Effect of acute stress on oesophageal motility in patients with gastro-oesophageal reflux disease.
Effect of acute stress on oesophageal motility in patients with gastro-oesophageal reflux disease.
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DOI：
10.1136/gut.38.4.492
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发表时间：
1996-04
期刊：
影响因子：
24.5
通讯作者：
B. T. Johnston;R. J. Mcfarland;J. Collins;A. H. Love
中科院分区：
文献类型：
--
作者：
B. T. Johnston;R. J. Mcfarland;J. Collins;A. H. Love
背景和目的——64%的胃灼热患者认为压力会加剧胃灼热。食道运动的改变可能是应激引起这种明显变化的机制之一。本研究旨在评估急性应激源对胃食管反流病（GORD）患者食管运动的影响。方法：对60例患者进行研究。20例有食道炎，20例在pH监测下食道酸暴露增加但无内镜下食道炎，20例既无食道炎也无异常食道酸暴露。研究心理应激（Stroop试验）和生理应激（冷压试验）下患者的食道运动。结果：血压（BP）和心率在两种应激源下均升高(平均收缩压升高10mm Hg，舒张压升高4mm Hg，心率升高> 3次/分钟（p < 0.00001）。食道蠕动收缩的幅度、持续时间和传播速度不受应激源的影响。食道炎患者在冷压试验期间同时波的百分比增加（这些患者的中位数增加为6% (p < 0.05)）。在没有食管炎的患者中没有发现这种效果。结论：急性应激源不会引起GORD患者食管运动的显著变化，但不会引起食管炎。对于这些患者，运动障碍不太可能是食道症状的原因，而食道症状会因压力而加重。然而，食道炎患者在冷压应激期间同步波显著增加。
BACKGROUND AND AIM--Sixty four per cent of people with heartburn believe that it is exacerbated by stress. An alteration in oesophageal motility is one possible mechanism for this apparent change with stress. This study aimed to assess the effect of acute stressors on oesophageal motility in patients with gastro-oesophageal reflux disease (GORD). METHODS--Sixty patients were studied. Twenty had oesophagitis, 20 had increased oesophageal acid exposure on pH monitoring but no endoscopic oesophagitis, and 20 had neither oesophagitis nor abnormal oesophageal acid exposure. Oesophageal motility was studied in these patients during psychological stress (Stroop test) and physical stress (cold pressor test). RESULTS--Blood pressure (BP) and heart rate increased in response to both stressors (mean systolic BP increased by > 10 mm Hg, diastolic BP by > 4 mm Hg and heart rate by > 3 beats per minute (p < 0.00001). The amplitude, duration, and velocity of propagation of oesophageal peristaltic contractions were not altered by the stressors. The percentage of simultaneous waves increased in patients with oesophagitis during the cold pressor test (median increase in these patients was 6% (p < 0.05)). This effect was not noted in the patients without oesophagitis. CONCLUSION--Acute stressors did not induce significant changes in oesophageal motility in patients with GORD but no oesophagitis. For these patients, dysmotility is not likely to be a cause of oesophageal symptoms which are exacerbated by stress. There was, however, a significant increase in simultaneous waves during cold pressor stress in patients with oesophagitis.