Cucchiara S, Staiano A, Di Lorenzo C, De Luca G, della Rocca A, Auricchio S
Department of Pediatrics, Second School of Medicine, University of Naples, Italy.
J Pediatr Gastroenterol Nutr. 1988 Nov-Dec;7(6):830-6. doi: 10.1097/00005176-198811000-00006.
We investigated the mechanisms of gastroesophageal reflux (GER) and esophageal motility during endogenous esophageal acid exposure in 17 patients with reflux disease alone (age range 3-20 months) (group A) and in 10 patients with reflux disease complicated by esophagitis (age range 4-19 months) (group B), by simultaneous recording distal esophageal sphincter relaxation was the predominant mechanism of reflux in both groups of subjects; however, it was more frequent in group B patients (Bpts), whereas reflux episodes due to appropriate sphincter relaxation were detected more frequently in group A patients (Apts). During endogenous acid exposure, primary peristalsis was the most frequent esophageal motor event in all patients; furthermore, its amplitude was significantly higher in Apts as compared with Bpts. Primary peristalsis was more efficacious (rise of intraluminal pH by at least 0.5 unit) in patients with reflux disease alone, whereas nonspecific motor irregularities were more common in children with reflux esophagitis. It is concluded that the major mechanism of GER in patients with reflux esophagitis is an inappropriate sphincter relaxation; reflux due to appropriate sphincter relaxation is associated with less severe reflux disease; and patients with esophagitis exhibit a deranged esophageal motility during spontaneous acid exposure.
我们通过同步记录，对17例单纯反流病患者（年龄范围3 - 20个月）（A组）和10例反流病合并食管炎患者（年龄范围4 - 19个月）（B组）内源性食管酸暴露期间的胃食管反流（GER）机制和食管动力进行了研究。两组受试者中，远端食管括约肌松弛均为反流的主要机制；然而，B组患者（Bpts）中这种情况更常见，而A组患者（Apts）中因适当括约肌松弛导致的反流发作更频繁。在内源性酸暴露期间，原发性蠕动是所有患者中最常见的食管运动事件；此外，与Bpts相比，Apts中原发性蠕动的幅度明显更高。原发性蠕动在单纯反流病患者中更有效（管腔内pH值至少升高0.5个单位），而非特异性运动异常在反流性食管炎患儿中更常见。研究得出结论，反流性食管炎患者GER的主要机制是括约肌不适当松弛；因适当括约肌松弛导致的反流与较轻的反流病相关；食管炎患者在自发酸暴露期间表现出食管动力紊乱。
