轻度反流性食管炎与非糜烂性反流病远端食管酸暴露和食管动力学变化

目的:探讨轻度反流性食管炎(RE)与非糜烂性反流病(NERD)食管远端酸暴露及食管动力变化特点.方法:符合洛杉矶诊断标准的RE30例(LA-A16例,LA-B14例),NERD16例,健康对照组10例被纳入本研究,所有患者及对照组均接受24h食管pH监测及压力测定,比较食管pH监测及测压结果.结果:LA-A组、LA-B组、NERD组DeMeester评分明显高于对照组,差异显著(P<0.05).LA-A组与NERD组比较DeMeester评分无明显差异,但NERD组的立位反流时间百分比与长反流周期数多于LA-A组,差异显著;LA-B组DeMeester评分比LA-A组和NERD组明显增高,LA-B组与LA-A组比较食管pH监测各项指标均存在明显差异.LA-A组、NERD组及对照组比较下食管括约肌静息压(LESP)、食管体部蠕动波幅度(PA)无显著差异,LA-A组和NERD组食管下段PA有增高趋势;LA-B组与LA-A组、NERD组及对照组比较LESP明显降低(P<0.05),LA-B组食管下段PA明显低于LA-A组(P<0.05).RE组无效食管运动(IEM)明显高于对照组,差异显著.结论:轻度RE(LA-B)与NERD远端食管酸暴露存在差异.DeMeester评分、LES功能不全及食管蠕动功能障碍与RE的严重程度呈正相关.LES功能不全及食管蠕动功能障碍可能不是轻度RE(LA-A)及NERD的主要致病因素.IEM与RE关系密切,且与RE有关的食管动力异常主要为IEM.

Distal esophageal acid exposure and esophageal motility in patients with mild reflux esophagitis or nonerosive reflux disease

AIM:To investigate the characteristics of and changes in distal esophageal acid exposure and esophageal motility in patients with mild reflux esophagitis(RE) or non-erosive reflux disease(NERD) by performing esophageal PH monitoring and manometry.METHODS:Thirty RE patients(16 LA-A cases and 14 LA-B cases) and 16 NERD patients who were diagnosed according to the Los Angeles classification criteria and 10 healthy subjects were recruited in our study,all of whom received 24-h esophageal PH monitoring and esophageal manometry.RESULTS:DeMeester scores of the LA-A,LA-B and NERD groups were signif icantly higher than that of the control group.Although there was no difference in DeMeester score between the LA-A group and NERD group,the upright acid exposure time and the number of long reflux periods in the latter group were dramatically increased.Significantly higher DeMeester score was seen in the LA-B group than in the LA-A and NERD groups.All variables of 24-h esophageal PH monitoring were signif icantly different between the LA-A and LA-B groups.No differences in the lower esophageal sphincter pressure(LESP) and peristaltic amplitude(PA) of esophageal body were observed among the LA-A,NERD and control groups,though PA showed a tendency to increase in the distal esophagus in the former two groups.LESP in the LA-B group was lower than that in other groups.In addition,the LA-B group had a lower PA in the distal esophagus than the LA-A group.The number of ineffective esophageal motility(IEM) in the RE group was obviously elevated in comparison to the control group.CONCLUSION:There is a difference in acid exposure of the distal esophagus between patients with mild RE(LA-B) and those with NERD.DeMeester score,LES dysfunction and esophageal peristaltic dysfunction positively correlate with the severity of RE.LES dysfunction and esophageal peristaltic dysfunction may not be the major pathogenic factors for RE(LA-A) or NERD.IEM is the primary motility disorder of reflux esophagitis.