Bhalla Vikas, Liu Jianmin, Puckett James L, Mittal Ravinder K
Section of Gastroenterology 111D, University of California-San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
Am J Physiol Gastrointest Liver Physiol. 2004 Jul;287(1):G65-71. doi: 10.1152/ajpgi.00420.2003. Epub 2004 Feb 19.
Several investigators have observed that repeated acid infusions induce stronger symptoms (symptom hypersensitivity). The goal of our study was to determine whether symptom hypersensitivity is associated with esophageal contractile hypersensitivity. Subjects with chronic heartburn symptoms underwent simultaneous pressure and ultrasound imaging of esophagus. Normal saline and 0.1 N HCl were sequentially infused into the esophagus, and subjects scored heartburn symptoms on a 1-10 scale. Saline and HCl infusions were repeated in 10 subjects with a positive Bernstein test. Esophageal contraction amplitude and duration and muscularis propria thickness were measured using a computerized method during recording. Acid infusion induced heartburn. Esophageal contractions had higher amplitudes (pressure 114.2 +/- 7.0%) and longer duration (116.8 +/- 4.4%) during acid infusion compared with saline infusion. Average muscle thickness was greater during acid infusion than saline infusion (107.0 +/- 2.0%). Sustained esophageal contractions (SECs) were identified during acid infusion. A second acid infusion (acid-2) induced heartburn with shorter latency (93.0 +/- 15.0 vs. 317.0 +/- 43.0 s) and stronger severity (8.5 +/- 0.5 vs. 5.3 +/- 0.8) than the first acid infusion (acid-1). Contraction amplitudes (140.2 +/- 13.0%), average muscle thickness (118.0 +/- 3.3%), and contraction duration (148.5 +/- 5.6 vs. 116.8 +/- 4.4%) were higher during acid-2 than acid-1. Also, numbers of SECs were greater during acid-2 than acid-1 (31 in 8 subjects vs. 11 in 6 subjects). Our data show that acid infusion into esophagus induces esophageal hypersensitivity and that a close temporal correlation exists between symptom hypersensitivity and contractility hypersensitivity.
几位研究者观察到，重复酸灌注会诱发更强的症状（症状超敏反应）。我们研究的目的是确定症状超敏反应是否与食管收缩超敏反应相关。患有慢性烧心症状的受试者接受了食管压力和超声成像同步检查。将生理盐水和0.1N盐酸依次注入食管，受试者按1-10分对烧心症状进行评分。对10名伯恩斯坦试验呈阳性的受试者重复进行生理盐水和盐酸灌注。在记录过程中，使用计算机化方法测量食管收缩幅度、持续时间和固有肌层厚度。酸灌注诱发了烧心。与生理盐水灌注相比，酸灌注期间食管收缩幅度更高（压力为114.2±7.0%），持续时间更长（116.8±4.4%）。酸灌注期间的平均肌肉厚度大于生理盐水灌注期间（107.0±2.0%）。在酸灌注期间识别出持续性食管收缩（SECs）。第二次酸灌注（酸-2）诱发烧心的潜伏期比第一次酸灌注（酸-1）更短（93.0±15.0秒对317.0±43.0秒），严重程度更强（8.5±0.5对5.3±0.8）。酸-2期间的收缩幅度（140.2±13.0%）、平均肌肉厚度（118.0±3.3%）和收缩持续时间（148.5±5.6对116.8±4.4%）高于酸-1。此外，酸-2期间的SECs数量多于酸-1（8名受试者中有31次，6名受试者中有11次）。我们的数据表明，向食管内注入酸会诱发食管超敏反应，并且症状超敏反应与收缩性超敏反应之间存在密切的时间相关性。
