Scheffer R C H, Akkermans L M A, Bais J E, Roelofs J M M, Smout A J P M, Gooszen H G
Department of Surgery, Gastrointestinal Research Unit, University Medical Center, Utrecht, The Netherlands.
Neurogastroenterol Motil. 2002 Dec;14(6):647-55. doi: 10.1046/j.1365-2982.2002.00366.x.
The aim of this study was to compare the effect of graded gastric barostat distension and meal-induced fundic relaxation on the elicitation of transient lower oesophageal sphincter relaxation (TLOSR). In 15 healthy subjects, stepwise fundic distension and oesophageal manometry were performed simultaneously. Next, the effect of meal ingestion on proximal stomach volume and lower oesophageal sphincter function was studied. During stepwise barostat distension of the proximal stomach, a significant linear correlation between intragastric pressure (r = 0.91; P < 0.01) and the TLOSR rate during inflation and subsequent deflation (r = 0.96; P < 0.01) was found. A similar relationship was found for volume. In addition, after meal ingestion, the TLOSR rate increased significantly from 1.40 +/- 3 to 5.4 +/- 1.5 h-1 (P < 0.01) and 5.2 +/- 1.7 h-1 (P < 0.01), respectively, during the first and second 30-min postprandially. However, at similar calculated intragastric volumes, barostat distension led to a significantly higher TLOSR rate than the meal. Similarly, distension-induced increase in gastric wall tension, estimated from the measured bag pressure and volume using Laplace's law, was associated with significantly higher TLOSR rates (P < 0.01). In conclusion, the rate of TLOSRs in healthy volunteers is directly related to the degree of proximal gastric distension and pressure-controlled barostat distension is a more potent trigger of TLOSRs than a meal. The latter finding suggests that tension receptor activation is an important stimulus for TLOSRs.
本研究的目的是比较分级胃内压监测下的胃扩张和进餐诱导的胃底松弛对诱发一过性下食管括约肌松弛（TLOSR）的影响。对15名健康受试者同时进行逐步胃底扩张和食管测压。接下来，研究进餐对胃近端容积和下食管括约肌功能的影响。在对胃近端进行逐步胃内压监测扩张期间，发现胃内压与充气及随后放气期间的TLOSR发生率之间存在显著的线性相关性（r = 0.91；P < 0.01），容积方面也发现了类似关系。此外，进餐后，在餐后第一个30分钟和第二个30分钟期间，TLOSR发生率分别从1.40±3显著增加至5.4±1.5 h-1（P < 0.01）和5.2±1.7 h-1（P < 0.01）。然而，在计算的胃内容积相似时，胃内压监测下的扩张导致的TLOSR发生率显著高于进餐。同样，根据拉普拉斯定律通过测量的气囊压力和容积估算的扩张诱导的胃壁张力增加与显著更高的TLOSR发生率相关（P < 0.01）。总之，健康志愿者中TLOSR的发生率与胃近端扩张程度直接相关，压力控制的胃内压监测下的扩张比进餐更能有效诱发TLOSR。后一发现表明张力感受器激活是TLOSR的重要刺激因素。
