不同类型胃食管反流病患者的食管动力、酸反流情况的差异

Association Between Acid Reflux and Esophageal Dysmotility in Patients with Gastroesophageal Reflux Disease

目的研究不同类型胃食管反流病(GERD)患者的食管动力和酸反流情况的差异。方法随机选取94例有烧心、反酸、胸痛等症状且反流性疾病问卷的症状积分(Sc)≥12的患者行上消化道内镜、高分辨率食管测压(HRM)及24h食管pH监测。根据内镜诊断结果分为反流性食管炎(RE)组和非糜烂性反流病(NERD)组,比较RE与NERD两组食管动力和酸反流情况。同时根据24h食管pH监测结果分为生理性酸反流(pH-)组和病理性酸反流(pH+)组,比较两组患者食管动力学指标的变化。结果 RE组的下食管括约肌压力(LESP)、下食管括约肌长度(LESL)、食管收缩波幅、远段收缩积分(DCI)及有效蠕动比例与NERD相比差异无统计学意义(P>0.05);而RE组LESP减低的发生率及食管裂孔疝的发生率高于NERD(分别为63.0%vs.31.7%,P<0.01;37.0%vs.14.3%,P<0.05)。28例GERD患者发生pH+,RE组pH+发生率高于NERD组(63.0%vs.17.5%,P<0.01);RE组24h食管pH监测各项指标均高于NERD组,差异有统计学意义(P<0.05)。pH+组LESP及食管收缩波幅低于pH-组,且pH+组LESP减低发生率及食管裂孔疝发生率高于pH-组,差异有统计学意义(P<0.05);pH+组LESL、DCI及有效蠕动比例低于pH-组,但差异无统计学意义(P>0.05)。结论 RE患者较NERD患者更易见酸反流和食管裂孔疝;有pH+的GERD病患者更易见食管动力障碍,这种差异可能与食管动力障碍和酸反流的相互作用有关。

Objective To investigate the association between esophageal motility and acid reflux in patients with gastroesophageal reflux disease （GERD）. Methods A total of 94 patients with typical reflux symptoms such as heartburn, regurgitation and chest pain, whose score （Sc） of reflux diagnostic questionnaire （RDQ） was greater than or equal to 12 were enrolled in the study. Each participant was evaluated by upper gastrointestinal endoscopy, high resolution manometry （HRM） of esophagus and 24 h esophageal pH monitoring. The participants were divided into groups of reflux esophagitis （RE） and non-erosive reflux disease （NERD） on the basis of endoscopy findings. The 24 h esophageal pH monitoring categorized participants into physiologic reflux （pH-） and pathologic reflux （pH＋ ）. The characteristics of esophageal motility and acid reflux were compared between the two groups of participants. Results Lower but non-significant differences （P〉0.05） were found in pressure of lower esophageal sphincter （LESP）, length of lower esophageal sphincter （LESL）, esophageal contraction amplitude （CA）, distal contractile integral （DCI） and effective peristalsis proportion （EPP） in the participants in the RE group compared with those in the NERD group. Participants in the RE group had significantly higher prevalence of reduced LESP （63.0% vs. 31.7%, P〈0.01） and hiatus hernia （HH） （37.0% vs. 14.3%, P〈0.05） than those in the NERD group, pH＋ was more prevalent in the RE group than in the NERD group （63. 0% vs. 17. 5%, P〈0. 01）. Indicators of 24 h esophageal pH monitoring were significantly higher in participants in the RE group compared with those in the NERD group （P〈0.05）. Participants with pH＋ had significantly lower LESP, CA and higher HH and prevalence of reduced LESP compared with those with pH- （P〈0.05）. LESL, DCI and EPP were lower in those with pH＋ compared with those with pH- , hut without statistical significance （P〈0. 05）. Conclusion RE is closely associated with acid reflux and hiatus hernia. Esophageal dysmotility is more likely to appear in patients with pH＋. The interaction of acid reflux and esophageal dysmotility may play a role in GERD.