The relationship between esophageal acid exposure and the esophageal response to volumetric distention.
The relationship between esophageal acid exposure and the esophageal response to volumetric distention.
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DOI：
10.1111/nmo.13240
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发表时间：
2018-03
影响因子：
3.5
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Carlson DA;Kathpalia P;Craft J;Tye M;Lin Z;Kahrilas PJ;Pandolfino JE
食管胃交界（EGJ）膨胀性增加被认为是胃食管反流病（GERD）的原因之一。使用功能性管腔成像探针（FLIP），我们旨在评估接受食管pH监测的患者对食管扩张的反应。25例患者（年龄22 - 73岁，其中13例为女性）在非质子泵抑制剂的情况下进行了动态无线食管pH测试，并在镇静的上端内窥镜检查中使用FLIP进行了评估。用酸暴露时间的总百分比（AET, < 6%为正常）来量化食管反流。使用定制程序生成FLIP地形图来分析FLIP研究，以确定食管收缩模式并计算egj -膨胀指数（DI）。用GERDQ评估反流症状。数值反映中位数（四分位数范围）。在所有患者中，AET为7.2% (3.7 - 11.1)，EGJ-DI为4.2 (2.5 - 7.6)mm2/mmHg。25例患者中有19例（76%）发生重复性顺行性收缩（RACs）；有RACs的患者AET（6.1%, 3 - 7.8）低于无RACs的患者（14.9,8.5 - 22.3）（p = 0.009）。AET与EGJ-DI、GERDQ与AET、GERDQ与EGJ-DI相关性较弱且不显著。AET异常患者（n = 16）和AET正常患者（n = 9） EGJ-DI相似，分别为4.6 mm2/mmHg (2.9 - 9.2) vs 3.2 (2.2 - 5.1), p = 0.207， GERDQ, p = 0.138。异常食道酸暴露与食道体积膨胀的收缩反应受损有关。这支持酸暴露依赖于酸清除机制。在用无线食管pH值测试和功能性管腔成像探头评估反流的患者中，对包括重复、顺行收缩的容量扩张的反应与食管酸暴露程度的降低有关。然而，食管胃交界处的扩张指数与食管酸暴露的相关性很低。
Increased esophagogastric junction (EGJ) distensibility is thought to contribute to gastroesophageal reflux disease (GERD). Using the functional lumen imaging probe (FLIP), we aimed to assess the esophageal response to distension among patients undergoing esophageal pH monitoring. 25 patients (ages 22 – 73; 13 females) that underwent ambulatory wireless esophageal pH testing while off proton-pump inhibitors were evaluated with FLIP during sedated upper endoscopy. Esophageal reflux was quantified by total percent acid exposure time (AET; < 6% was considered normal). FLIP studies were analyzed using a customized program generate FLIP topography plots to identify esophageal contractility patterns and to calculate the EGJ-distensibility index (DI). Reflux symptoms were assessed with the GERDQ. Values reflect median (interquartile range). Among all patients, the AET was 7.2% (3.7 – 11.1) and EGJ-DI was 4.2 (2.5 – 7.6) mm2/mmHg. Repetitive antegrade contractions (RACs) were induced in 19/25 (76%) of patients; AET was lower among patients with (6.1%, 3 – 7.8) than without (14.9, 8.5 – 22.3) RACs (p = 0.009). Correlation was weak and insignificant between AET and EGJ-DI, GERDQ and AET, and GERDQ and EGJ-DI. Patients with abnormal AET (n = 16) and normal AET (n = 9) had similar EGJ-DI, 4.6 mm2/mmHg (2.9 – 9.2) vs 3.2 (2.2 – 5.1), p = 0.207 and GERDQ, p = 0.138. Abnormal esophageal acid exposure was associated with an impaired contractile response to volume distention of the esophagus. This supports that acid exposure is dependent on acid clearance mechanisms. Among patients evaluated for reflux with wireless esophageal pH testing and the functional lumen imaging probe, a response to volumetric distension comprising repetitive, antegrade contractions was associated with a reduced degree of esophageal acid exposure. The esophagogastric-junction distensibility index, however, was poorly correlated with esophageal acid exposure.
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