Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Digestive Physiology, Hospices Civils de Lyon and Lyon I University and Inserm U1032, LabTAU, Lyon, France.
Neurogastroenterol Motil. 2017 Dec;29(12). doi: 10.1111/nmo.13104. Epub 2017 May 24.
High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD.
Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated.
Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD.
CONCLUSIONS & INFERENCES: Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.
高分辨率测压（HRM）技术揭示了胃食管反流病（GERD）的病理生理学新发现。需要进一步明确新的 HRM 运动模式对反流负担的影响，这导致了 GERD 运动测试的现代方法。
进行了重点文献检索，评估 GERD 的病理生理学，重点关注 HRM。结果与国际专家组进行了讨论，以就 HRM 在 GERD 中的作用达成共识。提出了一种与 GERD 相关的食管运动异常分类系统。
生理性胃食管反流是所有人都固有的，是由于短暂的食管下括约肌（LES）松弛，允许胃中的空气以打嗝的形式排出。在病理性胃食管反流中，短暂的 LES 松弛伴随着胃内容物的反流。食管胃结合部（EGJ）屏障的结构破坏和反流物的不完全清除会导致异常高的食管反流负担，从而定义 GERD。食管 HRM 可定位 LES 以放置 pH 和 pH 阻抗探头，并在侵入性抗反流治疗和抗反流手术之前评估食管体蠕动功能。此外，HRM 可评估 EGJ 和食管体参与反流的机制，并排除模拟 GERD 的情况。
结构和运动性 EGJ 和食管过程有助于 GERD 的病理生理学。提出了一种分类方案，纳入了 HRM 期间 EGJ 和食管运动发现以及激发试验中的收缩储备。
