pH监测正常与异常的非糜烂性反流病患者高分辨率食管测压特征分析

目的应用高分辨率食管测压比较pH监测正常与异常非糜烂性反流病(NERD)患者的食管动力学特征。方法按标准选取具有典型胃食管反流症状的NERD患者35例和健康体检者10例,分别行上消化道内镜检查、24 h食管pH监测和高分辨率食管测压。依据动态pH监测Demeester评分将NERD患者分为pH监测异常组和pH监测正常组,比较3组患者食管动力的差异。结果 pH监测异常组食管下括约肌(LES)长度较对照组显著缩短(P<0.05),LES压力(LESP)显著降低(P<0.05),pH监测正常组与对照组比较则无明显差异。pH监测正常组和异常组均存在食管体部动力障碍,表现为食管远端收缩波波幅及远端收缩积分降低和有效蠕动比例减少,pH监测异常组改变更为明显。结论 pH监测不同NERD患者间存在食管动力特征差异,pH监测异常NERD组患者存在LES长度和压力异常,食管远端动力障碍更为明显。     

食管运动功能在重度反流性食管炎中的地位

目的　通过对重度反流性食管炎(RE)治愈前后食管体部运动功能的研究,了解食管体部运动功能在重度RE中的地位。方法　对70例胃食管反流病患者进行食管压力测定。从中筛选23例重度RE(内镜诊断为洛杉矶C和D级食管炎);且24h食管内pH监测证实为病理性酸反流;食管压力测定证实有食管体部运动障碍患者。给予兰索拉唑30mg/d治疗3~6个月至内镜下食管炎完全愈合后,再行食管压力测定,观察下食管括约肌静息压(LESP)及食管体部运动功能的变化。以湿咽成功率、食管远端收缩波幅和食管蠕动的传导速度作为食管体部运动功能的指标。结果　食管炎治愈前后,LESP[ (6 00±0 86 )mmHg比(5 10±0 87)mmHg, 1kPa=7 5mmHg, P=0 476],食管远端收缩波幅[ (34 1±4 1)mmHg比(37 2±4 0)mmHg,P=0 593]、湿咽成功率[ (33 5±6 5)%比(38 6±7 1 )%,P=0 592 ]比较差异均无统计学意义,其均值仍显著低于正常对照组。结论　治愈食管炎并不能提高LESP及改善食管体部的运动功能。食管体部运动功能障碍和酸反流是RE的重要发病机制,尤其是重度RE。     

胃食管反流病食管黏膜损伤程度的影响因素

目的探讨胃食管反流病（gastroesophageal reflux disease，GERD）患者中，影响食管黏膜损伤严重程度的因素。方法将消化专科门诊具有典型反流症状，并经24h食管pH监测异常或（和）胃镜检查证实的GERD患者，分为非糜烂性反流病组、轻度糜烂性食管炎组和重度糜烂性食管炎组。比较3组患者一般情况和食管pH监测指标。用logistic回归分析年龄、性别、食管裂孔疝、烟酒嗜好、幽门螺杆菌感染和食管酸暴露程度对食管损伤严重程度的影响。结果共有156例患者纳入本次研究，其中非糜烂性反流病组83例，轻度糜烂性食管炎组51例，重度糜烂性食管炎组22例。重度糜烂性食管炎组患者的平均年龄和合并食管裂孔疝比例显著高于轻度糜烂性食管炎组和非糜烂性反流病组（P〈0．05）。食管pH监测指标中卧位长反流次数在严重的食管黏膜损伤患者中显著增加（P〈0.05）。食管裂孔疝是食管黏膜损伤程度的独立相关因素（OR=15．032，95％CI：3．767-22．723，P〈0．01）。结论GERD患者中高龄、男性、合并食管裂孔疝和卧位反流增加的患者中严重的食管黏膜损伤更加常见，食管裂孔疝在食管黏膜损伤的进展过程中起着重要作用。     

