食管测压对反流性食管炎的诊断价值

目的探讨食管测压对反流性食管炎的诊断价值．方法使用专用软件控制的高分辨多道灌注测压系统（ＰＣｐｏｌｙｇｒａｆＨＲ瑞典产）测定了正常人１２例及反流性食管炎患者３２例的食管下括约肌动力指标、胸腹段长度及食管体动力参数．结果患者组ＬＥＳＰ，ＬＥＳＲＰ压力（ｋＰａ）明显低于对照组（１０±０７对２６±１０；０１±０４对０４±０２，Ｐ均＜００１）；食管中远段振幅（ｋＰａ）亦低于对照组（干咽：４６±３３对６５±２６，５３±３７对９１±３７，Ｐ均＜００５；湿咽：５３±３３对８９±３６，６１±４６对±１２４±４５，Ｐ均＜００５）．患者组ＬＥＳＬ１（ｃｍ）比对照组短（１７±０８对２６±０９，Ｐ＜００１）．结论反流性食管炎患者ＬＥＳＰ低下，ＬＳＥＬ１过短，食管体中远段动力低下，为临床选用动力药提供了客观依据     

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。     

老年健康人及反流性食管炎患者食管运动功能的测定

目的比较老年和非老年健康人、反流性食管炎患者食管运动功能的异同。方法应用微气囊法对３０例老年健康人、１９７例非老年健康人、３０例老年反流性食管炎患者、４５例非老年反流性食管炎患者食管运动功能进行检测。结果（１）老年健康人食管下括约肌（ＬＥＳ）松弛时间为（８．１±０．８）秒,长于非老年健康人的（７．１±１．０）秒（Ｐ＜０．０１）,食管蠕动波压力和食管上括约肌压力〔（４０．５±２．９）ｍｍＨｇ和（４８．７±１８．１）ｍｍＨｇ,１ｍｍＨｇ＝０．１３３ｋＰａ〕低于非老年健康人的（４５．０±１０．５）ｍｍＨｇ和（５６．１±２１．２）ｍｍＨｇ（Ｐ＜０．０１）,同步收缩波发生率较非老年健康人增多（Ｐ＜０．０１）;（２）老年反流性食管炎组ＬＥＳ松弛时间〔（１０．８±１．１）秒〕延长和食管蠕动波压力〔（３３．２±２．９）ｍｍＨｇ〕降低比非老年组〔（９．２±３．７）秒、（４０．３±６．３）ｍｍＨｇ〕更明显（均为Ｐ＜０．０１）。结论（１）老年健康人有食管运动功能障碍;（２）老年反流性食管炎患者食管运动障碍比非老年患者明显。     

胃－食管返流的临床研究

作者采用国产ＳＧＹ－３型多功能消化道检测仪对８０例具有胃－食管返流（ＧＥＲ）症状患者进行了食管测压研究。患者分为两组：Ａ组３３例，内镜及活检食管粘膜正常；Ｂ组４７例，内镜及活检均证实有食管炎。正常对照组６０例。食管炎患者给予吗丁啉口服。结果显示：（１）Ａ、Ｂ两组患者食管下括约肌压力（ＬＥＳＰ）、胃－食管屏障压、食管下括约肌（ＬＥＳ）松驰率明显降低，ＬＥＳ松驰时间明显延长、ＬＥＳ长度（ＬＥＳＬ）短于正常，食管蠕动波压力明显降低（Ｐ＜０．０５，０．０１）；（２）Ｂ组ＬＥＳＰ、胃－食管屏障压明显低于Ａ组（Ｐ＜０．０５），这与临床上ＧＥＲ症状发生率Ｂ组高于Ａ组相符合；（３）吗丁啉使Ｂ组ＬＥＳＰ胃－食屏障压分别升高０．３９±０．４８和０．３４±０．４９ｋＰａ，但对食管蠕动无影响。因而，应用吗丁啉治疗ＬＥＳ功能低下引起的ＧＥＲ是合理、有效的。     

