Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Neurogastroenterol Motil. 2018 Mar;30(3). doi: 10.1111/nmo.13240. Epub 2017 Nov 2.
Increased esophagogastric junction (EGJ) distensibility is thought to contribute to gastroesophageal reflux disease (GERD). Using the functional lumen imaging probe (FLIP), we aimed to assess the esophageal response to distension among patients undergoing esophageal pH monitoring.
25 patients (ages 22-73; 13 females) who underwent ambulatory wireless esophageal pH testing while off proton-pump inhibitors were evaluated with FLIP during sedated upper endoscopy. Esophageal reflux was quantified by total percent acid exposure time (AET; <6% was considered normal). FLIP studies were analyzed using a customized program generate FLIP topography plots to identify esophageal contractility patterns and to calculate the EGJ-distensibility index (DI). Reflux symptoms were assessed with the GERDQ. Values reflect median (interquartile range).
Among all patients, the AET was 7.2% (3.7-11.1) and EGJ-DI was 4.2 (2.5-7.6) mm /mm Hg. Repetitive antegrade contractions (RACs) were induced in 19/25 (76%) of patients; AET was lower among patients with (6.1%, 3-7.8) than without (14.9, 8.5-22.3) RACs (P = .009). Correlation was weak and insignificant between AET and EGJ-DI, GERDQ and AET, and GERDQ and EGJ-DI. Patients with abnormal AET (n = 16) and normal AET (n = 9) had similar EGJ-DI, 4.6 mm /mm Hg (2.9-9.2) vs 3.2 (2.2-5.1), P = .207 and GERDQ, P = .138.
Abnormal esophageal acid exposure was associated with an impaired contractile response to volume distention of the esophagus. This supports that acid exposure is dependent on acid clearance mechanisms.
人们认为食管胃结合部（EGJ）的扩张能力增加有助于胃食管反流病（GERD）的发生。本研究使用功能腔成像探头（FLIP），旨在评估正在接受食管 pH 监测的患者在食管扩张时的食管反应。
评估了 25 名（年龄 22-73 岁；13 名女性）在停用质子泵抑制剂后接受无线食管 pH 监测的患者。通过总酸暴露时间（AET；<6%被认为是正常的）来量化食管反流。使用定制程序分析 FLIP 研究，生成 FLIP 拓扑图以识别食管收缩模式并计算食管下括约肌（EGJ）扩张指数（DI）。使用 GERDQ 评估反流症状。数值反映中位数（四分位数范围）。
所有患者的 AET 为 7.2%（3.7-11.1），EGJ-DI 为 4.2（2.5-7.6）mm /mm Hg。在 25 名患者中有 19 名（76%）诱导出重复性前向收缩（RAC）；有 RAC 的患者的 AET 低于无 RAC 的患者（分别为 6.1%，3-7.8 和 14.9%，8.5-22.3，P=0.009）。AET 与 EGJ-DI、GERDQ 与 AET 以及 GERDQ 与 EGJ-DI 之间相关性弱且无统计学意义。AET 异常（n=16）和正常（n=9）的患者 EGJ-DI 相似，分别为 4.6mm /mm Hg（2.9-9.2）和 3.2mm /mm Hg（2.2-5.1），P=0.207，GERDQ，P=0.138。
异常的食管酸暴露与食管对容量扩张的收缩反应受损有关。这支持酸暴露取决于酸清除机制。
