滑动型食管裂孔疝患者高分辨率食管测压及阻抗-pH监测特点

目的应用高分辨率食管测压(HRM)及多通道腔内阻抗-pH监测技术(MII-pH)研究滑动型食管裂孔疝(HH)患者食管动力及胃食管反流的特点。方法将内镜诊断的滑动型食管裂孔疝患者连续入组,并进行HRM及MII-pH监测后分为短段HH不伴糜烂性食管炎组(HHs)、短段HH伴糜烂性食管炎组(HHs+EE)及长段HH伴糜烂性食管炎组(HHL+EE)。另外选取10名志愿者作为健康对照组(HC)。结果 8例HH患者及10例健康志愿者纳入研究(HHs:7,HHs+EE:15,HHL+EE:6,HC:10)。3组HH患者的LES长度、LES静息压、膈脚张力、有效蠕动比例均明显低于对照组,但长段与短段HH组间无显著性差异。HH患者各组食管酸暴露明显重于对照组,DeMeester评分HHL+EEHHs+EEHHs(P0.05)。HHL+EE组近端反流及卧位反流比例更高。结论滑动型食管裂孔疝患者食管动力障碍及病理性胃食管反流程度较对照组重,长段HH患者食管酸暴露、近端反流及卧位反流更重。

Characteristics of high resolution manometry and multichannel intraluminal impedance-pH monitoring on sliding hiatal hernia patients

Objective To investigate the features of esophageal motility and gastroesophageal reflux on sliding hiatal hernia patients with high resolution manometry and multichannel intraluminal impedance -pH monitoring. Methods Consecutive patients with sliding hiatal hernia diagnosed by endoscopy were enrolled to short segment HH without erosive esophagitis （HHs） group, short segment HH with erosive esophagitis （HHs ＋ EE） group and long segment HH with erosive esophagitis （HHL ＋ EE） group after high resolution manometry and multichannel intraluminal impedance-pH monitoring. Another 10 healthy controls （HC） were recruited. Results Twenty-eight HH patients and 10 healthy controls（HHs： 7, HHs ＋ EE： 15, HHL ＋ EE： 6, HC： 10） were enrolled. LES length, LES resting pressure, tension of crural diaphragm at resting and effective peristalsis pro- portion in HHs, HHs ＋ EE and HHL ＋ EE groups were significantly lower than that in HC group, but difference between HHs ＋ EE and HHL ＋ EE groups had no statistical significance. DeMeester scores in the three HH groups were higher than that in HC group and followed the order of HHL ＋ EE HHs ＋ EE HHs （P 0.05）. There were more refluxes and proximal refluxes in decumbent position in HHL ＋ EE group. Conclusion Esophageal motility disorder and the degree of gastroesophageal reflux were both more severe in sliding hiatal hernia patients, especially in long segment HH subjects with more serious esophageal acid exposure, more de- cumbent position refluxes and more proximal refluxes.