无效食管动力在胃食管反流病中作用的探讨

Potential role of ineffective esophageal motility in pathogenesis of gastroesophageal reflux disease

目的探讨无效食管动力(IEM)在胃食管反流病(GERD)发病中的作用。方法选取2014年7月至2016年2月在上海同济大学附属东方医院就诊的GERD患者,所有患者均接受高分辨率(HRM)食管测压和24h动态pH监测,排除食管-胃连接处(EGJ)压力和(或)形态异常的情况,共纳入49例GERD患者。根据HRM测压下食管远端收缩积分(DCI)将GERD患者分为IEM组、异常动力组和正常动力组。比较各组间食管动力及反流情况。结果 49例GERD患者中,IEM组19例,异常动力组15例,正常动力组15例。IEM组中反流性食管炎所占比例显著高于异常动力组和正常动力组(P<0.05),正常动力组与异常动力组相比较差异无统计学意义。IEM组平均吞咽DCI显著低于异常动力组及正常动力组(P<0.01),异常动力组显著低于正常动力组(P<0.01)。IEM组食管体部蠕动中断长度相较于异常动力组及正常动力组显著延长(P<0.01),异常动力组较正常动力组显著延长(P<0.01)。各组间酸反流次数、弱酸反流次数、非酸反流次数和总反流次数比较差异无统计学意义。IEM组DeMeester得分及合计酸反流时间较异常动力组及正常动力组显著增加,差异有统计学意义(P<0.05),异常动力组及正常动力组DeMeester得分及合计酸反流时间比较差异无统计学意义。49例GERD患者中,平均吞咽DCI与食管蠕动中断长度呈负相关(P<0.01),平均吞咽DCI与合计酸反流时间呈负相关(P<0.01)。结论 GERD患者中食管动力障碍与酸反流相关,食管体部收缩力度减弱,蠕动中断延长,与酸反流严重程度相关。IEM患者食管收缩力度较弱,酸反流时间较长,更易导致食管炎发生。

Objective This paper intents to explore the potential role of ineffective esophageal motility（IEM）in the pathogenesis of gastroesophageal reflux disease（GERD）.Methods The GERD patients of East Hospital affiliated to Tongji University from July 2014 to February 2016 were selected and received high-resolution esophageal manometry（HRM）and 24-hour multichannel intraluminal impedance-pH monitoring.Forty-nine GERD patients were enrolled excluding patients with abnormal esophagogastric junction.All the patients were divided into the IEM group,the abnormal motility group,and the normal motility group according to the result of HRM.The esophageal motility and reflux condition among the three groups were compared.Results Of the 49 GERD patients,19 were in the IEM group,15 in the abnormal motility group,and 15 in the normal motility group.The proportion of reflux esophagitis in the IEM group was found to be significantly higher than that in the abnormal motility group and the normal motility group（P〈0.05）,and there was no significant difference between the normal motility group and the abnormal motility group（P〉0.05）.The average swallowing distal contractile integral（DCI）in the IEM group was significantly lower than that in the abnormal motility group and the normal motility group（P〈0.01）,and the average swallowing DCI in the abnormal motility group was significantly lower than that in normal motility group（P〈0.01）.The length of peristaltic break of esophageal body in the IEM group was significantly longer than that in the abnormal motility group and the normal motility group（P〈 0.01）,and the length of peristaltic break of esophageal body in the abnormal motility group was significantly longer than that in the normal motility group（P〈0.01）.There was no significant differences in the number of acid reflux,weak acid reflux,nonacid reflux,and the total number of reflux among the three groups（P〉0.05）.The DeMeester score and the total acid reflux time of the IEM group were significantly higher than that of the abnormal motility group and the normal motility group（P〈0.05）,and there was no significant difference in the DeMeester score and the total acid reflux time between the abnormal motility group and the normal motility group（P〉0.05）.There was a negative correlation between the average swallowing DCI and the length of the peristaltic break of the esophageal body（P〈0.01）,and there was a negative correlation between the average swallowing DCI and the total acid reflux time（P〈0.01）among the 49 GERD patients.Conclusions Esophageal motility disorders is related to acid reflux.Esophageal acid relux would be more severe when the strength of the esophageal body weakened or the length of the peristaltic break of the esophageal body prolonged.The strength of the esophageal body is weak and the total reflux time is longer in IEM patients,which might lead to the incidence of esophagitis.