摘要
背景:食管酸暴露增加在胃食管反流病(GERD)的发病中起重要作用。食管体部蠕动不完全或缺乏可造成食管清除功能障碍。目的:评估食管体部动力异常,包括非特异性食管动力紊乱(NEMD)和无效食管收缩(IEM)在GERD患者中的发生率,以及NEMD和IEM与胃食管酸反流和内镜下食管炎的关系,以探讨它们在GERD中的作用。方法:对116例GERD患者行标准食管测压和24h食管pH监测,其中75例患者行内镜检查。结果:98例(84.5%)GERD患者存在食管体部动力异常,其中77例为NEMD,NEMD中8例符合IEM的诊断标准。合并NEMD或IEM的GERD患者的pH<4总时间百分比显著高于食管动力正常患者(8.0%±9.3%和15.7%±13.5%对3.0%±4.7%,P<0.05);立位和卧位pH<4时间百分比亦显著高于食管动力正常患者(立位:8.8%±11.1%和17.4%±21.0%对3.6%±4.1%,P<0.01;卧位:7.0%±10.4%和16.1%±12.2%对2.3%±6.7%,P<0.05)。合并IEM的GERD患者总食管酸清除(EAC)时间和立位EAC时间较食管动力正常患者显著延长(总EAC时间:1.89min/反流±1.82min/反流对0.66min/反流±0.58min/反流,P<0.05;立位EAC时间:1.96min/反流±1.96min/反流对0.59min/反流±0.48min/反流,P<0.05)。75例行内镜检查的GERD患者中。
Background: Increased esophageal acid exposure contributes to the pathogenesis of gastroesophageal reflux disease(GERD),and the absence or dysmotility of esophageal body peristalsis may lead to esophageal clearance dysfunction.Aims:In order to reveal the role of esophageal body motility disorders in GERD,the aim of this study was to identify the prevalence of esophageal body motility disorders,including nonspecific esophageal motility disorder(NEMD)and ineffective esophageal motility(IEM)in patients with GERD,and to evaluate the relationship between NEMD and IEM,and gastroesophageal acid reflux and endoscopic esophagitis.Methods:Esophageal manometry and ambulatory24-hour esophageal pH monitoring were performed in116patients with GERD,and endoscopy was performed in75cases of these patients.Results:Ninety-eight pa-tients(84.5%)with GERD were found to have disordered motility in esophageal body.Among them,77were NEMD,and8were NEMD that were concordant with the diagnostic criteria for IEM.The total time percentage of pH<4was significantly in-creased in GERD patients with NEMD or IEM than that in normal esophageal motility patients(8.0%±9.3%and15.7%±13.5%vs.3.0%±4.7%,P<0.05);so did the upright and recumbent time percentages of pH<4(upright time percentage:8.8%±11.1%and17.4%±21.0%vs.3.6%±4.1%,P<0.01;recumbent time percentage:7.0%±10.4%and16.1%±12.2%vs.2.3%±6.7%,P<0.05).The total esophageal acid clearance(EAC)time and upright EAC time were delayed markedly in GERD pa-tients with IEM when compared with those in normal esophageal motility patients(total EAC time:1.89min/reflux±1.82min/reflux vs.0.66min/reflux±0.58min/reflux,P<0.05;upright EAC time:1.96min/reflux±1.96min/reflux vs.0.59min/reflux±0.48min/reflux,P<0.05).Among the75GERD patients undergoing endoscopy,56.1%with NEMD and42.9%with IEM had endoscopic esophagitis,no significant difference was found as compared with the normal esophageal motility patients(69.2%).Conclusions:Esophageal body motility disorders can be detected in patients with GERD,and NEMD is more common.GERD patients with NEMD or IEM have more gastroesophageal acid reflux,and the acid clearance in patients with IEM de-layed more significantly,which indicate that both NEMD and IEM play important roles in GERD.The esophageal mucosal le-sions are not prerequisite for the occurrence of esophageal body motility disorders.
出处
《胃肠病学》
2004年第1期13-16,共4页
Chinese Journal of Gastroenterology
