Pouderoux P, Shi G, Tatum R P, Kahrilas P J
Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611-3053, USA.
Am J Gastroenterol. 1999 Jun;94(6):1457-63. doi: 10.1111/j.1572-0241.1999.01126.x.
Our aim was to assess the efficacy and mechanism of solid bolus transit through the esophagus.
Eight healthy volunteers were studied with concurrent manometry and videofluoroscopy while swallowing 5 ml liquid barium, a 5-6 mm diameter bread ball, and 4 g chewed bread in both a supine and upright posture. As many as four successive swallows were performed until clearance was achieved.
The esophageal clearance of liquid barium was 100% with the first swallow. Clearance of the unchewed bread ball occurred with the first swallow in only 6.7% of trials in the upright posture and 5.9% in the supine posture. After four swallows, clearance was 100% and 52.9% in the upright and supine postures, respectively. Chewed bread was more readily cleared than unchewed bread, with 100% clearance after two swallows in the upright posture and 91% clearance after four swallows in the supine posture. The most common locus of bread stasis was at the aortic arch and carina. The bread boluses were noted to move more effectively when localized in the head as opposed to the tail of the bolus composite. Nonocclusive contractions often occurred at the bolus tail despite the increased peristaltic amplitude seen with the chewed bread. Failed peristalsis, a frequent cause for solid clearance failure, was observed during 30% of all bread swallows. This usually occurred distal to the stopping point of the bolus, suggesting it to be the result rather than the cause of impaired transit.
Although infrequently perceived by these normal subjects and in contradistinction to liquid clearance, bread is rarely cleared from the esophagus with a single swallow. Mastication and an upright posture facilitate the esophageal transport of solids. Bolus composition and impaired bolus transit alter the amplitude and conductance of peristalsis. Manometric data pertaining to liquid clearance through the esophagus do not readily apply to bread.
我们的目的是评估固体食团通过食管的有效性及机制。
对8名健康志愿者在吞咽5毫升液体钡剂、一个直径5 - 6毫米的面包球以及4克咀嚼后的面包时，采用同步测压法和视频荧光透视法进行研究，姿势包括仰卧位和直立位。连续进行多达4次吞咽，直至食团清除。
液体钡剂在首次吞咽后食管清除率为100%。未咀嚼的面包球在直立位首次吞咽时清除率仅为6.7%，仰卧位为5.9%。4次吞咽后，直立位清除率为100%，仰卧位为52.9%。咀嚼后的面包比未咀嚼的面包更容易清除，直立位2次吞咽后清除率为100%，仰卧位4次吞咽后清除率为91%。面包滞留最常见的部位是主动脉弓和隆突。发现食团位于头部时比位于食团复合体尾部时移动更有效。尽管咀嚼后的面包蠕动幅度增加，但食团尾部仍常出现非梗阻性收缩。在所有面包吞咽过程中，30%观察到无效蠕动，这是固体清除失败的常见原因。这通常发生在食团停止点的远端，表明它是传输受损的结果而非原因。
尽管这些正常受试者很少察觉到，且与液体清除不同，面包很少能通过单次吞咽从食管清除。咀嚼和直立姿势有助于食管对固体食物的传输。食团组成和食团传输受损会改变蠕动的幅度和传导。与食管液体清除相关的测压数据不适用于面包。
