Shafik Ahmed, Shafik Ismail, El-Sibai Olfat, Shafik Ali A
Department of Surgery and Experimental Research, Cairo University, Egypt.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):401-7. doi: 10.1016/j.jtcvs.2004.08.048.
The cause of lower esophageal sphincter incompetence in gastroesophageal reflux disease is not clearly understood. We investigated the hypothesis that the esophagogastric junction incompetence results from failure of the gastric distention to produce the lower esophageal sphincter and crural diaphragm contraction caused by a disordered reflex action.
The study was performed in 19 subjects (mean age, 42.6 +/- 7.2 years; 11 men and 8 women) who had reflux esophagitis and hiatus hernia and were scheduled for a fundoplication operation. Eight control volunteers (mean age, 41.8 +/- 6.9; 5 men and 3 women) who had huge supraumbilical ventral hernia but no reflux esophagitis or hiatus hernia were studied during operative hernia repair. The electromyographic activity and pressure response of the lower esophageal sphincter and crural diaphragm to separate esophageal and gastric distention were recorded.
In the control subjects (volunteers) esophageal distention caused diminished electromyographic activity of the crural diaphragm and lower esophageal sphincter with decreased esophagogastric junction pressure, whereas gastric distention increased the electromyographic activity of the crural diaphragm and lower esophageal sphincter with increased esophagogastric junction pressure. In the patients the crural diaphragm and lower esophageal sphincter showed diminished resting electromyographic activity, with either no response or a paradoxical response to esophageal or gastric distention.
The current study has demonstrated that the lower esophageal sphincter and crural diaphragm in patients with gastroesophageal reflux disease exhibited a diminished resting electric activity and either did not respond or reacted paradoxically to esophageal and gastric distention, constituting what we call esophagosphincteric and gastroesophageal paradox or dyssynergia. The cause of lower esophageal sphincter and crural diaphragm dysfunction is not known; a neurogenic cause was proposed. Further studies are required to investigate this point.
胃食管反流病中食管下括约肌功能不全的病因尚不清楚。我们研究了这样一个假说，即食管胃交界处功能不全是由于胃扩张未能通过紊乱的反射作用引起食管下括约肌和膈脚收缩所致。
本研究对19例反流性食管炎和食管裂孔疝患者（平均年龄42.6±7.2岁；11例男性，8例女性）进行，这些患者计划接受胃底折叠术。在手术修复巨大脐上腹壁疝的过程中，对8例对照志愿者（平均年龄41.8±6.9岁；5例男性，3例女性）进行了研究，这些志愿者有巨大脐上腹壁疝但无反流性食管炎或食管裂孔疝。记录食管下括约肌和膈脚对食管和胃分别扩张时的肌电活动和压力反应。
在对照受试者（志愿者）中，食管扩张导致膈脚和食管下括约肌的肌电活动减弱，食管胃交界处压力降低，而胃扩张则增加了膈脚和食管下括约肌的肌电活动，并使食管胃交界处压力升高。在患者中，膈脚和食管下括约肌的静息肌电活动减弱，对食管或胃扩张无反应或出现矛盾反应。
目前的研究表明，胃食管反流病患者的食管下括约肌和膈脚静息电活动减弱，对食管和胃扩张无反应或出现矛盾反应，构成了我们所称的食管括约肌和胃食管矛盾或协同失调。食管下括约肌和膈脚功能障碍的原因尚不清楚；有人提出是神经源性原因。需要进一步研究来探讨这一点。
