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目的 探讨食管无效收缩 (IEM)在胃食管反流病 (GERD)的发病作用。方法 对GERD病人行食管测压和 2 4h食管pH监测 ,分析IEM在GERD的发生率以及比较IEM与食管酸暴露、酸清除和食管炎的关系。结果 86例GERD病人中 5 9例 (6 8 6 % )存在非特异性食管动力障碍 (NEMD) ;其中 5 5例 (占 93 2 % )符合IEM诊断标准 ;GERD病的IEM发生率为 6 3 95 %。IEM的GERD患者总的pH <4时间 (% ) (5 91)及立位 (4 4 3)和卧位 (6 92 )pH <4时间 (% )显著大于食管正常蠕动的GERD患者 (分别为 3 16 ,1.6 1,和 4 31) ,尤以卧位明显 (P <0 0 1)。IEM患者平均卧位食管酸清除时间 (EAC)为每次 12 6 3min ,显著长于正常食管动力GERD患者的每次 3 15min(P<0 0 1) ,而立位EAC则与正常食管动力组无差异。 2 7例正常食管动力GERD有 10例 (37% )有糜烂性食管炎 ;5 5例IEM患者有 19例 (35 % )有食管炎 ,二组间食管炎发生比例差异无显著性 (P >0 0 5 )。结论 GERD病的食管动力障碍大多数系IEM。IEM比正常食管动力患者更易发生反流和存在食管酸清除障碍。IEM是GERD病的主要异常表现。
Objective To investigate the incidence of gastroesophageal reflux disease (GERD) in patients with esophageal ineffective contraction (IEM). Methods Esophageal manometry and 24 h esophageal pH monitoring were performed in GERD patients. The incidence of IEM in GERD and the relationship between IEM and esophageal acid exposure, acid clearance and esophagitis were compared. Results Ninety-five (68.6%) of the 86 GERD patients had nonspecific esophageal motility disorders (NEMD), of which 55 (93.2%) met the IEM diagnostic criteria. The incidence of IEM in GERD patients was 6 3 95 %. The GERD patients with GERD in IEM had significantly lower total pH <4 hours (%) (5 91) and standing position (443) and lying position (6 92) pH <4 time 3 16, 1.6 1, and 4 31), especially in the lying position (P <0.01). The mean duration of esophageal acid clearance (EAC) was 12 6 3 min in each IEM group, significantly longer than that in the normal esophageal GERD group (P 0 01), while the standing EAC group was not significantly different from the normal esophageal motoneurons group . Esophagitis was found in 10 (37%) of the 7 normal esophageal motility GERD patients, esophagitis in 19 (35%) of 5 5 IEM patients, and no significant difference in esophagitis between the two groups (P> 0 0 5). Conclusions The majority of esophageal motility disorders in GERD are IEM. IEM is more prone to reflux and presence of esophageal acid clearance than patients with normal esophageal motility. IEM is a major aberrant manifestation of GERD disease.