Klopocka Maria, Budzyński Jacek, Swiatkowski Maciej, Pulkowski Grzegorz, Meder Agnieszka
Department of Gastroenterology, Vascular Diseases, and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland.
Med Sci Monit. 2006 Sep;12(9):CR387-92.
First- and second-order esophageal contractions are important factors responsible for esophageal clearance of refluxed gastric content. The aim of this study was to estimate the influence of acid reflux on second-order esophageal peristalsis.
MATERIAL/METHODS: Simultaneous 24-h esophageal pH-metry and 24-h motility monitoring was performed in 213 patients with non-cardiac chest pain. Pathological gastroesophageal acid reflux (pGER) was defined as pH <4 for more than 4.5% of the total monitoring time.
The group of pGER patients (n=65, 31%) had a lower percentage of complete and effective peristalsis, a higher percentage of incomplete peristalsis, and a lower mean contraction amplitude than the group of patients with normal esophageal acid exposure (nGER). Analysis of motility parameters in three periods, i.e. during acid reflux and 2 min before and 10 min after episodes (second-order peristalsis), showed that the pGER group had a lower percentage of effective peristalsis (20.6 +/- 13.3 vs. 29.6 +/- 16.2%, p = 0.002) and a higher percentage of ineffective peristalsis both during and after acid reflux, a lower mean contraction amplitude (56.5 +/- 30.3 vs. 70.0 +/- 32.8 mmHg, p=0.025), and a lower contraction frequency during acid reflux (1.6 +/- 0.7 vs. 2.6 +/- 3.1/min, p=0.001) and 10 min after (1.9 +/- 1.9 vs. 20.6 +/- 30.2/min, p=0.002), which indicated a lack of esophageal peristalsis acceleration after acid reflux in the pGER group.
(1) pGER patients had ineffective esophageal peristalsis more frequently than nGER patients. (2) Impaired second-order peristalsis in pGER patients may be an important factor determining prolonged exposure of the esophageal mucosa to gastric content in addition to lower esophageal sphincter function.
一级和二级食管收缩是食管清除反流胃内容物的重要因素。本研究旨在评估酸反流对二级食管蠕动的影响。
材料/方法：对213例非心源性胸痛患者进行了同步24小时食管pH监测和24小时动力监测。病理性胃食管酸反流（pGER）定义为pH值<4的时间占总监测时间的4.5%以上。
pGER患者组（n=65，31%）与食管酸暴露正常的患者组（nGER）相比，完全有效蠕动的百分比更低，不完全蠕动的百分比更高，平均收缩幅度更低。对三个时间段（即酸反流期间以及发作前2分钟和发作后10分钟，二级蠕动）的动力参数进行分析，结果显示，pGER组有效蠕动的百分比更低（20.6±13.3%对29.6±16.2%，p = 0.002），酸反流期间及之后无效蠕动的百分比更高，平均收缩幅度更低（56.5±30.3对70.0±32.8 mmHg，p=0.025），酸反流期间（1.6±0.7对2.6±3.1次/分钟，p=0.001）和酸反流后10分钟（1.9±1.9对20.6±30.2次/分钟，p=0.002）的收缩频率更低，这表明pGER组酸反流后食管蠕动缺乏加速。
（1）pGER患者食管蠕动无效的情况比nGER患者更常见。（2）除食管下括约肌功能外，pGER患者二级蠕动受损可能是决定食管黏膜长时间暴露于胃内容物的一个重要因素。
