Cuomo R, Grasso R, Sarnelli G, Bruzzese D, Bottiglieri M E, Alfieri M, Sifrim D, Budillon G
Dipartimento di Medicina Clinica e Sperimentale, Epatogastroenterologia, Università degli Studi di Napoli Federico II, Naples, Italy.
Dig Dis Sci. 2001 Dec;46(12):2687-94. doi: 10.1023/a:1012723412257.
The rapid pull-through (RPT) technique during esophageal manometry helps to identify various pressure profiles of hiatal hernia (HH), based on the presence of two high pressure zones: the diaphragmatic crura (DC) and the lower esophageal sphincter (LES). Our aim was to correlate different HH profiles with frequency of reflux episodes in patients with gastroesophageal reflux disease (GERD). Seventy-eight patients with GERD and HH underwent esophageal manometry with RPT and were grouped according to the prevalent pressure profile of HH. Twenty-four-hour pH-metry served to quantify traditional (TR) and nontraditional refluxes (drop of 1 pH unit with pH > 4 or pH < 4 and time < 5 sec) (NTR) during total, upright, and recumbent periods. The group with a prevalent "flat" HH profile, representing LES and DC impairment, had significantly more TRs in total time of reflux (P < 0.01) and in recumbent and upright periods (P < 0.05) compared to the group with a prevalence of the two pressure peaks, corresponding to LES and DC efficiency. However, the group with the flat profile had significantly more NTRs + TRs than the group with pressure peaks in total time (P < 0.01) and recumbent position (P < 0.001) but not in the upright position. Hiatal hernia predisposes to GERD, but only the associated impairment of the LES and diaphragmatic crura pressures represents a condition of high risk for gastroesophageal reflux events.
食管测压期间的快速牵拉通过（RPT）技术，基于两个高压区即膈脚（DC）和食管下括约肌（LES）的存在，有助于识别食管裂孔疝（HH）的各种压力曲线。我们的目的是将不同的HH曲线与胃食管反流病（GERD）患者的反流发作频率相关联。78例GERD合并HH患者接受了RPT食管测压，并根据HH的主要压力曲线进行分组。24小时pH监测用于量化总时间、直立位和卧位期间的传统反流（TR）和非传统反流（pH>4或pH<4且时间<5秒时pH下降1个单位）（NTR）。以“平坦”HH曲线为主的组，代表LES和DC功能受损，与以两个压力峰值为主的组相比，在总反流时间（P<0.01）、卧位和直立位时的TR明显更多（P<0.05），后一组对应LES和DC功能正常。然而，平坦曲线组在总时间（P<0.01）和卧位（P<0.001）时的NTR+TR明显多于压力峰值组，但在直立位时并非如此。食管裂孔疝易导致GERD，但只有LES和膈脚压力的相关受损才代表胃食管反流事件的高风险状态。
