Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2012 Dec;24(12):e573-9. doi: 10.1111/nmo.12024. Epub 2012 Oct 17.
Esophageal impedance monitoring has made it possible to distinguish two types of belches, designated gastric and supragastric. We aimed to compare the esophageal pressure characteristics during supragastric belches and gastric belches using combined high-resolution manometry and impedance monitoring.
We included 10 patients with severe and frequent belching. Combined high-resolution manometry and impedance monitoring was performed.
Whereas gastric belching was relatively rare in all patients (median incidence 2 per 90-min period), nine of the 10 patients exhibited excessive supragastric belching (36 in 90 min). Supragastric belches were characterized by: (i) movement of the diaphragm in aboral direction and increased esophagogastric junction (EGJ) pressure, (ii) decrease in esophageal pressure, (iii) upper esophageal sphincter (UES) relaxation, (iv) antegrade airflow into the esophagus, and (v) increase in esophageal and gastric pressure leading to expulsion of air out of the esophagus in retrograde direction. In contrast, gastric belches were characterized by: (i) decreased or unchanged EGJ pressure, which was significantly lower than during supragastric belches, (ii) absence of decreased esophageal pressure preceding entrance of air into the esophagus (iii) retrograde airflow into the esophagus, (iv) common cavity phenomenon, and (v) upper esophageal sphincter relaxation after the onset of the retrograde airflow.
CONCLUSIONS & INFERENCES: In gastric belching UES relaxation is a late event, allowing efflux of air that entered the esophagus from the stomach. In most patients with supragastric belching air is brought into the esophagus by movement of the diaphragm in aboral direction, creation of negative esophageal pressure, and UES relaxation.
食管阻抗监测使得区分两种类型的嗳气（胃源性嗳气和食管上源性嗳气）成为可能。我们旨在使用联合高分辨率测压和阻抗监测来比较食管上源性嗳气和胃源性嗳气时的食管压力特征。
我们纳入了 10 例严重且频繁嗳气的患者。进行了联合高分辨率测压和阻抗监测。
虽然在所有患者中胃源性嗳气相对少见（90 分钟期间中位数发生率为 2 次），但 10 例患者中有 9 例存在过度的食管上源性嗳气（36 次/90 分钟）。食管上源性嗳气的特征为：（i）膈向口咽部运动，食管下括约肌（EGJ）压力增加；（ii）食管压力降低；（iii）UES 松弛；（iv）前向气流进入食管；（v）食管和胃压力增加，导致空气逆行排出食管。相比之下，胃源性嗳气的特征为：（i）EGJ 压力降低或不变，显著低于食管上源性嗳气时的压力；（ii）在空气进入食管之前，食管压力无降低；（iii）反流气流进入食管；（iv）共同腔现象；（v）反流气流开始后 UES 松弛。
在胃源性嗳气中，UES 松弛是一个晚期事件，允许从胃反流进入食管的空气逸出。在大多数食管上源性嗳气患者中，空气通过膈向口咽部的运动、产生负食管压力和 UES 松弛被带入食管。
