难治性胃食管反流病食管运动功能及反流特征的临床研究

Clinical study of esophageal motor function and reflux characteristics of refractory gastroesophageal reflux disease

目的研究难治性胃食管反流病(refractory gastroesophageal reflux disease,r GERD)食管运动功能和反流特点。方法应用高分辨率食管测压仪检测40例r GERD患者上食管括约肌(UES)压力、下食管括约肌(LES)压力及食管体部运动功能。同时应用便携式24 h食管p H-阻抗监测仪研究r GERD患者的酸暴露特点、反流类型及反流特点。结果 40例r GERD患者中32.5%的患者存在UES压力偏高,65.0%的患者LES压力偏低,42.5%的患者有食管体部压力偏低或蠕动异常,52.5%的患者存在胃内压力偏高。40.0%的r GERD患者为酸反流,31.4%的r GERD患者为弱酸反流,62.9%的r GERD患者为混合反流。结论 r GERD患者存在UES压力偏高、LES压力下降和食管廓清能力下降,胃内压力偏高。酸抑制不完全、弱酸反流及食管高敏感可能是导致r GERD的重要原因。

Objective To study the esophageal motor function and the reflux characteristic of refractory gastroesoph- ageal reflux disease （rGERD）. Methods High-resolution esophageal pressure instrument was applied to detect, upper esophageal sphincter （UES） pressure, lower esophageal sphincter （LES） pressure and esophageal body movement func- tion in 40 rGERD patients. Meanwhile 24 hours esophageal pH-impedance applications portable monitor was used to study the acid exposure characteristics, reflux type and the reflux characteristics of rGERD. Results In 40 rGERD pa- tients, 32.5% of patients had higher UES pressure, while 65.0% had lower LES pressure, 42.5% of patients had low- er pressure or abnormal peristalsis with esophageal body, 52. 5% of patients had higher gastric internal pressure. 40.0% of rGERD Patients were acid reflux, 31.4% were weak acid reflux, while 62.9% of patients were mixed reflux. Conclusion The rGERD patients may have higher UES pressure, lower LES pressure and reduced ability of esophageal clearance, higher intragastric pressure. The acid incomplete suppression, weak acid reflux and esophageal hypersensitiv- ity may be important reasons of rGERD.