食管酸灌注对非糜烂性胃食管反流病患者食管内脏敏感性的影响

Effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease

目的研究酸灌注刺激对非糜烂性胃食管反流病(NERD)患者食管内脏敏感性的影响,探讨内脏感觉异常在NERD发病机制中的作用。方法10例正常健康自愿者和21例NERD患者参与试验;采用Synectics内脏刺激器/电子气压泵和带有低顺应性气囊及多个灌注式压力通道的导管给食管以快速时相性气球扩张性刺激和进行食管酸灌注;利用食道气囊扩张术检测受试者对食管气囊扩张的反应。结果酸灌注前NERD患者食管气囊扩张诱发的初始感觉阈值和最大耐受疼痛阈值均低于健康对照组(P<0.01)。酸灌注后NERD患者初始感觉阈值和最大耐受痛阈均比相应基线值降低(P=0.015);酸灌注后健康对照组初始感觉阈值比相应基线值明显降低(P<0.05),但最大耐受痛阈值无显著变化。NERD患者酸灌注的最大耐受痛阈为(9.70±3.06)ml,显著低于健康志愿者的(22.10±4.91)ml(P<0.01)。食管生理盐水灌注对NERD组和健康对照组的各项内脏敏感性指标均无明显的影响。结论酸灌注致敏食管壁化学感受器可明显增加NERD患者对食道机械刺激的反应,提示酸敏感的化学感受器和压力敏感的机械感受器之间可协同作用共同促进食管内脏高敏感性的形成。

Objective To investigate the effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease （NERD） and to evaluate the role of visceral hypersensitivity in NERD pathogenesis. Methods We recruited 21 NERD patients and 10 normal healthy volunteers. Mechanical distentions stimulation and acid perfusion through esophagus were performed using the balloon-affixed and polyvinyl multilumen catheter. Esophageal visceral perception thresholds were examined before and after acid perfusion with esophageal balloon distention by means of a computer-controlled barostat. Results As compared with healthy subjects, NERD patients demonstrated significantly lower initial perception threshold and maximally tolerated pain threshold （P 〈 0.001 ） to esophageal mucosal distention before esophageal mucosal acid exposure. After acid perfusion, the initial perception threshold and maximally tolerated pain threshold of NERD patients were significantly lower than the basic values （ P = 0. 015 ） , the initial volume-to-sensory threshold of normal control subjects also lower than the basic values （ P 〈 0. 05 ） , but infused acid had no effect on their pain threshold. The maximal pain thresholds induced by esophageal balloon distention in NERD patients undergone acid perfusion was significantly lower than that in control group [ （9.70±3.06） ml vs （22.10±4.91） ml, P 〈0. 001 ]. No remarkable changes in visceral perception thresholds were found in two groups before and after saline infusion. Conclusion The sensitization of esophageal mucosal chemoreceptors after acid infusion exerts a significant influence on the pressure-sensitive mechanoreceptors to mechanical distentions stimulation. There is the cooperative interaction between acid-sensitive chemoreceptors and pressure-sensitive mechanoreceptors in process of esophageal visceral hypersensitivity.