CHARACTERISTICS AND FREQUENCY OF TRANSIENT RELAXATIONS OF THE LOWER ESOPHAGEAL SPHINCTER IN PATIENTS WITH REFLUX ESOPHAGITIS
CHARACTERISTICS AND FREQUENCY OF TRANSIENT RELAXATIONS OF THE LOWER ESOPHAGEAL SPHINCTER IN PATIENTS WITH REFLUX ESOPHAGITIS
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DOI：
10.1016/s0016-5085(88)80003-9
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发表时间：
1988-09-01
期刊：
影响因子：
29.4
通讯作者：
MCCALLUM, RW
中科院分区：
文献类型：
--
作者：
MITTAL, RK;MCCALLUM, RW
对12例有主观和客观胃食管反流（格尔）病证据的患者同时进行颏下肌肌电图、食管测压和pH研究，以确定食管下括约肌（LES）短暂松弛的频率和GER的机制，并与10例无症状健康志愿者的数据进行比较。在空腹状态下和标准850千卡餐后3小时进行记录。LES的短暂松弛是正常人酸反流的唯一机制，占格尔病患者酸反流发作的73.0%。在正常受试者和格尔患者中，大量的一过性松弛在其发作时与减弱的颏下EMG复合波、小的咽部收缩和食管收缩相关。两个研究人群中这些相关事件的发生率相似。格尔患者LES的短暂舒张频率与对照组相同。即使在9例患有内镜下食管炎的格尔病患者中，频率也没有差异。正常受试者中36%的一过性LES松弛伴有pH值反流证据，但在内镜下食管炎的格尔患者中，65%的一过性LES松弛导致反流事件。深吸气时的酸反流是我们患者中第二常见的格尔反流机制。四名患者证明了这一机制有食管裂孔疝和更严重的食管炎比其余的组。我们的研究结果证实LES的短暂松弛是反流性食管炎患者发生格尔的主要机制。然而，这种松弛在格尔患者和健康无症状受试者中的相似频率表明，除短暂LES松弛外的因素在格尔病的发病机制中起重要作用。
Electromyogram of the submental muscles, esophageal manometry, and pH studies were simultaneously performed in an unselected group of 12 patients with subjective and objective evidence of gastroesophageal reflux (GER) disease to determine the frequency of transient relaxation of the lower esophageal sphincter (LES) and mechanisms of GER. Findings from these patients were compared with data from 10 asymptomatic healthy volunteers. Recordings were obtained for 1 h in the fasting state and 3 h after a standard 850-kcal meal. Transient relaxation of the LES was the only mechanism of acid reflux in normal subjects and accounted for 73.0% of the episodes of acid reflux in patients with GER disease. In both normal subjects and patients with GER, a large number of transient relaxations were associated at their onset with an attenuated submental EMG complex, a small pharyngeal contraction, and an esophageal contraction. The incidences of these associated events were similar in the two study populations. The frequency of transient relaxation of the LES in patients with GER was identical to that of controls. The frequency did not differ even in 9 patients with GER disease who had endoscopic esophagitis. Thirty-six percent of transient relaxations in the normal subjects were accompanied by pH evidence of reflux, but in the GER patients with endoscopic esophagitis 65% of the transient LES relaxations resulted in a reflux event. Acid reflux at the moment of deep inspiration was the second most common mechanism of GER in our patients. Four patients who demonstrated this mechanism had hiatal hernias and more severe esophagitis than the rest of the group. Our findings confirm that transient relaxation of the LES is the major mechanism of GER in patients with reflux esophagitis. However, the similar frequency of this relaxation in GER patients and in healthy asymptomatic subjects suggests that factors other than transient LES relaxation play an important role in the pathogenesis of GER disease.