Traube M, McCallum R W
Drugs. 1985 Jul;30(1):66-77. doi: 10.2165/00003495-198530010-00007.
Various oesophageal manometric disorders have been associated with chest pain or dysphagia. The classic motility disorders are achalasia and diffuse oesophageal spasm. In achalasia, a disorder of aperistalsis in the oesophageal body and incomplete relaxation of the lower oesophageal sphincter, either surgical myotomy or pneumatic dilatation is an effective approach, although some investigators have suggested a role for pharmacological therapy. For the treatment of diffuse oesophageal spasm, a disorder of non-peristaltic motor activity in the oesophagus, various pharmacological approaches with nitrates, anticholinergics, and calcium antagonists have been used. In the presence of associated lower oesophageal sphincter dysfunction, bouginage or pneumatic dilatation may be indicated. Long oesophagomyotomy should be considered for those patients who fail to respond to these measures. Recent manometric techniques have led to the identification of patients with chest pain or dysphagia who have abnormalities of increased contractile amplitude ('nutcracker' oesophagus) or duration. An association with gastro-oesophageal reflux or with psychiatric disturbance has been suggested. Treatment directed towards these factors is indicated and may be supplemented by pharmacological intervention, e.g. by calcium antagonists or anticholinergics.
多种食管测压紊乱与胸痛或吞咽困难有关。典型的动力障碍是贲门失弛缓症和弥漫性食管痉挛。在贲门失弛缓症中，食管体部蠕动障碍且食管下括约肌松弛不完全，手术肌切开术或气囊扩张术是有效的治疗方法，尽管一些研究者建议药物治疗也可发挥作用。对于弥漫性食管痉挛的治疗，食管非蠕动性运动活动障碍，已使用了多种药物治疗方法，包括硝酸盐类、抗胆碱能药物和钙拮抗剂。若存在相关的食管下括约肌功能障碍，可能需要进行探条扩张术或气囊扩张术。对于对这些措施无反应的患者，应考虑行长段食管肌切开术。最近的测压技术已能识别出胸痛或吞咽困难且收缩幅度增加（“胡桃夹”食管）或持续时间异常的患者。有人提出这些患者与胃食管反流或精神障碍有关。针对这些因素进行治疗，并可辅以药物干预，如使用钙拮抗剂或抗胆碱能药物。
