Pandolfino John E, Shi Guoxiang, Trueworthy Brian, Kahrilas Peter J
Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Gastroenterology. 2003 Oct;125(4):1018-24. doi: 10.1016/s0016-5085(03)01210-1.
Flow across the esophagogastric junction (EGJ) is strongly related to opening dimensions. This study aimed to determine whether opening of the relaxed EGJ was altered in patients with gastroesophageal reflux disease (GERD).
Seven normal subjects (NL), 9 GERD patients without hiatus hernia (NHH), and 7 with hiatus hernia (HH) were studied. Cross-sectional area (CSA) of the relaxed EGJ was measured during low-pressure distention using a modified barostat technique that resulted in filling a compliant bag straddling the EGJ with renograffin to the set pressure. Swallows were imaged fluoroscopically at distensive pressures of 2-12 mm Hg. The diameter of the narrowest point of the EGJ in PA and lateral projections was measured from digitized images. CSA was determined as a function of intrabag pressure.
The minimal EGJ opening aperture occurred at the diaphragmatic hiatus in all subjects. At pressures </=0 mm Hg, EGJ opening was observed only in HH patients, making it plausible for these patients to reflux during deglutitive relaxation. At pressures >0 mm Hg, there were significant increases in EGJ CSA both for HH and NHH compared with NL (P < 0.001) and for HH compared with NHH (P < 0.005). This difference may explain the diminished air/water discrimination seen during transient lower esophageal sphincter (LES) relaxation-associated reflux in GERD patients.
Anatomic degradation of the EGJ distinguishes GERD patients from normal subjects, and these changes may impact on both the observed mechanisms of reflux and the constituents of reflux during transient LES relaxation. Therapy focused on EGJ compliance may benefit GERD patients.
流经食管胃交界（EGJ）的血流与开口尺寸密切相关。本研究旨在确定胃食管反流病（GERD）患者松弛状态下的EGJ开口是否发生改变。
对7名正常受试者（NL）、9名无食管裂孔疝的GERD患者（NHH）和7名有食管裂孔疝的患者（HH）进行研究。使用改良的恒压器技术在低压扩张期间测量松弛状态下EGJ的横截面积（CSA），该技术通过向横跨EGJ的顺应性袋中注入泛影葡胺至设定压力来实现。在2-12 mmHg的扩张压力下对吞咽动作进行荧光透视成像。从数字化图像中测量PA和侧位投影中EGJ最窄点的直径。CSA根据袋内压力确定。
所有受试者的EGJ最小开口孔径均出现在膈肌裂孔处。在压力≤0 mmHg时，仅在HH患者中观察到EGJ开口，这使得这些患者在吞咽时的松弛过程中发生反流成为可能。在压力>0 mmHg时，HH和NHH患者的EGJ CSA均较NL患者显著增加（P<0.001），且HH患者较NHH患者增加更显著（P<0.005）。这种差异可能解释了GERD患者在短暂下食管括约肌（LES）松弛相关反流期间空气/水辨别能力下降的现象。
EGJ的解剖结构退化将GERD患者与正常受试者区分开来，这些变化可能会影响反流的观察机制以及短暂LES松弛期间反流的成分。针对EGJ顺应性的治疗可能会使GERD患者受益。
