Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has...Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.展开更多
目的分析无效食管动力(IEM)的临床特征。方法选择2021年7月至2022年7月因胃食管反流病(GERD)样症状或吞咽梗阻于四川大学华西医院行高分辨率食管测压及食管24 h pH监测的患者338例。根据IEM发生情况将其分为正常食管动力组(n=264)和IEM...目的分析无效食管动力(IEM)的临床特征。方法选择2021年7月至2022年7月因胃食管反流病(GERD)样症状或吞咽梗阻于四川大学华西医院行高分辨率食管测压及食管24 h pH监测的患者338例。根据IEM发生情况将其分为正常食管动力组(n=264)和IEM组(n=74)。比较两组人口学特征、食管测压数据、酸暴露时间百分比(AET)、临床症状及对质子泵抑制剂治疗的反应情况。结果IEM组男性人数比例大于正常食管动力组,胃食管结合部(EGJ)基础压低于正常食管动力组,差异有统计学意义(P<0.05)。两组年龄、体质量指数、EGJ分型比较差异无统计学意义(P>0.05)。两组反酸/烧心、胸痛、咽喉不适、吞咽梗阻、非特异症状发生情况比较差异无统计学意义(P>0.05)。IEM组总AET>4.0%、立位AET>6.0%及卧位AET>2.0%人数比例均高于正常食管动力组,差异有统计学意义(P<0.05)。两组抑酸治疗有效率差异无统计学意义(52.08%vs 47.37%;χ^(2)=0.341,P=0.559)。多因素logistic回归分析结果显示,IEM和Ⅱ/Ⅲ型EGJ是促进GERD发生的独立危险因素(P<0.05);较高的EGJ基础压力是抑制GERD发生的保护因素(P<0.05)。结论IEM与食管酸暴露增加有关,临床表现不具有特异性,IEM对质子泵抑制剂的疗效无显著影响。展开更多
目的:分析难治性胃食管反流病(RGERD)的食管动力学状态及反流特点。方法:选取2019年8月-2020年12月本院消化内科收治的60例RGERD患者作为病例组,另选取本院消化内科收治的60例非难治性的胃食管反流病(GERD)患者作为对照组。采用高分辨...目的:分析难治性胃食管反流病(RGERD)的食管动力学状态及反流特点。方法:选取2019年8月-2020年12月本院消化内科收治的60例RGERD患者作为病例组,另选取本院消化内科收治的60例非难治性的胃食管反流病(GERD)患者作为对照组。采用高分辨率食管测压(HREM)监测并比较两组食管动力学参数[食管上端括约肌(UES)压力、食管下端括约肌(LES)压力、LES长度、远端收缩积分(DCI)、收缩前沿速度(CFV)、胃食管连接处收缩积分(EGJ-CI)]。采用24 h食管pH-阻抗监测(24 h MⅡ-pH)监测并比较两组反流指标。结果:病例组UES压力与LES压力均低于对照组(P<0.05);病例组弱酸反流、非酸反流、气体反流及气液混合反流次数均多于对照组(P<0.05)。结论:RGERD患者的食管动力学状态以UES压力及LES压力明显降低为主,反流特点以弱酸、非酸、气体及气液混合反流为主。展开更多
文摘Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.
文摘目的分析无效食管动力(IEM)的临床特征。方法选择2021年7月至2022年7月因胃食管反流病(GERD)样症状或吞咽梗阻于四川大学华西医院行高分辨率食管测压及食管24 h pH监测的患者338例。根据IEM发生情况将其分为正常食管动力组(n=264)和IEM组(n=74)。比较两组人口学特征、食管测压数据、酸暴露时间百分比(AET)、临床症状及对质子泵抑制剂治疗的反应情况。结果IEM组男性人数比例大于正常食管动力组,胃食管结合部(EGJ)基础压低于正常食管动力组,差异有统计学意义(P<0.05)。两组年龄、体质量指数、EGJ分型比较差异无统计学意义(P>0.05)。两组反酸/烧心、胸痛、咽喉不适、吞咽梗阻、非特异症状发生情况比较差异无统计学意义(P>0.05)。IEM组总AET>4.0%、立位AET>6.0%及卧位AET>2.0%人数比例均高于正常食管动力组,差异有统计学意义(P<0.05)。两组抑酸治疗有效率差异无统计学意义(52.08%vs 47.37%;χ^(2)=0.341,P=0.559)。多因素logistic回归分析结果显示,IEM和Ⅱ/Ⅲ型EGJ是促进GERD发生的独立危险因素(P<0.05);较高的EGJ基础压力是抑制GERD发生的保护因素(P<0.05)。结论IEM与食管酸暴露增加有关,临床表现不具有特异性,IEM对质子泵抑制剂的疗效无显著影响。
文摘目的探讨食管动力学障碍不同亚型在胃食管反流病(gastroesophageal reflux disease,GERD)中的作用。方法收集40例GERD典型症状患者,全部行食管高分辨率测压(high-resolution manometry,HRM)和24 h食管动态p H阻抗监测,根据HRM结果,分为动力正常组、失蠕动收缩组、弱蠕动收缩组、间断收缩组。分析食管动力学障碍不同亚型及正常食管动力患者胃食管病理性反流情况。结果 40例典型GERD症状患者中动力正常组10例(25.0%),失蠕动收缩组11例(27.5%),弱蠕动收缩组19例(47.5%),间断收缩组30例(75.0%)。失蠕动收缩组及弱蠕动收缩组反流次数明显多于食管动力正常组(96.7±65.5、92.7±49.1 vs 69.5±31.3,P<0.05),以弱酸反流(53.3±52.2、47.7±34.6 vs 20.3±15.3,P<0.05)为主;而病理性酸暴露程度无明显差别。与食管动力正常组相比,间断收缩组患者总p H<4时间(%)明显升高(8.4±3.9 vs 14.3±7.6,P<0.05);De Meester评分有升高趋势,但差异无统计学意义(27.9±43.9 vs 50.6±60.6,P>0.05)。结论食管收缩力差的患者更易出现反流次数增加且以弱酸反流为主;而食管收缩模式障碍的患者则与食管远端酸暴露更为相关。
文摘目的:分析难治性胃食管反流病(RGERD)的食管动力学状态及反流特点。方法:选取2019年8月-2020年12月本院消化内科收治的60例RGERD患者作为病例组,另选取本院消化内科收治的60例非难治性的胃食管反流病(GERD)患者作为对照组。采用高分辨率食管测压(HREM)监测并比较两组食管动力学参数[食管上端括约肌(UES)压力、食管下端括约肌(LES)压力、LES长度、远端收缩积分(DCI)、收缩前沿速度(CFV)、胃食管连接处收缩积分(EGJ-CI)]。采用24 h食管pH-阻抗监测(24 h MⅡ-pH)监测并比较两组反流指标。结果:病例组UES压力与LES压力均低于对照组(P<0.05);病例组弱酸反流、非酸反流、气体反流及气液混合反流次数均多于对照组(P<0.05)。结论:RGERD患者的食管动力学状态以UES压力及LES压力明显降低为主,反流特点以弱酸、非酸、气体及气液混合反流为主。
