正常人和胃食管反流病人的昼夜食管pH和动力变化

Esophageal pH and Pressure Changes during Day and Night in Health Subjects and Patients with Gastroesophageal Reflux Disease

目的:为探讨正常人和胃食管反流病(gastroesophageal reflux disease,GERD)病人昼夜食管运动规律以及食管运动与酸反流的关系。方法:45例GERD病人和10名正常人均接受食管测压和动态食管pH及压力同步监测。结果:(1)下食管括约肌压、远端食管蠕动压及有效食管蠕动百分比在酸反流DeMeester高计分组明显低于低计分组(P<0.05),在反流性食管炎组也明显低于非反流性食管炎组(P<0.05)。(2)有GERD症状或食管炎的卧位有效蠕动百分比明显低于立位(P<0.05)。反流性食管炎组80％有夜间或伴有夜间反流,而不伴反流性食管炎的GERD无1例出现夜间反流。结论:昼夜食管pH和压力动态监测有利于进一步探讨GERD的运动病理,除LES功能外,食管清除功能在GERD发病中起重要作用。

Background/Aims: To explore esophageal pH and motor changes in health subjects (HS) and gastroesophageal reflux disease (GERD) during day and night. Methods: All subjects received stationary esophageal manometry, both ambulatory esophageal pH and pressure monitoring simultaneously. The pH electrode was positioned at 5cm above LES, and triple micropressure transducers, 5cm in space, were placed from the proximal to distal esophagus. Parameters included LES pressure (LESP), the distal esophageal peristalsis amplitude (AP), percentage of effective peristalsis (EP) during supine, postprandial and meal. Results: (1) LESP, distal AP and percentage of effective peristalsis in higher DeMeester Score group were significantly lower than that in the lower Score groups (P<0.05). These parameters also were lower in patients with reflux esophagitis than those without reflux esophagitis. (2) Percentage of effective peristalsis during supine was lower than upright position in patients with GERD symptom or reflux esophagitis. (3) Eighty per cent of patients with reflux esophagitis showed nocturnal reflux or both nocturnal and day reflux. No nocturnal reflux was shown in patients without reflux esophagitis. Conclusions: (1) Ambulatory esophageal pH and pressure monitoring during day and night is helpful to understand motor pathophysiology in GERD. (2) In addition to LES function, esophageal clearance plays an important role in the pathogenesis of GERD.