Ribolsi Mentore, Balestrieri Paola, Biasutto Dario, Emerenziani Sara, Cicala Michele
Digestive Disease Unit, Campus Bio Medico University, Rome, Italy.
J Neurogastroenterol Motil. 2016 Oct 30;22(4):606-612. doi: 10.5056/jnm15182.
BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP.
Forty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring.
Impaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms ( < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; < 0.01).
The presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa.
背景/目的：胃食管反流病（GERD）是非心源性胸痛（NCCP）最常见的病因。现有数据显示NCCP与动力障碍之间的关系较弱。此外，尚不清楚为何有些反流被感知为烧心，而另一些则被感知为NCCP。我们旨在评估反流模式和食管动力在NCCP患者中的作用。
纳入48例NCCP患者（第1组）和50例仅有典型GERD症状的患者（第2组），并进行高分辨率测压（HRM）和多通道腔内阻抗-pH监测。
60%的NCCP患者和24%的有典型症状的患者存在蠕动受损（<0.05）。在第1组患者中，与胸痛相关的反流发作多数为酸性和混合性。混合反流的比例高于第2组。在第1组中，与NCCP相关的反流发作中，在5 cm、9 cm和15 cm处测得的反流清除时间长于与典型症状相关的反流发作（平均±95%可信区间：27.2±5.6、23.3±4.4和14.6±2.3秒对18.3±3.5、13.3±2.2和11.1±1.8秒；<0.01）。
反流物中存在气体似乎与NCCP有关。在NCCP患者中观察到的动力障碍可能在延迟反流清除方面起相关作用，从而增加反流物与食管黏膜的接触时间。
