Division of Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland.
Neurogastroenterol Motil. 2011 Jun;23(6):517-e200. doi: 10.1111/j.1365-2982.2011.01669.x. Epub 2011 Jan 28.
Non-specific esophageal dysmotility with impaired clearance is often present in patients with gastro-esophageal reflux disease (GERD), especially those with erosive disease; however the physio-mechanic basis of esophageal dysfunction is not well defined.
Retrospective assessment of patients with erosive reflux disease (ERD; n=20) and endoscopy negative reflux disease (ENRD; n=20) with pathologic acid exposure on pH studies (>4.2% time/24 h) and also healthy controls (n=20) studied by high resolution manometry. Esophageal motility in response to liquid and solid bolus swallows and multiple water swallows (MWS) was analyzed. Peristaltic dysfunction was defined as failed peristalsis, spasm, weak or poorly coordinated esophageal contraction (>3cm break in 30 mmHg isocontour).
Peristaltic dysfunction was present in 33% of water swallows in controls, 56% ENRD and 76% ERD respectively (P<0.023 vs controls, P=0.185 vs ENRD). The proportion of effective peristaltic contractions improved with solid compared to liquid bolus in controls (18%vs 33%, P=0.082) and ENRD (22%vs 54%, P=0.046) but not ERD (62%vs 76%, P=0.438). Similarly, MWS was followed by effective peristalsis in 83% of controls and 70% ENRD but only 30% ERD patients (P<0.017 vs controls and P<0.031 vs ENRD). The association between acid exposure and dysmotility was closer for solid than liquid swallows (r=0.52 vs 0.27).
CONCLUSIONS & INFERENCES: Peristaltic dysfunction is common in GERD. ERD patients are characterized by a failure to respond to the physiologic challenge of solid bolus and MWS that is likely also to impair clearance following reflux events and increase exposure to gastric refluxate.
非特异性食管动力障碍伴清除功能障碍在胃食管反流病（GERD）患者中很常见，尤其是在有糜烂性疾病的患者中；然而，食管功能障碍的生理-力学基础尚不清楚。
回顾性评估有糜烂性反流病（ERD；n=20）和内镜阴性反流病（ENRD；n=20）的患者，这些患者在 pH 研究中存在病理性酸暴露（>4.2%时间/24 小时），同时还纳入了健康对照组（n=20），所有患者均接受高分辨率测压检查。分析液体和固体团块吞咽以及多次水吞咽（MWS）时的食管运动。蠕动功能障碍定义为蠕动失败、痉挛、食管收缩弱或不协调（在 30mmHg 等压线上 3cm 内有中断）。
对照组中 33%的水吞咽存在蠕动功能障碍，ENRD 为 56%，ERD 为 76%（P<0.023 与对照组相比，P=0.185 与 ENRD 相比）。与液体相比，固体团块吞咽时对照组（18%对 33%，P=0.082）和 ENRD（22%对 54%，P=0.046）中有效的蠕动收缩比例增加，但 ERD 患者中无明显变化（62%对 76%，P=0.438）。同样，MWS 后对照组中有 83%和 ENRD 中有 70%的患者出现有效的蠕动，而 ERD 患者仅有 30%（P<0.017 与对照组相比，P<0.031 与 ENRD 相比）。固体吞咽时酸暴露与动力障碍的相关性强于液体吞咽（r=0.52 对 0.27）。
GERD 患者常存在蠕动功能障碍。ERD 患者的特点是固体团块和 MWS 不能引起生理反应，这可能也会影响反流事件后的清除功能，并增加胃反流物的暴露。
