van Herwaarden M A, Samsom M, Smout A J
Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center Utrecht, The Netherlands.
Gastroenterology. 2000 Dec;119(6):1439-46. doi: 10.1053/gast.2000.20191.
BACKGROUND & AIMS: Esophageal acid exposure is higher in gastroesophageal reflux disease (GERD) patients with hiatus hernia than in those without. We investigated the effect of a sliding hiatus hernia on the mechanisms underlying spontaneous gastroesophageal reflux over 24 hours.
Twelve GERD patients with and 10 GERD patients without hiatus hernia were studied for 24 hours. Combined esophageal pH and manometric recordings of the pharynx, lower esophageal sphincter (LES), and stomach were performed using a multiple-lumen assembly incorporating a Dent sleeve connected to a portable water-perfused manometric system and a pH glass electrode.
Patients with hiatus hernia had greater esophageal acid exposure (7.6% vs. 3.3%; P < 0.01) and more reflux episodes (3.1 vs. 1.8/h; P < 0.001) than those without. LES pressure, the incidence of transient LES relaxations (TLESRs), and the proportion of TLESRs associated with acid reflux were comparable in both groups. Both groups had equal numbers of reflux episodes associated with TLESRs and swallow-associated prolonged LES relaxations. Patients with hiatus hernia had more reflux associated with low LES pressure, swallow-associated normal LES relaxations, and straining during periods with low LES pressure.
The excess reflux in GERD patients with hiatus hernia compared with those without is caused by malfunction of the gastroesophageal barrier during low LES pressure, swallow-associated normal LES relaxations, deep inspiration, and straining.
与无食管裂孔疝的胃食管反流病（GERD）患者相比，有食管裂孔疝的GERD患者食管酸暴露更高。我们研究了滑动性食管裂孔疝对24小时内自发性胃食管反流潜在机制的影响。
对12例有食管裂孔疝的GERD患者和10例无食管裂孔疝的GERD患者进行了24小时研究。使用多腔组件进行食管pH值与咽、食管下括约肌（LES）和胃的测压联合记录，该组件包含连接到便携式水灌注测压系统的登特套管和pH玻璃电极。
与无食管裂孔疝的患者相比，有食管裂孔疝的患者食管酸暴露更多（7.6%对3.3%；P<0.01），反流发作更频繁（3.1次对1.8次/小时；P<0.001）。两组的LES压力、短暂LES松弛（TLESRs）发生率以及与酸反流相关的TLESRs比例相当。两组与TLESRs和吞咽相关的长时间LES松弛相关的反流发作次数相等。有食管裂孔疝的患者有更多与LES低压、吞咽相关的正常LES松弛以及LES低压期间用力相关的反流。
与无食管裂孔疝的GERD患者相比，有食管裂孔疝的GERD患者反流过多是由LES低压、吞咽相关的正常LES松弛、深吸气和用力期间胃食管屏障功能障碍引起的。
