Aubert A, Lazareth I, Vayssairat M, Fiessinger J N, Petite J P
Service des Maladies de l'Appareil Digestif, Hôpital Broussais, Paris.
Gastroenterol Clin Biol. 1991;15(12):945-9.
Forty-six patients with progressive systemic sclerosis (37 women and 9 men) were successively evaluated by endoscopy, manometry, and esophageal pH monitoring. Fourteen patients (30.4 percent) had erosive esophagitis. Twenty-four patients were symptomatic; nineteen patients complained of dysplagia. Erosive esophagitis was significantly more frequent in symptomatic patients than in asymptomatic patients (50.0 percent vs 9 percent, P less than 0.01) and especially in patients complaining of dysphagia (57.9 percent vs 11.1 percent, P less than 0.01). Erosive esophagitis was not correlated with symptoms of gastroesophageal reflux. Abnormal esophageal motility was found in 34 patients (73.9 percent). Occurrence of erosive esophagitis was not linked with esophageal dysmotility. In patients with erosive esophagitis lower esophageal sphincter pressures were significantly lower than those in patients without erosive esophagitis. Twenty-four hr-pH monitoring showed pathological gastroesophageal reflux in 20 patients (43.5 percent). Erosive esophagitis was more frequent in patients with pathological gastroesophageal reflux than in patients with normal gastroesophageal reflux (50.0 percent vs 15.4 percent, P less than 0.02) especially in patients with pathological supine nighttime gastroesophageal reflux (61.5 percent vs 18.2 percent, P less than 0.01). Our data suggest that symptoms, dysphagia, diminished lower esophageal sphincter pressures, and pathologic nighttime gastroesophageal reflux are reliable predictors of the presence of erosive esophagitis in patients with progressive systemic sclerosis.
46例进行性系统性硬化症患者（37例女性，9例男性）先后接受了内镜检查、测压和食管pH监测。14例患者（30.4%）患有糜烂性食管炎。24例患者有症状；19例患者主诉吞咽困难。糜烂性食管炎在有症状的患者中比无症状的患者更常见（50.0%对9%，P<0.01），尤其在主诉吞咽困难的患者中（57.9%对11.1%，P<0.01）。糜烂性食管炎与胃食管反流症状无关。34例患者（73.9%）存在食管动力异常。糜烂性食管炎的发生与食管动力障碍无关。糜烂性食管炎患者的食管下括约肌压力显著低于无糜烂性食管炎的患者。24小时pH监测显示20例患者（43.5%）存在病理性胃食管反流。病理性胃食管反流患者的糜烂性食管炎比胃食管反流正常的患者更常见（50.0%对15.4%，P<0.02），尤其在病理性仰卧位夜间胃食管反流患者中（61.5%对18.2%，P<0.01）。我们的数据表明，症状、吞咽困难、食管下括约肌压力降低和病理性夜间胃食管反流是进行性系统性硬化症患者糜烂性食管炎存在的可靠预测指标。
