Howard P J, Pryde A, Heading R C
Department of Medicine, Royal Infirmary of Edinburgh.
Gut. 1989 Sep;30(9):1179-86. doi: 10.1136/gut.30.9.1179.
Dysphagia is a frequent cause of referral for oesophageal manometry although the motor response to eating is not routinely studied. We examined symptoms and oesophageal motor patterns in response to eating bread in 30 patients with either gastro-oesophageal reflux (n = 20), or normal oesophageal function tests (n = 10). No patient experienced symptoms while swallowing water but one complained of heartburn and one developed symptomatic oesophageal 'spasm' during eating. In eight further patients, pain or dysphagia which occurred with swallowing bread was associated with aperistalsis. Comparing asymptomatic and symptomatic periods, there was a slight increase in mean swallow frequency from 7.5 (0.79) (SEM) to 9.0 (1.17) swallows per minute (NS; n = 10). The mean number of aperistalsis swallows increased from 4.5 (0.96) per minute to 6.2 (1.30) (p less than 0.01; n = 10). Aperistalsis during symptoms was mainly caused by non-conducted swallows rather than synchronous contractions (mean 5.8 (1.45) per minute compared with 1.2 (0.44]. Aperistalsis can be produced by rapid swallowing in the normal oesophagus through 'deglutitive inhibition'. These results suggest that some patients experience dysphagia associated with aperistalsis perhaps as a response to increased frequency of swallowing. Functional abnormalities of this nature will not be detected by conventional oesophageal manometry.
吞咽困难是食管测压转诊的常见原因，尽管对进食的运动反应通常未被研究。我们检查了30例患有胃食管反流（n = 20）或食管功能测试正常（n = 10）的患者在进食面包后的症状和食管运动模式。没有患者在吞咽水时出现症状，但有1例抱怨烧心，1例在进食时出现有症状的食管“痉挛”。在另外8例患者中，吞咽面包时出现的疼痛或吞咽困难与无蠕动有关。比较无症状期和有症状期，平均吞咽频率从每分钟7.5（0.79）（标准误）略有增加至9.0（1.17）次吞咽（无显著性差异；n = 10）。无蠕动吞咽的平均次数从每分钟4.5（0.96）次增加至6.2（1.30）次（p < 0.01；n = 10）。症状发作时的无蠕动主要由未传导的吞咽引起，而非同步收缩（平均每分钟5.8（1.45）次，相比之下为1.2（0.44）次）。在正常食管中，通过“吞咽抑制”快速吞咽可产生无蠕动。这些结果表明，一些患者经历与无蠕动相关的吞咽困难，可能是对吞咽频率增加的一种反应。这种性质的功能异常通过传统食管测压无法检测到。