胃食管反流病食管测压与24小时pH监测的相关性研究

目的：对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测，运用统计学方法分析测压和ｐＨ结果，研究其相关性。方法：应用多导胃肠功能测定仪及便携式ｐＨ监测记录仪，对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测。结果：应用多元回归分析发现，ｐＨ的百分比和腹段下食管括约肌（ＬＥＳ）的长度、ＬＥＳ静息压及远端食管的蠕动压明显相关。依据测压及ｐＨ结果，使用ｔ检验方法，结果提示食管蠕动压不仅与ｐＨ＜４的百分化相关，也与酸反流大于５分钟的时间、最长反流时间有关（Ｐ＜００１）。结论：腹段ＬＥＳ的长度及食管下段的蠕动收缩是重要的抗反流屏障。食管酸暴露时间延长减弱食管体部酸清除能力     

体位与胃食管反流关系的初步探讨

为了解体位与胃食管反流发生的关系及胃食管反流的发生机理，对１２例具有典型胃食管反流症状、内镜检查有下段食管炎的患者进行食管内ｐＨ值监测、食管内压、下食管括约肌压力及胃内压力测定，比较直立位和卧位餐后反流的发生频率及发生机理。结果显示，直立位与卧位时的酸反流次数（５６．４±６５．２次比３２．５±４９．７次）、ｐＨ值＜４的百分时间（２６．４％±２７．６％比２０．５％±２１．７％）及酸清除时间（１０．３±１４．５分钟比１３．８±１７．１分钟）相比较，差异均无显著性（Ｐ＞０．０５）。两种体位与下食管括约肌松弛有关的反流频率（５６．７％比４３．２％）及与胃内压升高有关的反流频率（２３．５％比１９．７％）比较，差异无显著性（Ｐ＞０．０５）。本研究结果表明，直立位反流在反流性食管炎的发病中与卧位反流起同等重要的作用。两种反流的主要发生机理均为下食管括约肌的松弛，胃内压升高也在胃食管反流的发病中起一定的作用。     

下食管括约肌压力与局部组织内一氧化氮和血管活性肠肽含量的 …

目的 研究下食管括约肌（ＬＥＳ）局部组织内一氧化氮（ＮＯ）和血管活性肠肽（ＶＩＰ）含量与ＬＥＳ压力（ＬＥＳＰ）的关系。方法 检测了１０８例食管运动功能障碍性疾病患者ＬＥＳ局部组织内ＮＯ和ＶＩＰ含量及ＬＥＳＰ。结果 ＬＥＳＰ与组织内ＮＯ和ＶＩＰ含量呈负相关（r＝－９０．７，Ｐ〈０．０１；r＝－９２．３，Ｐ〈０．０１），ＮＯ和ＶＩＰ含量之间呈正相关（r＝８８．５，Ｐ〈０．０１）。结论 胃食管反流性疾病（     

肝硬化食管静脉曲张的食管动力初探

为进一步研究曲张静脉及硬化／套扎治疗对食管功能的影响，对１９例肝硬化食管静脉曲张患者行食管下段测压（ＬＥＳ）研究。结果示：１．食管静脉曲张组ＬＥＳ静息压为２．８７±０．８３ｋＰａ，对照组为２．４９±０．６３Ｋｐａ，两组无差异（Ｐ＞０．０５）。轻度与中重度曲张组、未治疗组与硬化／套扎治疗组的ＬＥＳ压力无差异。２．食管体部的蠕动：（１）静脉曲张组与正常组比较，其食管下段蠕动波幅（ＰＡ）减低，蠕动时间（ＰＤ）延长，蠕动传导速度（ＰＶ）减慢（Ｐ＜０．０５）。（２）中重度曲张组与轻度曲张组比较，其ＰＡ减低，ＰＤ延长（Ｐ＞０．０５）。３）６例硬化／套扎治疗组与非治疗组比较无显著差异，可能与例数少有关。肝硬化食管静脉曲张的食管动力改变主要表现为食管下段的蠕动波幅减低，蠕动传导时间延长，传导速度减慢，且与曲张程度有一定关系。其原因可能系曲张静脉本身直接的机械作用所致，硬化治疗可引起食管下段功能障碍，有必要对ＥＶＳ患者使用促动力药。     

胃—食管返流的临床研究

作者采用国产ＳＧＹ－３型多功能消化道检测仪对８０例具有胃－食管返流（ＧＥＲ）症状患者进行了食管测压研究。患者分别为两组：Ａ组３３例、内镜及活检食管粘膜正常；Ｂ组４７例，内及活检均证实有食管炎。正常对照组６０例。食管炎患者给予吗丁啉口服。结果显示，（１）Ａ、Ｂ两组患者食管下括约肌压力（ＬＥＳＰ）、胃－食管屏障压、食管下括约肌（ＬＥＳ）松驰率明显降低，ＬＥＳ松弛时间明显延长，ＬＥＳ长度（ＬＥＳＬ）短于     

