Low esophageal mucosal blood flow in patients with nutcracker esophagus
Low esophageal mucosal blood flow in patients with nutcracker esophagus
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DOI：
10.1152/ajpgi.00359.2015
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发表时间：
2016-03-15
影响因子：
4.5
通讯作者：
Mittal, Ravinder K.
中科院分区：
文献类型：
--
作者：
Jiang, Yanfen;Mittal, Ravinder K.
胡桃夹子食管（NE）的特点是食管高振幅蠕动性收缩，这些患者常表现为“心绞痛样”或非心源性胸痛症状。组织缺血是内脏疼痛的已知原因，我们本研究的目的是确定NE患者的食管壁血灌注（EWBP）是否减少。研究了14名正常受试者（平均年龄51岁，11名男性）和12名患有NE和非心源性胸痛的患者（平均年龄53岁，9名男性）。使用特制的激光多普勒探头连续测量EWBP，该探头系在Bravo胶囊上，并将其固定在食管壁上。正常受试者基线EWBP为651 +/- 27灌注单位。在NE患者中，基线EWBP显著低于正常受试者（451 +/- 32灌注单位）。在正常受试者和NE患者中，erophonium（可增加肌肉收缩）注射后EWBP降低，而舌下硝酸甘油（可放松肌肉）注射后EWBP升高。记录期间自发性疼痛事件通常与EWBP下降有关。我们认为低EWBP导致食管组织缺氧，这可能是NE患者食管疼痛的机制之一。
Nutcracker esophagus (NE) is characterized by high-amplitude peristaltic esophageal contractions, and these patients often present with symptoms of "angina-like" or non-cardiac chest pain. Tissue ischemia is a known cause of visceral pain, and the goal of our present study was to determine whether esophageal wall blood perfusion (EWBP) is reduced in patients with NE. Fourteen normal subjects (mean age 51 yr, 11 men) and 12 patients (mean age 53 yr, 9 men) with NE and non-cardiac chest pain were investigated. The EWBP was measured continuously using a custom-designed laser Doppler probe tethered to a Bravo capsule, which anchored it to the esophageal wall. The baseline EWBP in normal subjects was 651 +/- 27 perfusion units. In patients with NE, the baseline EWBP was significantly lower than in the normal subjects (451 +/- 32 perfusion units). The EWBP decreased after injection of edrophonium (which increases muscle contractions) and increased following sublingual nitroglycerin administration (which relaxes muscle) in normal subjects, as well as in NE patients. Spontaneous pain events during the recording period were often associated with drops in the EWBP. We propose that low EWBP leads to hypoxia of the esophageal tissue, which may be a mechanism of esophageal pain in patients with NE.