Esophageal dysmotility and gastroesophageal reflux disease
Esophageal dysmotility and gastroesophageal reflux disease
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DOI：
10.1016/s1091-255x(01)80046-9
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发表时间：
2001-05-01
影响因子：
3.2
通讯作者：
Way, LW
中科院分区：
文献类型：
--
作者：
Diener, U;Patti, MG;Way, LW
胃食管反流病（GERD）产生一系列从轻微到严重的症状。虽然食管下括约肌在胃食管反流发病机制中的作用已被广泛研究，但对食管蠕动的关注较少，尽管蠕动控制着食管酸的清除。本研究的目的是评估胃食管反流患者的以下方面：(1)食管蠕动的性质；(2)食管蠕动与胃食管反流、粘膜损伤和症状的关系。根据食管压力测量显示的食管蠕动特征，将连续进行24小时pH监测确诊的胃食管反流病患者共1600例分为三组：(1)正常蠕动（蠕动波的振幅、持续时间和速度正常）；(2)食管运动不良（IEM；远端食管振幅30%同步波）；(3)非特异性食管运动障碍（NSEMD，运动功能障碍介于其他两组之间）。563例正常（56%），216例IEM(21%)， 227例NSEMD（23%）。蠕动异常的患者反流更严重，食管酸清除更慢。IEM患者胃灼热、呼吸道症状和粘膜损伤均更为严重。这些数据显示，21%的GERD患者食管蠕动严重受损（TEM），该组患者反流更严重，酸清除更慢，粘膜损伤更严重，呼吸道症状更频繁。我们的结论是，食管测压和pH监测可以用来判断胃食管反流的严重程度，这反过来应该有助于确定哪些人将从手术治疗中获益最多。
Gastroesophageal reflux disease (GERD) produces a spectrum of symptoms ranging from mild to severe. While the role of the lower esophageal sphincter in the pathogenesis of GERD has been studied extensively, less attention has been paid to esophageal peristalsis, even though peristalsis governs esophageal acid clearance. The aim of this study was to evaluate the following in patients with GERD: (I) the nature of esophageal peristalsis and (2) the relationship between esophageal peristalsis and gastroesophageal reflux, mucosal injury and symptoms. One thousand six consecutive patients with GERD confirmed by 24-hour pH monitoring were divided into three groups based on the character of esophageal peristalsis as shown by esophageal manometry: (1) normal peristalsis (normal amplitude, duration, and velocity of peristaltic waves); (2) ineffective esophageal motility (IEM; distal esophageal amplitude 30% simultaneous waves); and (3) nonspecific esophageal motility disorder (NSEMD; motor dysfunction inter mediate between the other two groups). Peristalsis was classified as normal in 563 patients (56%), IEM in 216 patients (21%), and NSEMD in 227 patients (23%). Patients with abnormal peristalsis had worse reflux and slower esophageal acid clearance. Heartburn, respiratory symptoms, and mucosal injury were all more severe in patients with IEM. These data show that esophageal peristalsis was severely impaired (TEM) in 21% of patients with GERD, and this group had more severe reflux, slower acid clearance, worse mucosal injury and more frequent respiratory symptoms. We conclude that esophageal manometry and pH monitoring can be used to stage the severity of GERD, and this, in turn, should help identify those who would benefit most from surgical treatment.