体质量对反流性食管炎患者下食管括约肌压力和24h食管pH监测结果的影响

目的探讨反流性食管炎（RE）患者中,体质量对下食管括约肌压力（LESP）和24h食管pH监测结果的影响。方法对18例体质量正常RE患者和22例超重肥胖RE患者进行LESP和24h食管pH监测,对结果进行统计分析。结果超重肥胖组RE患者的LESP、pH〈4总反流时问百分比、反流时间〉5min的反流次数、总反流数、DeMeester分与体质量正常组RE患者比较,差异均有统计学意义（P均〈0．05）;而超重肥胖组RE患者与体质量正常组RE患者的下食管括约肌松弛率（LESRR）比较,差异无统计学意义（P〉0．05）。结论在RE患者中,超重肥胖可影响食管动力并增加食管的酸暴露,控制体质量对治疗RE可能有一定作用。     

不同类型胃食管反流病发病机制的差异

目的:比较不同类型胃食管反流病(GERD),即反流性食管炎(RE)、非糜烂性反流病(NERD)和Barrett食管(BE)发病机制的差异.方法:113例GERD患者,根据内镜下表现及病理情况分为RE、NERD、BE三组,比较三组患者内镜下表现、食管测压和24 h pH监测指标、合并食管裂孔疝(HH)情况的差异.结果:RE组较NERD组与BE组下食管括约肌压力减低,但无统计学差异.食管体部各段的收缩波幅比较,RE组减低最明显,NERD组减低最少,两组比较P<0.05;无效食管运功比较,RE组较另两组明显增多( P<0.05).RE、NERD、BE组24 h食管pH监测的DeMeester计分分别为90.2、55.2、48.8;RE组以重度酸暴露多见(43%),反流总时间阳性率较高;NERD组以轻度酸暴露多见(45.8%),反流频率阳性率较高;BE组以长反流时间阳性率较高.HH在RE、NERD、BE组中的检出率分别为50%、14.6%、25.7%( P = 0.003).结论:下食管括约肌及食管体部运动功能受损程度、酸反流情况的差异可能是造成三种不同类型GERD食管黏膜损伤表现不同的主要原因.     

肝硬化患者食管动力与肝功能障碍的关系研究

目的研究肝功能减退对食管动力的影响.方法对无腹水或经治疗腹水消退后的肝硬化患者63例,进行Child-pugh分级,和健康对照组22例分别进行食管测压及24小时pH监测.结果肝硬化组下食管括约肌压力(LESP)、远端食管蠕动波幅(PA)、蠕动时间(PD)和蠕动传导速度(PV)与对照组比较显著异常(P＜0.05).LESP在ChildC级较ChildB级显著下降(P＜0.05),与Child-Pugh分数呈负相关(r＝-0.523,P＜0.01),伴各胃食管酸反流指标显著异常和胃食管反流病(GERD)发生率升高,P均小于0.01.食管静脉曲张程度也显著影响PA、PD和PV(P＜0.05),而LESP无明显下降.结论肝硬化患者食管动力异常和胃食管酸反流的原因除食管静脉曲张外,肝功能减退使其加重和LESP下降.     

