胃食管反流病的食管动力功能

Esophageal Motor Function of Gastroesophageal Reflux Disease

目的探讨无效食管运动及下食管括约肌压力降低与食管黏膜损害程度及酸反流之间的关系。方法符合胃食管反流病诊断标准的89例患者被纳入本研究,所有患者接受食管pH监测及食管压力测定,其中77例患者同期接受上消化道内镜检查。结果无效食管运动及下食管括约肌压力降低是胃食管反流病的常见现象。伴有无效食管运动和下食管括约肌压力降低的患者远端食管反流指数、合计反流时间、长反流时间高于单纯无效食管运动组、单纯下食管括约肌压力降低组和非无效食管运动非下食管括约肌压力降低组患者(P<0.05);远端食管反流指数、合计反流时间、反流周期、长反流时间与食管炎程度呈正相关(P<0.05),而与下食管括约肌压力、远端食管收缩振幅呈负相关(P<0.05);远端食管收缩振幅与食管炎严重程度呈负相关(P<0.05);食管炎严重程度与无效食管运动的程度无相关性(P>0.05);无效食管运动伴下食管括约肌压力降低者中,重度食管炎检出率明显高于其他各组(P<0.05),各组轻度食管炎的检出率差异无统计学意义(P>0.05)。结论胃食管反流病是多因素参与的疾病过程,无效食管运动和下食管括约肌压力降低可能参与胃食管反流病的发病过程,但仅用一种机制难以解释所有病理现象。胃食管反流病也许是两种或两种以上因素协同作用的结果。

Objective To study the relationship between esophageal motor functional disorder [decreased lower esophageal sphincter pressure(LESP)and ineffective motility(IEM)]and gastroesophageal reflux disease(GERD).Methods Totally 89 patients with GERD were enrolled in this study.All of them underwent 24-hour pH monitoring with dual-channel probe and stationary esophageal manometry.In addition,77 of these patients underwent upper endoscopy.Results IEM and LESP < 10 mmHg were common disturbances in patients with GERD(54% and 48%,respectively).The number of the acid reflux events of distal esophagus and prevalence of moderate or severe erosive esophagitis(EE)were significantly higher in patients with low LESP and IEM than patients without low LESP(P < 0.05).The number of the acid reflux events in distal esophagus was significantly correlated with the severity of esophagitis,distal esophagus amplitude,and LESP,while no such correlation was found between IEM and degree of esophageal acid exposure or esophagitis.Conclusions The pathophysiology of GERD is probably multifactorial.Lower LESP or IEM is not a independent pathophysiological factor for GERD.However,one single factor is insufficient to explain all the pathogenic mechanism of GERD.