食管远端与近端酸反流患者的食管动力特点分析

Characteristics of esophageal motility in patients with upper or lower-esophageal reflux

  • 摘要: 目的 研究食管远端与近端酸反流患者的食管动力特点,分析胃食管反流病与咽喉反流病患者的食管动力变化。 方法 收集40例因胃食管反流相关症状进行24 h双通道食管pH监测及高分辨率食管测压的检查结果,按照不同反流形式将患者分组,对比分析其食管测压结果。 结果 40例中食管远端、近端酸反流均阳性者9例(A组),男4例,女5例,年龄35 ~ 74岁;单独近端酸反流阳性者8例(B组),男3例,女5例,年龄40 ~ 57岁;单独远端反流阳性者11例(C组),男4例,女7例,年龄33 ~ 74岁;无病理性酸反流者12例(对照组),男4例,女8例,年龄29 ~ 62岁。A、B、C组及对照组食管下括约肌压力(lower esophageal sphincter pressure,LESP)分别为(16.86±6.84) mmHg (1 mmHg=0.133 kPa)、(17.36±8.74) mmHg、(20.91±16.01) mmHg和(30.73±12.39) mmHg,食管下括约肌腹内长度分别为0.50(1.75 ~ 0.05) cm、0.48(1.12 ~ 0.12) cm、0.56(1.95 ~ 0.15) cm和1.85(2.75 ~ 0.20) cm,A、B、C组的LESP均低于对照组,食管下括约肌的腹内段长度均明显短于对照组(P< 0.05);A、B、C组与对照组上食管括约肌松弛恢复时间分别为(434.22±177.81)ms、(423.00±93.00) ms、(485.27±159.89) ms和(559.75±130.48) ms,A、B组上食管括约肌松弛恢复时间明显短于对照组(P< 0.05);A、B、C组及对照中仅有食管体部运动功能障碍、食管裂孔疝或同时患有这两种疾病的例数分别为1例、2例、4例,1例、0例、4例,2例、2例、4例,0例、0例、1例,A、B、C组的病例数较对照组多。 结论 食管下括约肌压力减低、食管体部运动功能障碍及食管裂孔疝是胃食管反流病与咽喉反流病共有的反流基础,食管上括约肌动力功能改变可能与食管近端酸反流相关。

     

    Abstract: Objective To explore the characteristics of esophageal motility in patients with upper or lower-esophageal reflux, and analyze esophageal motility changes in patients with esophageal reflux disease (GERD) or laryngopharyngeal reflux disease (LPRD). Methods Retrospective analysis was carried out in 40 patients with GER symptoms. All of these patients underwent 24 hours dualprobe pH monitoring of esophagus and high-resolution manometry (HRM) at the same time. Then the outcomes of these patients were collected and the patients were divided into four groups according to different esophageal reflux types, and the HRM parameters were compared between four groups. Results There were 9 patients with both lower and upper-esophageal reflux (group A, 4 males and 5 females with age ranging from 35-74 years), 8 patients with upper-esophageal reflux only (group B, 3 males and 5 females with age ranging from 40-57 years), 11 patients with lower-esophageal reflux only (group C, 4 males and 7 females with age ranging from 33-74 years), and 12 patients without pathologic gastroesophageal reflux (control group, 4 males and 8 females with age ranging from 29-62 years). The lower esophageal sphincter pressure (LESP) of patients in group A, B, C were significantly lower than control group (16.86±6.84) mmHg, (17.36±8.74) mmHg, (20.91±16.01) mmHg vs (30.73±12.39) mmHg, P< 0.05, and the abdominal LES length of patients in group A, B, C was significantly shorter than control group (0.50, 1.75-0.05) cm, (0.48, 1.12-0.12)cm, (0.56, 1.95-0.15) cm vs (1.85, 2.75-0.20) cm, P< 0.05. The recovery time of upper esophageal sphincter (UES) relaxation of patients in group A and B was significantly shorter than control group (434.22±177.81) ms, (423.00±93.00) ms vs (559.75±130.48) ms, P< 0.05. The number of patients with motility abnormalities in esophageal body only or hiatal hernia only or both of the two diseases in group A (n=1, 2, 4), B (n=1, 0, 4), C (n=2, 2, 4) was more than control group (n=0, 0, 1). Conclusion The decrease of LESP, motility abnormalities in esophageal body and hiatal hernia are closely related to both GERD and LPRD.

     

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