胃食管反流病维持治疗方式的影响因素分析

目的评估胃食管反流病(GERD)维持治疗方式的影响因素.方法调查1999-09～2001-12北京协和医院门诊156例GERD病人,根据治疗后的症状及生活质量改善情况,分为按需治疗组和连续治疗组.探讨两种维持治疗方式与病程、症状积分、食管动力功能、24 h食管pH监测结果及内镜下炎症程度之间的关系.并对同期接受内镜、食管动力以及24 h食管pH监测的86例患者,进行影响因素的Logistic分析.结果 (1)96.7%GERD患者对药物治疗有效,其中按需治疗组92例,连续治疗组59例.(2)按需治疗组病程(年)和反流症状积分明显低于连续治疗组(P<0.05),(3)按需治疗组的LESP和食管远端蠕动收缩波幅显著低于连续治疗组(P<0.05);(4)按需治疗组中Ⅱ～Ⅲ级RE占10.9%,明显低于连续治疗组52.5%(P<0.05),同时按需治疗组(19.6%)合并食管裂孔疝的百分比也较连续治疗组(39.0%)低(P<0.01);(5)按需治疗组和连续治疗组的24 h食管pH监测均以卧位型酸反流为主.与按需治疗组比较,连续治疗组24 h总的酸反流的时间百分比和卧位酸反流的时间百分比明显增加(P<0.05);(6)对于同期接受内镜、24 h食管pH监测和食管动力检查的86例患者进行多因素Logistic分析显示,食管炎程度、食管远端收缩波幅和卧位酸反流程度对于采用维持治疗方式具有明显的影响作用.结论病程、内镜下的炎症程度、食管的动力功能以及卧位酸反流的程度是决定是否需连续治疗方式的关键因素.     

非糜烂性反流病临床和动力特征的初步研究

目的　对非糜烂性反流病 (NERD)临床和食管功能检查的特征进行初步的探讨。方法　 74例根据内镜检查、2 4h食管pH和胆汁联合监测的结果分为NERD组 ( 3 6例 )和反流性食管炎 (RE) ( 3 8例 ) ,对其进行一般状况、内镜表现和动力检查等方面的比较分析。结果　NERD组的女性发病倾向、合并食管裂孔疝少 ,与RE存在显著差异。两组 2 4h食管pH监测无显著差异 ,但NERD组 2 4h食管胆汁监测的各项指标 :光吸收值 >0 .14时间百分比 ( % )、反流 >5min的次数分别为 8.6± 11.8、3 .0± 3 .8,均显著RE低于相应的 17.1± 2 2 .2、5 .4± 6.0 ,体部收缩波幅则高于RE患者 (P <0 .0 5 )。结论　NERD与RE患者的临床、食管动力特征存在差异 ,RE患者中十二指肠胃食管反流 (DGER)发生更频繁 ,相对更为严重 ,提示两者病理生理机制可能有不同之处     

食管体部动力异常在胃食管反流病中的作用

背景:食管酸暴露增加在胃食管反流病(GERD)的发病中起重要作用。食管体部蠕动不完全或缺乏可造成食管清除功能障碍。目的:评估食管体部动力异常,包括非特异性食管动力紊乱(NEMD)和无效食管收缩(IEM)在GERD患者中的发生率,以及NEMD和IEM与胃食管酸反流和内镜下食管炎的关系,以探讨它们在GERD中的作用。方法:对116例GERD患者行标准食管测压和24h食管pH监测,其中75例患者行内镜检查。结果:98例(84.5%)GERD患者存在食管体部动力异常,其中77例为NEMD,NEMD中8例符合IEM的诊断标准。合并NEMD或IEM的GERD患者的pH<4总时间百分比显著高于食管动力正常患者(8.0%±9.3%和15.7%±13.5%对3.0%±4.7%,P<0.05);立位和卧位pH<4时间百分比亦显著高于食管动力正常患者(立位:8.8%±11.1%和17.4%±21.0%对3.6%±4.1%,P<0.01;卧位:7.0%±10.4%和16.1%±12.2%对2.3%±6.7%,P<0.05)。合并IEM的GERD患者总食管酸清除(EAC)时间和立位EAC时间较食管动力正常患者显著延长(总EAC时间:1.89min/反流±1.82min/反流对0.66min/反流±0.58min/反流,P<0.05;立位EAC时间:1.96min/反流±1.96min/反流对0.59min/反流±0.48min/反流,P<0.05)。75例行内镜检查的GERD患者中,合并NEMD和IEM的患者与食管动力正常患者的内镜下食管炎发生率无显著差异     

