Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance
Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance
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DOI：
10.1136/gut.44.1.47
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发表时间：
1999-01-01
期刊：
影响因子：
24.5
通讯作者：
Janssens, JJ
中科院分区：
文献类型：
--
作者：
Sifrim, D;Silny, J;Janssens, JJ
背景：在正常人中，打嗝被认为是酸性胃食道反流的主要机制。目的：用腔内电阻抗法研究正常受试者一过性下食道括约肌(LOS)松弛时气液两相反流的模式，这是酸反流的主要机制。方法：在猫体内和体外研究与气体排出相关的阻抗变化。11名正常受试者在餐后进行了食道测压、pH和管腔内电阻抗测量。结果：气体反流引起阻抗突然增加，并迅速传播到食道近端，而液体反流引起阻抗的逆传下降。在大多数(102/141)瞬时LOS松弛期间，阻抗显示为气体或液体回流。当酸反流发生时，阻抗显示大多数(78%)的事件显示食道内液体逆行流动。在几乎一半(47%)的胃酸反流事件中发现了气体逆流的证据。然而，当液体同时存在时，44%的情况下液体先于气体。总体而言，气体反流仅在25%的胃酸反流事件中作为初始事件发生。结论--这些发现表明，在直立的正常人中，尽管打嗝会导致胃酸反流，但大多数胃酸反流都是作为主要事件发生的。
Background-Belching has been proposed as a major mechanism underlying acid gastro-oesophageal reflux in normal subjects. However, the presence of oesophageal gas has not been measured directly but only inferred from manometry.Aims-To investigate, using intraluminal electrical impedance, the patterns of gas and liquid reflux during transient lower oesophageal sphincter (LOS) relaxations, the main mechanism of acid reflux in normal subjects.Methods-Impedance changes associated with the passage of gas were studied in vitro, and in vivo in cats. Oesophageal manometry, pH, and intraluminal electrical impedance measurements were performed in 11 normal subjects after a meal.Results-Gas reflux caused a sudden increase in impedance that propagated rapidly to the proximal oesophagus whereas liquid reflux induced a retrogressively propagated fall in impedance. Impedance showed gas or liquid reflux during most (102/141) transient LOS relaxations. When acid reflux occurred, impedance showed evidence of intraoesophageal retrograde flow of liquid in the majority (78%) of events. Evidence of gas retroflow was found in almost half (47%) of acid reflux episodes. When present together, however, liquid preceded gas on 44% of occasions. Overall, gas reflux occurred as the initial event in only 25% of acid reflux episodes.Conclusions-These findings suggest that in upright normal subjects, although belching can precipitate acid reflux, most acid reflux occurs as a primary event.