下食管括约肌运动和功能与胃食管反流病

目的　观察胃食管反流病 (GERD)患者与对照组餐前、餐后食管pH情况 ,下食管括约肌(LES )运动模式的变化以及酸反流事件与一过性下食管括约肌松弛 (TLESR )、低LES压力 (LESP)的关系。方法　两组受试者均接受连续性 4h食管压力测定 (分别为空腹和餐后 1、2、3h)和食管pH监测 (GERD组检测 4h ,对照组检测 2 4h)。结果　GERD组酸反流事件明显高于对照组 (P <0 0 5 )。两组间TLESR发生率差异无显著性 (P >0 0 5 ) ,但与空腹比较 ,两组餐后 1h和 2hTLESR发生率明显增多 ;GERD组伴有酸反流的TLESR明显高于对照组 (P <0 0 0 1)。 4 3% (2 9/ 6 8)的酸反流事件发生在TLESR期间。 31% (2 1/ 6 8)的酸反流事件出现于低LESP状态中。结论　GERD是多因素参与的病理过程。LES运动形式变化和功能不全是GERD的重要背景因素。

The relationship between lower esophageal sphincter motility and function with gastroesophageal reflux disease

Subjective To evaluate the motor pa ttern and function of lower esophageal sphincter (LES) and esophageal acidificat ion episodes before and after intragastric load in the patients with gastroesoph ageal reflux disease( GERD) and in controls, and identify the relationship bet ween transient LES relaxations (TLESR),and low LES pressure and acid reflux epis odes .Methods All of them undergone a pH / manometric monitorin g during fasting and for 3 h after meal.Results 68 episodes of acid reflux were detected totally, and 43%(29/68) occurred during transient LES relaxation, 31%(21/68) occurred af ter down drifts (<1mm Hg/s) in basal LES pressure or in persisting low basal LES pressure. There were more patients with acid reflux episodes comparied TLESR in patients with GERD than in volunteers (P<0.05). More acid reflux episodes in patients with GERD than in controls(P<0.001) . But ingestion of the meal induced a significant increase in the TLESR frequency during the first and seco nd postprandial hours. Conclusions The pathophysiology of gastroesophageal reflu x disease is multifactorial. It is established that impaired lower esophageal sp hincter function play an important role in GERD. Transient LES relaxation could probably be considered one of the pathophysiologic mechanisms of gastroesophagea l reflux, but it is not a necessary prerequisite for the acidification events. S ome reflux episodes result from low resting LES pressure rather than from transi ent LES relaxations alone.