食管通过时间诊断胃食管反流的意义

目的建立坐位食管通过时间（ＥＴＴ）正常参数，并观察反流性食管炎（ＲＥ）患者坐位ＥＴＴ的变化．方法健康志愿者４５例，ＲＥ患者２８例，分别用９９ｍＴｃＤＴＰＡ标记的蒸鸡蛋和牛奶测定坐位固体及液体食物ＥＴＴ．结果健康志愿者固体及液体食物ＥＴＴ分别是６９０ｓ±１７３ｓ及２４７ｓ±０５６ｓ，ＲＥ患者为１１５０ｓ±５７０ｓ及３１６ｓ±１２０ｓ．健康志愿者及ＲＥ患者固体食物ＥＴＴ有差异（Ｐ＜００５）．结论核素显像法测定ＥＴＴ简单准确，对评估食管功能有一定的临床意义．     

Manometric changes induced by antireflux surgery (Nissen) and its relation to pH measurement and clinical findings. An analysis 6 months after the intervention]

We analyzed the preoperative ambulatory 24 hour ph-metric and manometric characteristics in a group of 20 patients treated surgically for gastroesophageal reflux (PGER) by Nissen fundoplication. At 6 months post-surgery they were reevaluated instrumentally (manometric and 24 hour ph-metry) and clinically. All ph-metric parameters of PGER (total reflux time, clearance, number of episodes, number of episodes greater than 5 minutes duration and duration of longest episode) were significantly improved (p less than 0.01-0.05) post-operatively (as globally as by position supine and upright) and this improvement was associated with resolution of symptoms in 19 (95%) patients. Of the manometric parameters evaluated (lower esophageal sphincter pressure--LESP--and length--LESL, peristaltic, triphasic, biphasic, absent and simultaneous waves and relaxation of LES) surgery only produced improvement in the lower esophageal sphincter pressure (LESP) and length (LESL) (p less than 0.001). We conclude that antireflux surgery (Nissen) by improving the pressure and length of the LES is capable of producing clinical and ph-metric remission in almost all (95%) of patients studied six months after.     

Esophageal body length, lower esophageal sphincter length, position and pressure in health and disease

We compared esophageal dimensions in control subjects and patients with differing motility disorders and severities of reflux disease. Patients (1108) and healthy controls (36) underwent manometry and 24-h pH monitoring. Subjects were grouped according to pH and manometry data into seven groups. Mean (s.e.m.) esophageal body length is greatest in achalasia [22.41 (0.27) cm] and least in reflux disease [20.06 (0.13) cm, p < 0.05]. Lower esophageal sphincter (LES) pressure is greatest in achalasia [17.46 (1.06) mmHg] and least in reflux disease [6.57 (0.24) mmHg, p < 0.05]. LES length is least in achalasia patients and control subjects. The ratio of intra-abdominal to intrathoracic LES is greatest in achalasia (1.29), no reflux and normal motility group, and controls and least in reflux disease (1.04, p < 0.05). In conclusion, esophageal body length is greatest in achalasia and least in reflux disease. This is associated with caudal movement of the LES in achalasia and cranial movement of the LES in reflux disease, relative to the diaphragm.     

老年胃食管反流病患者高分辨率食管测压压力特点分析

目的探讨老年胃食管反流病患者高分辨率（HRM）测压压力特点。方法2011年6月至2012年9月对反酸、烧心伴胸骨后不适等症状的老年患者行HRM检测,分析其食管动力特点。结果老年反流性食管炎（RE）组的下食管括约肌（LES）总长度、腹腔内LES长度、LES平均静息压分别为（2．50±0．62）cm、（1．90±0．19）cm和（21．48±8．48）mmHg,低于老年非糜烂性反流病（NERD）组的（3．33±0．43）cm、（2．50±0．46）cm和（24．83±O．64）mmHg（P〈0．05）。结论老年RE患者存在明显的抗反流机制障碍,在其发病机制中可能发挥重要作用。而老年NERD患者的食管运动功能失调不明显,推测其他机制可能参与了其发病过程。     

Three-dimensional imaging of the lower esophageal sphincter in healthy subjects and gastroesophageal reflux