胃食管反流病患者酸反流与食管运动功能障碍的关系

背景：异常酸反流和食管运动功能障碍与胃食管反流病（GERD）密切相关。目的：研究GERD患者的食管运动和酸反流与食管黏膜损害的关系，以及两者之间的相关性。方法：选取有反酸、烧心、胸痛等典型胃食管反流症状的患者72例行上消化道内镜检查、食管测压和24hpH监测。根据pH〈4总时间百分比〈4．5％且DeMeester计分〈14．7的标准。将食管炎患者分为生理性酸反流组（pH^-组）和病理性酸反流组（pH^＋组）。结果：内镜下食管炎组24hpH监测各项指标较无食管炎组显著增高（P〈0．05），病理性酸反流的发生率显著高于无食管炎组（P〈0．01）。两组食管测压各项指标无显著差异，食管炎组pH^＋者的食管下括约肌压力（LESP）较pH^-者显著降低，食管体部蠕动波传导速度减慢，湿咽成功率减少（P〈0．05）。结论：GERD患者食管炎的发生与酸反流密切相关，有病理性酸反流的GERD患者易见食管运动功能障碍。     

Determination of pH turning point with pH mapping of the gastroesophageal junction: an alternative technique to orientate esophageal pH monitoring

Manometric location of the lower esophageal sphincter (LES) has been mandatory before esophageal pH monitoring, despite costs and discomfort related with esophageal manometry. The aims of the study were: (i) to map the pH of the gastroesophageal junction (GEJ) to determine a pH turning point (PTP) and its relation with LES; and (ii) to test the feasibility of this technique to orientate esophageal pH monitoring. We studied 310 adult patients who underwent esophageal manometry and pH monitoring off acid‐suppressive therapy. GEJ pH mapping was carried out by step‐pulling the pH sensor from 5 cm below to 5 cm above LES, and a PTP was determined when pH changed from below to above 4, in centimeters from the nostril. Thirty‐six patients referred only for pH monitoring were studied with pH sensor placed at 5 cm above the PTP. Out of 310 patients, a PTP was found in 293 (94.5%): inside LES in 86.3%, into the stomach in 8.2% and in the esophageal body in 5.5% of patients. The median distance between PTP and place where pH sensor monitored reflux was 8 cm. Among 36 patients who performed pH monitoring without LES manometry, there was no gastric monitoring during reflux testing. In adult patients investigated off acid suppressive therapy, GEJ pH mapping with reflux monitoring 5 cm above the PTP can be an alternative technique to perform esophageal pH monitoring when LES manometry is not available. Additional studies are needed before the widespread use of GEJ pH mapping in the clinical practice.     

Effects of metabolic arterial pH changes on medullary ecf pH, csf pH and ventilation in peripherally chemodenervated cats with intact blood-brain barrier

Brain ecf and csf pH are regulated within narrow limits. In the present study we investigated whether--with an intact blood-brain barrier (bbb)--during acute (isocapnic) metabolic pHa disturbances, brain ecf and csf pH changes occur in the same direction as plasma pH. Experiments were performed in 4 ventilated, vagotomized, and in 17 spontaneously breathing cats. Medullary ecf pH and csf pH were measured with flat pH electrodes. Metabolic pHa disturbances were induced by isocapnic i.v. infusions of HCl and NaHCO3, and by non-isocapnic i.v. bolus injections of NaHCO3. In all cats both sinus nerves were cut. We found that: (1) during acute pHa changes, medullary ecf pH changes rapidly in the same direction despite an intact bbb (no extravasation of Evans Blue); (2) the time courses of the ecf and csf pH responses to a bolus injection of NaHCO3 are quite different: after an initial short (less than 10 sec) decrease, the ecf pH rapidly increases above control, whereas the csf pH shows a rapid and long lasting acidic response; (3) ventilation showed a biphasic response pattern to a NaHCO3 bolus: an initial increase followed by a slow decrease to about control level. It was argued that this response cannot be explained by the observed ecf or csf pH responses alone.     

