserted into the stomach first, then, to 0.5 ~ 1.0 cm / min speed out of the catheter, and esophageal pressure measurements. normal resting LES pressure of about 2 ~ 4kPa (15 ~ 30mmHg), or intraluminal LES pressure and gastric pressure ratio> 1. When the LES resting pressure <0.8kPa (6mmHg), or both, the ratio of <1, then prompt LES dysfunction or GER exist.
4. the stomach and esophageal scintigraphy. This method can be estimated stomach - the anti-reflux flow. Tied on the stomach in patients with inflatable athletic supporter, fasting oral 300μCi99mTc-Sc contains orange juice acid solution of 300ml (containing orange juice and 150ml 0.1N HCL150ml), and then drink cold water 15 ~ 30ml, to remove residual test solution esophageal, head-up imaging. normal 10 to 15 minutes after the stomach more than the existence of non-radioactive parts. unless there is expressed GER. This law sensitivity and specificity of about 90%.
5. endoscopic examination and biopsy. Through endoscopy and biopsy pathological examination, to determine whether there is reflux esophagitis of the pathological changes, and whether or not whether there is bile reflux reflux esophagitis of the pathological severity of the significant value. root show sub-standard Savary and Miller reflux esophagitis inflammatory lesions can be divided into four: Ⅰ level for a single or a few lesions of non-integration, manifested as erythema or superficial erosions; Ⅱ level for the integration of disease, but did not diffuse or circumferential; Ⅲ grade diffuse circumferential lesions, there are rotten to the core but not narrow; Ⅳ class of chronic diseases was variable, expressed as ulcer, stenosis, fibrosis, food and relaxation of Barrett esophagus shortened.