非糜烂性反流病患者食管动力特征分析

Analysis of Esophageal Motility in Patients with Nonerosive Reflux Disease

背景:食管动力障碍在胃食管反流病(GERD)的发生中起重要作用。目的:探讨不同类型非糜烂性反流病(NERD)的食管动力特征。方法:选取161例具有典型胃食管反流症状者和20名健康体检者,分别行上消化道内镜检查、24 h食管pH监测和食管测压。纳入内镜检查未见Barrett食管和食管黏膜破损、症状指数≥50%的NERD患者,根据其是否存在病理性酸反流分为异常酸反流组和食管酸高敏组,比较反流组(28例)、高敏组(13例)和对照组(15例)的食管测压结果。结果:反流组下食管括约肌(LES)长度较对照组显著缩短(P<0.05),LES压力显著降低(P<0.05),高敏组与对照组间则无明显差异。反流组和高敏组食管体部动力障碍均以食管远段为主,表现为收缩波幅降低、蠕动波传导速度减慢和非传导性收缩波比例增加,反流组改变更为明显。结论:不同类型NERD的食管动力特征存在差异。异常酸反流亚型NERD患者存在LES长度和压力异常,食管远段动力障碍更为明显。

Background：Esophageal motility disorder plays an important role in the pathogenesis of gastroesophageal reflux disease（GERD）.Aims：To investigate the characteristics of esophageal motility in different nonerosive reflux disease （NERD） subgroups.Methods：One hundred and sixty-one patients with typical gastroesophageal reflux symptoms and twenty healthy subjects were enrolled.Each individual was evaluated with upper gastrointestinal endoscopy,24-hour esophageal pH monitoring and esophageal manometry.NERD was diagnosed when the individual did not have either Barrett＇s esophagus or definite esophageal mucosal breaks at endoscopy and with a symptom index≥50%.According to the presence or absence of pathological acid reflux,patients with NERD were divided into abnormal acid reflux group and hypersensitive esophagus group.Manometric findings were compared between reflux group（n=28）,hypersensitivity group （n=13） and control group（n=15）.Results：Compared with control group,length of lower esophageal sphincter（LES） was shorter and LES pressure was lower in reflux group（P0.05）,but there were no significant differences between hypersensitivity group and control group.Motility disorders in esophageal body mainly appeared in distal esophagus in both NERD subgroups and were manifested as lowering of distal esophageal contraction amplitude,slowing of peristalsis transmission velocity,and increasing of non-transmitted contractions,these disorders were more prominent in reflux group than in hypersensitivity group.Conclusions：Different esophageal motility characteristics are found in different NERD subgroups.Reduced LES length and pressure and more prominent distal esophageal motility disorders are seen in abnormal acid reflux subgroup of NERD.