Makk L J, Leesar M, Joseph A, Prince C P, Wright R A
Department of Medicine, University of Louisville School of Medicine, Kentucky 40292, USA.
Dig Dis Sci. 2000 Dec;45(12):2451-4. doi: 10.1023/a:1005527522576.
Neural reflex arcs from the esophagus and heart have been shown in both animals and man. The purpose of this study was to further investigate these pathways in individuals undergoing cardiac catheterization. A total of 298 patients undergoing cardiac catheterization were asked to participate in the protocol. Thirty patients were able to complete the study. Esophageal manometry and pH were monitored throughout the cardiac procedure. Afterwards, esophageal provocation with ice water, hydrochloric acid, and balloon inflation was performed with observation of cardiac rate and rhythm. Twelve patients with normal coronary arteries developed diffuse esophageal spasm on either esophageal or cardiac provocation. In one patient with abnormal coronary arteries, coronary angioplasty precipitated diffuse esophageal spasm. Esophageal acid sensitivity was increased in patients with normal coronaries as compared to those that were abnormal. The esophageal pain threshold was significantly lower in patients undergoing angioplasty versus those undergoing coronary angiography alone. There was no significant change in esophageal pH during invasive cardiac maneuvers and manipulations. In conclusion, cardiac manipulation can induce esophageal motility abnormalities, but not gastroesophageal reflux. Coronary angioplasty is associated with esophageal hyperalgesia.
在动物和人类中均已证实存在来自食管和心脏的神经反射弧。本研究的目的是进一步调查接受心脏导管插入术患者的这些通路。共有298例接受心脏导管插入术的患者被要求参与该方案。30例患者能够完成研究。在整个心脏手术过程中监测食管测压和pH值。之后，用冰水、盐酸和球囊扩张对食管进行激发，并观察心率和心律。12例冠状动脉正常的患者在食管或心脏激发时出现弥漫性食管痉挛。在1例冠状动脉异常的患者中，冠状动脉血管成形术诱发了弥漫性食管痉挛。与冠状动脉异常的患者相比，冠状动脉正常的患者食管对酸的敏感性增加。接受血管成形术的患者与仅接受冠状动脉造影的患者相比，食管疼痛阈值显著降低。在侵入性心脏操作和手法操作期间，食管pH值无显著变化。总之，心脏操作可诱发食管运动异常，但不会导致胃食管反流。冠状动脉血管成形术与食管痛觉过敏有关。