The resting pressure and intraabdominal length are the most important factors which determine competence of the lower esophageal sphincter (LES). The intraabdominal sphincter vector volume (ISVV) is a single value which takes into account both of these measurements. Normal values of ISVV and of the total sphincter vector volume (TSVV) were established in 20 normal subjects. The sensitivity and the specificity of ISVV and TSVV were then evaluated in 81 patients with gastroesophageal reflux disease (GERD) and in 19 normal subjects and were compared with the usual stepwise pullback manometry (SPM) measuring the resting pressure of the LES at the respiratory inversion point. The motorized pullthrough technique was used to perform the vector volume procedure. Normal values of ISVV were 1870–10740 mm Hg² × mm, and of TSVV 2200–13110 mm Hg² × mm. The sensitivity of ISVV was 93.8% (p < 0.05), of TSVV 80.2%, and of SPM 81.5%. The specificity of ISVV and TSVV was 89.5% and of SPM 78.9% (not significant). Analysis of the intraabdominal sphincter vector volume is more sensitive than the total sphincter vector volume or standard stationary manometry in establishing a defective LES in patients with GERD. Intraabdominal sphincter vector volume analysis will allow surgeons better to identify patients with a defective LES who may be suitable for antireflux surgery.     

滑动型食管裂孔疝伴反流性食管炎患者的食管动力学研究

目的：探讨滑动型食管裂孔疝（HH）伴反流性食管炎患者的食管动力学改变。方法：30例经胃镜检查确诊的HH患者,根据食管炎程度分为HH1（食管炎A－B组,n=18)和HH2组（食管炎C－D级,n=12),行食管钡餐检查证实为滑动型HH。在X线透视下观察食管粘膜增粗、狭窄、痉挛等形态学改变及反流与廓清方式,同时监测24h食管pH、食管下括约肌（LES）压力以及反流期间食管蠕动的频率、幅度等情况。结果：30例HH患者X线透视下均有食管粘膜增粗,反流以抽吸型为主（80．0％）,廓清以被动廓清为主（36．7％）。24h食管pH监测中,HH组患者的总反流时间、卧位和立位反流时间百分比均显著高于对照组（P＜0．01）,但HH1和HH2组间无显著差异;HH组患者的LES静息压力显著低于对照组（P＜0．05）,LES长度组间无明显差异。HH组患者反流期间的食管体部蠕动频率和幅度均较对照组低,新时期明显延长,HH2组患者的顺行性蠕动百分比亦较对照组明显降低（P＜0．05）。结论：HH患者以抽吸型反流和被动廓清为主。食管酸暴露程度与食管炎严重并无关。LES静息压降低、反流期间食管蠕动频率、幅度降低和间期延长可能在滑动型HH的发病中起重要作用。     

Esophageal manometric changes and gastroesophageal reflux symptoms after distal gastrectomy for gastric cancer

BACKGROUND/AIMS: Gastroesophageal reflux is known to be a common complication after gastrectomy. However, its mechanism is not completely understood. We investigated the effects of distal gastrectomy for gastric cancer on the lower esophageal sphincter (LES) and esophageal motility. METHODOLOGY: In 18 patients who underwent distal gastrectomy reconstructed with Billroth I method for gastric cancer, esophageal motility and LES function were evaluated by means of a low-compliance manometric system. The LES pressure was determined by a rapid pull-through technique. Endoscopy before and after operation determined presence or absence of esophagitis and hiatus hernia. RESULTS: No significant differences were observed in esophageal contractile amplitudes before and after distal gastrectomy. After distal gastrectomy, five patients had reflux symptoms of heartburn and regurgitation; 11 had none. Endoscopy revealed esophagitis after distal gastrectomy in two patients with reflux symptoms and one patient without reflux symptoms. The LES pressure in patients with reflux symptoms decreased significantly after distal gastrectomy (before gastrectomy: 26.1 +/- 1.1 mmHg, after distal gastrectomy: 15.3 +/- 3.5 mmHg, p<0.05). There was no significant change in patients without reflux symptoms. CONCLUSIONS: This study demonstrated that LES pressure after distal gastrectomy in patients with reflux symptoms was significantly lower than that before gastrectomy. This result suggested that LES pressure decrease plays an important role in development of gastroesophageal reflux after distal gastrectomy reconstruction with the Billroth I method.     

