Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2013 Jan;28(1):84-9. doi: 10.1111/j.1440-1746.2012.07258.x.
There are heterogeneous subgroups among those with heartburn, and data on these individuals are relatively scant. We aimed to evaluate the effect of acid challenge on the segmental contractions of esophageal smooth muscle in endoscopy-negative patients with normal esophageal acid exposure.
High-resolution esophageal manometry (HRM) was performed on 30 endoscopy-negative patients with heartburn accompanied by normal esophageal acid exposure using 10 water swallows followed by 10 acidic pomegranate juice swallows. Patients were classified into functional heartburn (FH) and hypersensitive esophagus (HE) groups based on the results of 24-hr impedance pH testing. HRM topographic plots were analyzed and maximal wave amplitude and pressure volumes were measured for proximal and distal smooth muscle segments.
The pressure volume of the distal smooth muscle segment in the HE group measured during acidic swallows was higher than during water swallows (2224.1 ± 68.2 mmHg/cm per s versus 2105.6 ± 66.4 mmHg/cm per s, P = 0.027). A prominent shift in the pressure volume to the distal smooth muscle segment was observed in the HE group compared with the FH group (segmental ratio: 2.72 ± 0.08 versus 2.39 ± 0.07, P = 0.005). Manometric measurements during acidic swallows revealed that this shift was augmented in the HE group. The optimal ratio of pomegranate juice swallowing for discrimination of FH from HE was 2.82, with a sensitivity of 88.9% and a specificity of 100%.
Hypercontractile response of distal smooth muscle segment to acid swallowing was more prominent in the HE group than the FH group.
烧心患者存在异质性亚组，关于这些个体的数据相对较少。我们旨在评估酸挑战对内镜阴性、食管酸暴露正常的烧心患者食管平滑肌节段收缩的影响。
对 30 例内镜阴性、烧心伴正常食管酸暴露的患者进行高分辨率食管测压（HRM），采用 10 次水吞咽和 10 次酸性石榴汁吞咽。根据 24 小时阻抗 pH 检测结果，将患者分为功能性烧心（FH）和高敏感食管（HE）组。分析 HRM 拓扑图，并测量近端和远端平滑肌节段的最大波幅和压力容积。
HE 组酸性吞咽时远端平滑肌节段的压力容积高于水吞咽时（2224.1±68.2mmHg/cm/s 与 2105.6±66.4mmHg/cm/s，P=0.027）。与 FH 组相比，HE 组观察到压力容积明显向远端平滑肌节段转移（节段比：2.72±0.08 与 2.39±0.07，P=0.005）。酸性吞咽时的测压测量显示，HE 组这种转移增强。区分 FH 和 HE 的石榴汁吞咽最佳比值为 2.82，敏感性为 88.9%，特异性为 100%。
与 FH 组相比，HE 组远端平滑肌节段对酸吞咽的高收缩反应更为明显。
