胃食管反流病患者酸反流与食管运动功能障碍的关系

Correlation between Acid Reflux and Esophageal Dysmotility in Patients with Gastroesophageal Reflux Disease

背景:异常酸反流和食管运动功能障碍与胃食管反流病(GERD)密切相关。目的:研究GERD患者的食管运动和酸反流与食管黏膜损害的关系,以及两者之间的相关性。方法:选取有反酸、烧心、胸痛等典型胃食管反流症状的患者72例行上消化道内镜检查、食管测压和24hpH监测。根据pH<4总时间百分比<4.5%且DeMeester计分<14.7的标准,将食管炎患者分为生理性酸反流组(pH-组)和病理性酸反流组(pH+组)。结果:内镜下食管炎组24hpH监测各项指标较无食管炎组显著增高(P<0.05),病理性酸反流的发生率显著高于无食管炎组(P<0.01)。两组食管测压各项指标无显著差异,食管炎组pH+者的食管下括约肌压力(LESP)较pH-者显著降低,食管体部蠕动波传导速度减慢,湿咽成功率减少(P<0.05)。结论:GERD患者食管炎的发生与酸反流密切相关,有病理性酸反流的GERD患者易见食管运动功能障碍。

Background： Abnormal acid reflux and esophageal dysmotility are closely related with gastroesophageal reflux disease （GERD）. Aims： To investigate the correlation between esophageal motility and acid reflux, and their relations to esophageal mucosal injury in patients with GERD. Methods： A total of 72 patients with typical reflux symptoms as regurgitation, heartburn, and chest pain were recruited and evaluated by upper gastrointestinal endoscopy, esophageal manometry and 24-h pH monitoring. Patients with endoscopic esophagitis were divided into physiologic reflux （pH） and pathologic reflux （pH^＋） groups in accordance with the criteria of the total percentage time of pH below 4 less than 4.5% and DeMeester score 〈14.7. Results： Results of parameters of 24-h pH monitoring were significantly higher in endoscopic esophagitis group than those in non-esophagitis group （P〈0.05）, more patients with esophagitis had pathologic reflux （P〈 0.01）. However, there was no statistically significant difference in esophageal manometry readings between patients with and without esophagitis. In esophagitis group, lower esophageal sphincter pressure （LESP）, speed of esophageal peristalsis transmission, and the success rate of wet swallowing were significantly lower in patients with pathologic reflux than those in patients with physiologic reflux （P〈0.05）. Conclusions： The development of esophagitis in GERD is closely related with acid reflux and patients with pathologic reflux are more likely to have esophageal dysmotility.