Comparison of Lower Esophageal Sphincter Manometrics and Gastroesophageal Reflux Measured by 24-Hour pH Recording

We compared lower esophageal sphincter (LES) pressures to parameters of acid reflux measured during 24-h pH monitoring in 81 patients being evaluated for possible reflux disease. Mid-respiratory LES pressures were significantly higher (p less than 0.05) in patients with normal amounts of reflux than in those with abnormal reflux. This difference did not occur with LES pressure measured by end-expiratory station pull-through (SPT) or rapid pull-through (RPT). There was no significant difference in total length or intra-abdominal portion of LES between the two groups. However, the product of LES pressure and total LES length was greater (p less than 0.05) for patients with normal reflux than for these with abnormal reflux. No difference was noted in the percentage of abnormal contractions in the distal esophagus between groups. These studies support the following conclusions: 1) LES pressure may be a more important protective mechanism against reflux than LES length. 2) Mid-respiratory SPT technique appears to identify the LES antireflux barrier better than either end-expiratory SPT or RPT techniques. 3) Acid exposure time seems to be a better measure of gastroesophageal reflux than the number of reflux episodes.     

Morphological changes in the lower esophageal sphincter influencing the result of antireflux surgical interventions in chronic gastroesophageal reflux disease

BACKGROUND/AIMS: It is still unclear whether long-term reflux episodes result in morphological changes in the lower esophageal sphincter or not. If the answer is supposedly yes, do these changes influence the postoperative functional results following antireflux surgery? METHODOLOGY: Between 1 January 2002 and 2004, we performed antireflux surgery on 85 patients. Muscle samples were taken from the lower esophageal sphincter (LES) in 57 patients on operation. Patients with endoscopic findings of moderate or severe reflux esophagitis--Los Angeles B, C, D--were excluded. Control samples were obtained from muscle tissue at the gastroesophageal junction that had been removed from 16 patients undergoing gastric or esophageal resection. Histologic (hematoxylin and eosin and Giemsa), and immunohistologic (S-100 Protein, NCL-SERCA2, alpha-SMA) and electronmicroscopic analysis were used to evaluate the specimens. The number of smooth muscle cell nuclei in these intraoperative biopsies was used to compare the results of antireflux operations (Visick I and II-III). RESULTS: In 19% (11/57) of the reflux-type LES muscle samples perivascular inflammatory infiltration has been noted and in 6 of these cases (6/57 = 11%) this has incorporated marked intramuscular and adventitial granulocyte infiltration. In one patient (1/57 = 2%) eosinophil infiltration of the myenteric plexus and the ganglion has been revealed. Significantly lower Schwann and smooth muscle cell count could be detected in LES muscle samples taken from patients with GERD (p < 0.05). The analysis of the values of the 9 patients in Visick groups II and III at two months after surgery, has shown a significant decrease in the number of smooth muscle cell nuclei as compared to those patients in Visick group I (p < 0.01). CONCLUSIONS: Our results draw attention to the morphological changes occurring in the LES muscles of reflux patients. The enteric ganglionitis induced by GERD may result in various functional esophageal diseases. The histologic changes--that very much resemble hypertrophy--developing in LES muscles may serve as a reason for symptoms after antireflux surgery, presumably for the most common complaint of dysphagia.     

Antireflux surgery for symptomatic gastroesophageal reflux

To determine the effects of Nissen fundoplication upon the symptoms of reflux and the diagnostic tests employed to evaluate reflux and to examine the relationship between gastroesophageal reflux and lower esophageal sphincter pressure before and after fundoplication, 10 patients with symptomatic reflux were studied before and after operation. Clinical evaluation, barium esophagography, endoscopy with mucosal biopsy, esophageal manometry, acid-perfusion and acid-reflux testing, and gastroesophageal scintiscanning were performed on each patient before and after surgery. Following fundoplication, marked symptomatic, radiographic, endoscopic, and histologic improvement was observed. Serial acid-reflux tests at increasing gastroesophageal pressure gradients returned to normal after surgery. Lower-esophageal-sphincter (LES) pressure increased from 8.2±1.3 to 12.0±1.5 mm Hg (P<0.01). In addition, surgery resulted in a significant decrease in the gastroesophageal reflux index from 17.4±2.4 to 2.7±1.1% (P<0.001). Surprisingly, the pre- and postoperative resting LES pressures did not correlate significantly with corresponding gastroesophageal reflux indices for individual patients. We conclude that increased LES pressure alone does not explain adequately the functional and clinical improvement which follows fundoplication.