Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Aliment Pharmacol Ther. 2011 Aug;34(4):476-86. doi: 10.1111/j.1365-2036.2011.04742.x. Epub 2011 Jun 14.
Limited data are available regarding the frequency of oesophageal motility and bolus transit abnormalities in subgroups of patients with gastro-oesophageal reflux disease (GERD).
To assess oesophageal motility and bolus transit in endoscopically defined GERD subgroups.
Patients (N=755) with typical reflux symptoms underwent upper endoscopy, conventional or impedance oesophageal manometry and/or impedance-pH testing. They were divided into: erosive oesophagitis (EO; N=340), Barrett Oesophagus (BO; N=106), non-erosive reflux disease (NERD; endoscopy-, abnormal pH and/or SAP/SI+; N=239) and functional heartburn (FH; endoscopy-, normal pH and SAP/SI-; N=70). Manometric patterns and bolus transit were defined according to previously published criteria.
Increasing GERD severity was associated with decreased lower oesophageal sphincter resting pressure (P< 0.05) and distal oesophageal amplitude (P<0.01), higher prevalence of hiatal hernia (P<0.01) and increased prevalence of ineffective oesophageal motility (P<0.01). Patients with EO and BO had a significantly lower percentage of complete bolus transit compared with NERD and FH (P<0.01). Overall, abnormal bolus transit (ABT) for liquid swallows was found in 12% of FH, 20% of NERD, 54% of EO and 56% of BO (P<0.01). Combined impedance-manometry showed abnormal oesophageal function in 4% of FH, 4% of NERD, 22% of EO and 21% of BO patients with normal oesophageal manometry.
Oesophageal motility abnormalities increase in parallel with the severity of GERD from NERD to EO and BO. Bolus transit abnormalities in severe reflux disease underscore the importance of impaired oesophageal function in the development of mucosal injury.
有限的数据可用于胃食管反流病（GERD）亚组患者的食管运动和食团转运异常的频率。
评估内镜定义的 GERD 亚组的食管运动和食团转运。
有典型反流症状的患者（N=755）接受了上消化道内镜检查、常规或阻抗食管测压和/或阻抗-pH 检测。他们被分为：糜烂性食管炎（EO；N=340）、巴雷特食管（BO；N=106）、非糜烂性反流病（NERD；内镜下正常、异常 pH 和/或 SAP/SI+；N=239）和功能性烧心（FH；内镜下正常、正常 pH 和 SAP/SI-；N=70）。根据先前发表的标准定义了测压模式和食团转运。
随着 GERD 严重程度的增加，食管下括约肌静息压力（P<0.05）和远端食管振幅（P<0.01）降低，食管裂孔疝（P<0.01）的患病率增加，无效食管运动（P<0.01）的患病率增加。与 NERD 和 FH 相比，EO 和 BO 患者的完全食团转运百分比显著降低（P<0.01）。总体而言，液体吞咽时的异常食团转运（ABT）在 FH 中占 12%，NERD 中占 20%，EO 中占 54%，BO 中占 56%（P<0.01）。结合阻抗测压的食管功能异常在 FH 中占 4%，NERD 中占 4%，EO 中占 22%，BO 中占 21%，这些患者的食管测压正常。
从 NERD 到 EO 和 BO，随着 GERD 的严重程度增加，食管运动异常也随之增加。严重反流病的食团转运异常强调了食管功能障碍在黏膜损伤发展中的重要性。
