24小时食管pH监测和食管测压在胃食管反流病中的应用

目的：对８０例患者同时进行食管测压和２４小时ｐＨ值监测，探讨压力和２４小时ｐＨ值与胃食管反流及反流性食管 炎间的关系。方法：８０例病人分为Ａ组无反流症状；Ｂ组有反流症状，但内镜或Ｘ线检查无食管炎；Ｃ组有反流症状，内 镜或Ｘ线检查有食管炎。使用多导胃肠功能测定仪测定食管上、下括约肌及食管体静息和吞咽时压力及运动功能； 同时使用便携式２４小时ｐＨ监测仪监测食管２４小时ｐＨ值。结果：Ｂ、Ｃ两组的下食管括约肌压力（ＬＥＳＰ）低于Ａ组（Ｐ＜ ０．０５），且食管下段蠕动幅度低于Ａ组（Ｐ＜０．０１）；Ｃ组食管下段蠕动低于Ｂ组（Ｐ＜０．０５）；２４小时ｐＨ监测Ｂ、Ｃ两组各项 指标均明显高于Ａ组（Ｐ＜０．００１）。结论：胃食管反流与ＬＥＳＰ降低、食管下段蠕动减弱有关，ＬＥＳＰ低于１１ｍｍＨｇ食管 炎的危险性增加。其诊断以２４小时ｐＨ监测结果为准。

Ambulatory 24-hr Esophageal pH-metry and Esophageal Manometry in the Diagnosis of Gastroesophageal Reflux Disease

Background/Aims: To investigate the relationship between esophageal pressure, 24-hr pH and Gastroesophageal Reflux Disease (GRED). Methods: 80 patients were divided into three groups. Group A was asymptomatic; Group B was symptomatic, esophagitis was not X-ray-proven and endo- scopy-proven. In symptomatic group C esophagitis was confirmed by X-ray and endoscopy. The pressure and movement of upper and lower esophageal sphincter and esophageal body were investigated by esophageal manometry at rest and during swallow. Meanwhile all patients underwent the ambulatory 24-hr esophageal pH-metry. Results: The lower esophageal sphincter pressure (LESP) of group B and C was lower than that of group A (P<0.05). So was the peristaltic amplitude of lower esophagus (P<0.01). Lower esophageal peristaltic amplitude of group C was lower than that of group B (P<0.05). Various index of 24-hr pH-metry of group B and C were higher than that of group A (P<0.001). Conclusions: GRED relates to the lower LESP and weaker peristaltic of lower esophagus. Susceptivity of esophagitis was increased when LESP was lower than 11mmHg. The ambulatory 24-hr esophageal pH-metry was a more useful method in the diagnosis of GRED.