Stein H J, Schwizer W, DeMeester T R, Albertucci M, Bonavina L, Spires-Williams K J
University of Southern California School of Medicine, Department of Surgery, Los Angeles 90033-4612.
Dysphagia. 1992;7(4):220-5. doi: 10.1007/BF02493473.
Foreign body entrapment and mucosal injury caused by oral medications are increasingly reported to occur in the upper esophagus in apparently normal subjects. We performed esophageal manometry in 40 normal volunteers to determine whether a unique motility pattern in the upper third of the esophagus predisposes to entrapment of foreign bodies at this site; 18 normal volunteers also had transit scintigraphy of a gelatin capsule filled with a radionuclide. The esophageal body was divided into five consecutive segments starting proximally, with each segment corresponding to 20% of the total length. Amplitude, slope, and velocity of the esophageal contraction were markedly decreased in the second segment compared with the other segments. Entrapment and dissolution of a gelatin capsule occurred in 39% of volunteers in the proximal esophagus correlating to the second segment, i.e., the segment with the lowest amplitude, slope, and velocity of esophageal contractions. The observation that wet swallows have greater amplitudes (P less than 0.01) and steeper slopes (P less than 0.05) than dry swallows explains why the occurrence of pill entrapment was reduced when taken with sufficient water. However, even with a water chaser of 120 mL, pill entrapment occurred at the second segment of the esophagus in 1 of 18 volunteers. The observed motility pattern in the proximal esophagus provides a better explanation for the entrapment of foreign bodies at this site than compression of the esophagus by the left main stem bronchus, aortic arch, or left atrium as suggested by other investigators.
越来越多的报告显示，在看似正常的人群中，口服药物导致的异物嵌顿和黏膜损伤发生在上段食管。我们对40名正常志愿者进行了食管测压，以确定食管上段独特的运动模式是否易使异物在此处嵌顿；18名正常志愿者还对填充有放射性核素的明胶胶囊进行了通过闪烁扫描检查。食管体部从近端开始连续分为五个节段，每个节段对应总长度的20%。与其他节段相比，第二节段食管收缩的幅度、斜率和速度明显降低。在与第二节段相对应的近端食管中，39%的志愿者出现了明胶胶囊的嵌顿和溶解，即食管收缩幅度、斜率和速度最低的节段。湿吞咽比干吞咽具有更大幅度（P<0.01）和更陡斜率（P<0.05）这一观察结果解释了为什么在饮用足够水时服用药物，药丸嵌顿的发生率会降低。然而，即使饮用120 mL的水冲服，18名志愿者中有1人在食管第二节段仍出现药丸嵌顿。与其他研究者提出的左主支气管、主动脉弓或左心房对食管的压迫相比，观察到的近端食管运动模式为异物在此处的嵌顿提供了更好的解释。
