胃食管反流病的酸反流程度与食管动力、食管炎及贲门形态的相互关系

The relationship between acid reflux and esophageal motility,esophagitis and cardiac morphology in gastroesophageal reflux disease

目的分析胃食管反流病(GERD)患者的食管酸反流严重程度与食管动力、食管黏膜损伤以及胃食管交界区(GEJ)形态解剖学之间的关系及其意义.方法回顾分析2016年1月至2019年1月于火箭军特色医学中心胃食管外科同期行食管24 h pH-阻抗监测、胃镜和高分辨率测压(HRM)的GERD患者的临床资料,按DeMeester积分分为非病理性酸反流组、轻度病理性酸反流组和中重度病理性酸反流组,各组性别和年龄进行配对,每组均为60例.统计分析各组的上食管括约肌(UES)压力、下食管括约肌(LES)压力、LES长度、腹段LES长度、无效吞咽百分比、食管炎、GEJ的Hill分级和食管裂孔疝(HH)等参数的差异,并进行两两比较和相关性分析.结果各组男女比例均为33:27,年龄均为(57±13)岁,非参数检验分析显示LES压力及腹腔LES长度随酸反流的严重程度的升高而减小(P=0.033,P=0.015),测压HH的检出率随之显著增加(χ^2=0.001);食管炎评分随酸反流的严重程度的升高而升高(P<0.001),食管炎的检出率随之显著增加(χ^2<0.001);GEJ的Hill分级评分随酸反流严重程度的升高而升高(P<0.001),胃镜HH的检出率随之显著增加(χ^2<0.001).DeMeester积分与LES压力、腹段LES长度、无效吞咽百分比、食管炎评分、以及Hill分级评分的相关性均具有统计学意义(均P<0.05).结论GEJ区域食管低动力状态(如LES压力过低)和解剖学异常(腹段食管缩短、GEJ松弛乃至HH形成)与酸反流的严重程度显著相关,这些异常可能是造成酸反流加重的重要原因;另外,酸反流的加重亦可增加食管炎的发生率和严重程度.

Objective To analyze the relationship between the severity of esophageal acid reflux and esophageal motility,esophageal mucosal injury and morphological anatomy of gastroesophageal junction(GEJ)in patients with gastroesophageal reflux disease(GERD).Methods The clinicaldata of GERD patients who underwent 24 h pH-impedance monitoring,gastroscopy and high-resolution manometry(HRM)from January 2016 to January 2019 in the Gastroesophageal Surgery Department of PLA Rocket Force Characteristic Medical Center were retrospectively analyzed.The patients were divided into non-pathological acid reflux group,mild pathological acid reflux group and moderate to severe pathological acid reflux group according to the DeMeester score.The gender and age of each group were matched,with 60 cases in each group.Statistical analysiswas performed to analyze thedifferences in upper esophageal sphincter pressure,lower esophageal sphincter pressure(LES),LES length,length of ventral LES,percentage of ineffective swallowing,esophagitis,Hill grade of GEJ,and hiatus hernia(HH)in each group.The comparison and correlation analysis are also carried out between the groups.Results The male-female ratio was 33/27,and the age was(57±13)years in each group.Non-parametric analysis showed that the LES pressure and the length of the ventral LES decreased with the severity of acid reflux,and there was a statistical difference(P=0.033,P=0.015).The detection rate of HH by HRM increased significantly(χ^2=0.001)as well.Esophagitis score increased with the severity of acid reflux and there was statistical difference(P<0.001).The detection rate of esophagitis increased significantly(χ^2<0.001)as well.Hill grading score of GEJ increased with the severity of acid reflux,and there was statistical difference(P<0.001).The detection rate of HH by endoscopy increased significantly(χ^2<0.001)as well.The correlation between DeMeester score and LES pressure,length of ventral LES,percentage of ineffective swallowing,esophagitis score,and Hill grade score were statistically significant(P<0.05).Conclusions The esophageal low motility(such as low LES pressure)and anatomical abnormalities(abdominal esophageal shortening,GEJ flabbiness,and even HH formation)of the GEJ regionare significantly associated with the severity of acid reflux.These factors may be important causes of increased acid reflux.In addition,the aggravation of acid reflux can also increase the incidence and severity of esophagitis.