應用中文化GerdQ量表診斷國人胃食道逆流疾病之效能分析

Diagnosis of Gastroesophageal reflux disease in Taiwan – role of Chinese GerdQ

高佩君(Pei-Chun Kao)

指導教授 ： 林俊哲

中山醫學大學/醫學院/醫學研究所/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00085

摘要

胃食道逆流疾病 (Gastroesophageal reflux disease,GERD) 其定義是指患者因胃內容物不正常逆流至食道所形成的。其中以心灼熱感和胃酸逆流為最常見的症狀。雖然西方國家盛行率比東方國家高，但在台灣胃食道逆流疾病的族群有逐年增加的趨勢，不但對病患造成生活的困擾及生活品質的影響，也因此減低工作生產力，消耗診斷及治療的醫療資源也極為可觀。
胃食道逆流疾病的診斷主要是以症狀為主，在國外大部份的都以問卷方式來評估胃食道逆流的嚴重度，國外有許多文獻指出利用問卷來評估病人胃道逆流的症狀是一個新的診斷及評估治療效果，但在國內，因健保給付的關係，胃食道逆流疾病的診斷仍是以內視鏡檢查為主，然而內視鏡仍是屬於一種侵襲性診斷工具，會在檢查的過程中產生一些不適的感覺，往往造成病人精神及體力的耗損。再者，之前許多研究關於問卷評估逆流程度的填寫方式大都由病人自行填寫。目前國內有許多關於胃食道逆流的研究，對於症狀的評估及問卷的填寫方式大多由研究護士一對一訪談後填寫，有關於由病人自發性填寫問卷和由研究護士訪談後填寫兩者之間的比較少有研究。故本研究的動機在以前瞻性研究讓病人接受胃鏡前，利用有效的問卷來評估病人胃食道逆流疾病嚴重度以及發展出一個適合於國人的評估工具。並且比較由研究護士一對一訪填寫及病人自發性填寫問卷兩組之差異性，以做為關於日後問卷填寫方式為參考。
在中部某醫學中心之門診中有典型或非典型胃食道逆流症狀的患者共納入147人，在接受內視鏡檢查前予以問卷調查評估其症狀及頻率。本研究使用胃食道逆流疾病問卷GerdQ評估，並隨機分為兩組：由研究護士當面訪談並填寫問卷及由病人自發性填寫問卷來比較兩者之間不同模式差異性。在所有接受內視鏡完後的病人，結果發現在接受內視鏡的病人中以胃食道逆流者佔多數，其中以Grade A居多。在問卷分數與內視鏡下比較，隨著分數越高內視鏡下逆流程度越嚴重。比較在兩組病患基本背景資料，危險因子等均無差異下。經內視鏡與GerdQ問卷結果分析，由研究護士當面訪談並填寫問卷分數為6.08(±2.84)；由病人自主性填寫問卷為8.08(±2.87) 達到統計學上有意義（P<0.05）。
結論:利用中文化問卷來診斷國人胃食道逆流疾病具有較高特異性及敏感性，可作為臨床醫師與病人對於本身逆流症狀在做內視鏡前一個良好的溝通，預期將來可利用問卷來提供胃食道逆流疾病一個更良好的診斷工具及治療評估指引並提供接受內視鏡前之參考。研究護士訪談後填寫問卷與病人自發填寫問卷的分數來的低，並且做為日後問卷填寫方式為參考。

關鍵字

胃食道逆流疾病 ； 中文化 ； 問卷

並列摘要

Gastroesophageal reflux disease (GERD) is defined as patients with abnormal reflux of gastric contents to the esophagus Heart burn and acid reflux are the most common symptoms. Although such symptoms are more popular in Western countries, there is a rising trend in Taiwan. Not only to patients living in problems caused by the impact and quality of life, and thus reduces hagus formed. work productivity, consumption of diagnosis and treatment of medical resources is also very impressive.
The diagnosis of GERD is based on symptoms, therefore the most foreign patients are assessed by questionnaire the severity of GERD. There are many papers that the use of questionnaires to assess patients' symptoms of GERD is a new diagnostic and evaluated treatment result. However, because of the relationship between the National Health Insurance, GRED diagnostic endoscopic examination is still the main. But, endoscopy is still a form of invasive diagnostic, patients in the inspection process will produce some discomfort, and endoscopy will result in the depletion of human mental and physical. In addition, most of the degree of acid reflux questionnaires which were completed by the patients themselves. At present, research papers on GERD questionnaire approach is based on interviews with medical staff. Patients completed questionnaires on their own and the differences between the nurses interviewed is rarely been studied. This study was motivated by the patient before receiving endoscopy, questionnaires can be used effectively to assess the severity of patients with acid reflux disease, and the development of a suitable assessment tool for people. To fill out the questionnaire as a way for future reference, we should find the differences in comparing the two interviews by nurses and patients on self-completion questionnaire.
Typical or atypical symptoms of GERD were included 147 patients at a medical center hospital in the central. In an interview before endoscopy, we survey methods to assess the frequency of their symptoms. In this study, we used a questionnaire GerdQ to assess patients' symptoms. And randomly divided into two groups，one of them is face to face interviews by research nurses and fill out the questionnaire, which the other is spontaneous complete a questionnaire by the patient. We want to compare the differences between the two different modes. Among all patients after endoscopic, we found that in an endoscopic patients, GERD accounted for the majority of the majority and the Grade A. We compared the questionnaire scores and endoscopy in two ways, found that with the higher the score, endoscopic examination revealed more severe acid reflux. We compared two groups of the same basic background information and risk factors of patients.
By endoscopy and GerdQ questionnaire results, we found that face to face interviews by research nurses and fill out the questionnaire score is 6.08 (± 2.84); Spontaneously by the patients completed questionnaires score is 8.08 (± 2.87). This result is statistically valid to meet the P value (P <0.05). We get a conclusion, using questionnaires to diagnose people GRED , it can have a high specificity and sensitivity. This can be used as a good physician-patient communication. Medical staff questionnaire scores is lower than patients self-administered questionnaire scores. We expect that the future can be used to fill in questionnaires to provide GERD a better diagnostic tool. Before Endoscopic examination, the questionnaire approach can provide valuable reference.

並列關鍵字

Gastroesophageal reflux disease ； Taiwanese ； GerdQ

參考文獻

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