Intracellular pH of isolated rat diaphragm muscle with metabolic and respiratory changes of extracellular pH.

Relationships between intracellular and extracellular pH isolated rat diaphragms were determined both during respiratory and metabolic changes of extracellular pH. Metabolic changes of extracellular pH were produced by varying bicarbonate concentration of the suspending Krebs-Ringer solution and respiratory changes were produced by varying PCO2 of the suspending medium. At any defined extracellular pH, the bicarbonate concentration ratios between intracellular and extracellular space were the same during both metabolic and respiratory changes of extracellular pH. However, when extracellular pH varied within 7.15 and 7.4 intracellular pH remained essentially constant. In order to maintain the intracellular pH constant during extracellular pH changes, a bicarbonate efflux during metabolic changes from the intracellular compartment, and a bicarbonate influx during respiratory changes to the intracellular compartment must occur. The maintenance of identical intracellular/extracellular bicarbonate concentration ratios regardless of the mechanisms of extracellular pH changes (metabolic or respiratory) suggests an active mechanism for the transport of bicarbonate or H-+ ions.     

Measurement of jejunal surface pH in situ by plastic pH electrode in patients with coeliac disease

Attaching plastic pH electrodes to a Crosby capsule provides a means of measuring mucosal surface pH in the small intestine during jejunal biopsy. Plastic electrodes, with operating characteristics comparable to glass electrodes within the physiological pH range, were selected because of their mechanical flexibility. The sensing tip can be placed close to the capsule aperture to facilitate contact with the intestinal mucosa. Using this system, the jejunal mucosal surface pH was found to be 5.97 +/- 0.07 in 15 control subjects. In contrast, 13 coeliac patients had a significantly (p less than 0.001) higher jejunal surface pH of 6.73 +/- 0.15, subdivisible into 4 untreated patients with a mean value of 6.95 +/- 0.33 and 9 patients on a gluten-free diet with a mean value of 6.63 +/- 0.15, both higher (p less than 0.01, p less than 0.005) than the control value. An elevated jejunal surface pH in coeliac disease was associated with partial or subtotal villous atrophy and with low brush border enzyme activities. Confirming previous in vitro findings, the elevated surface pH in coeliac jejunum may affect digestive and absorptive processes occurring at the brush border.     

Radially asymmetric gastroesophageal acid reflux in the distal esophagus: examinations with novel pH sensor catheter equipped with 8 pH sensors

Background

Esophageal mucosal breaks in patients with Los Angeles (LA) grade A or B esophagitis are mainly found in the right anterior wall of the distal esophagus. The aim of this study was to reveal radial acid exposure in the distal esophagus and determine whether radial asymmetry of acid exposure is a possible cause of radially asymmetric distribution of the lesions.

Methods

We developed a novel pH sensor catheter using a polyvinyl chloride catheter equipped with 8 antimony pH sensors radially arrayed at the same level. Four healthy volunteers, 5 patients with non-erosive reflux disease (NERD), and 10 with LA grade A or B esophagitis were enrolled. The sensors were set 2?cm above the upper limit of the lower esophageal sphincter, and post-prandial gastroesophageal acid reflux was monitored for 3?h with the subjects in a sitting position.

Results

We successfully examined radial acid exposure in the distal esophagus in all subjects using our novel pH sensor catheter. Radial variations of acid exposure in the distal esophagus were not observed in the healthy subjects. In contrast, the patients with NERD and those with reflux esophagitis had radial asymmetric acid exposure that was predominant on the right wall of the distal esophagus. In the majority of patients with reflux esophagitis, the directions of longer acid exposure coincided with the locations of mucosal breaks.

Conclusions

Radial acid exposure could be examined using our novel 8-channel pH sensor catheter. We found that the directions of longer acid exposure were associated with the locations of mucosal breaks.