食管运动功能在重度反流性食管炎中的地位

Role of esophageal motility abnormalities in severe reflux esophagitis

目的通过对重度反流性食管炎(RE)治愈前后食管体部运动功能的研究,了解食管体部运动功能在重度RE中的地位.方法对70例胃食管反流病患者进行食管压力测定.从中筛选23例重度RE(内镜诊断为洛杉矶C和D级食管炎);且24 h食管内pH监测证实为病理性酸反流;食管压力测定证实有食管体部运动障碍患者.给予兰索拉唑30 mg/d治疗3～6个月至内镜下食管炎完全愈合后,再行食管压力测定,观察下食管括约肌静息压(LESP)及食管体部运动功能的变化.以湿咽成功率、食管远端收缩波幅和食管蠕动的传导速度作为食管体部运动功能的指标.结果食管炎治愈前后,LESP[(6.00±0.86)mm Hg比(5.10±0.87)mm Hg,1 kPa=7.5 mm Hg,P=0.476],食管远端收缩波幅[(34.1±4.1)mm Hg比(37.2±4.0)mm Hg,P=0.593]、湿咽成功率[(33.5±6.5)%比(38.6±7.1)%,P＝0.592]比较差异均无统计学意义,其均值仍显著低于正常对照组.结论治愈食管炎并不能提高LESP及改善食管体部的运动功能.食管体部运动功能障碍和酸反流是RE的重要发病机制,尤其是重度RE.

Objectives To evaluate the effects of prolonged treatment with proton pump inhibitor(PPI) on esophageal motility function in patients with severe erosive esophagitis associated with peristaltic dysfunction Methods Twelve controls and 70 patients with gastroesophageal reflux disease (GERD ) divided into two groups according to endoscopic finding (Los Angeles classification): 27 patients with non-erosive reflux disease (NERD), and 43 with reflux esophagitis(RE)(LA-CD severe eosphgitis) They all underwent an ambulatory 24 h pH monitoring and esophageal manometry Twenty-three patients with severe eosphgitis included in the study with PPI They all have pathological acid reflux and esophageal peristaltic dysfunction They were treated with lansoprazole 30 mg per day for three to six months until complete endoscopic healing was achieved After healing, a control esophageal manometry was then performed Results (1)Esophageal dysmotility occur in every group of GERD, The rates of esophageal dysmotility showed in RE high than NERD( P <0 05) (2)In PPI group, Before treatment, mean value contraction amplitude was significantly lower than mean contraction amplitude of control group( P <0 01), as well as mean percentage of peristaltic contractions ( P <0 01) At the end of treatment, no a statistically significant improvement of esophageal motility functions was observed for mean value lower esophageal sphincter pressure [(6 00±0 86 )mm Hg vs (5 10±0 87)mm Hg,1 kPa=7 5 mm Hg, P =0 476]、mean value contraction amplitude[(34 1±4 1) mm Hg vs (37 2±4 0)mm Hg, P =0 593]and peristaltic contractions[ (33 5±6 5)% vs (38 6±7 1)%, P =0 592] The post treatment values were still significantly lower than control values Conclusions This study suggests that both of dysmotility and acid reflux are important role in the mechanism of GERD, especially in severe patients