Department of Gastroenterology, Sandwell & West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, UK.
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.
Neurogastroenterol Motil. 2021 Apr;33(4):e14023. doi: 10.1111/nmo.14023. Epub 2020 Oct 28.
The mechanisms associated with gastro-esophageal reflux (GER) episodes were studied using combined High-resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD.
Sixteen subjects with mild-moderate esophagitis (Los Angeles (LA) grade A&B) (group A) and 11 subjects with severe esophagitis (LA grade C&D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe.
Post-prandial acid GER episodes were more common in group B (median 10 range (3-18) vs A (6.5 (0-18), p = 0.048). Postprandial acid clearance time was much longer in group B (median 0.71( 0.07-2.66 min) vs A (0.17 (0.04-2.44 min), p = 0.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post-prandial TLESRs with GER were more common in group B (median 17 (9-24) vs A 13.5 (7-34), p = 0.014), particularly during exercise (B 8 (6-9) vs A 6 (5-6.8), p = 0.007). Post-prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0-6.4) per hour vs exercise 4.7 (0-17.3), p = 0.005 and B 4 (0.8-9.6) vs 5.3 (2.7-13.3) per hour, p = 0.045).
TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post-prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal.
使用结合高分辨率阻抗测压（HRIM）和 pH 监测的方法，研究了不同胃食管反流病（GERD）模式下胃食管反流（GER）发作的相关机制。
研究了 16 例轻度至中度食管炎（洛杉矶（LA）分级 A 和 B）（A 组）和 11 例重度食管炎（LA 分级 C 和 D）或 Barrett 食管（BE）患者，在餐前、餐后、休息时、步行时和进行标准化运动时，使用 HRIM 和 pH 探头进行研究。
A 组（中位数 10 范围（3-18））餐后酸反流的 GER 发作比 B 组（6.5（0-18））更常见（p=0.048）。B 组餐后酸清除时间明显长于 A 组（中位数 0.71（0.07-2.66 min）比 A 组（0.17（0.04-2.44 min））（p=0.02）。TLESR 是两组患者 GER 发作最常见的相关机制。B 组（中位数 17（9-24））与 GER 相关的餐后 TLESR 比 A 组（中位数 13.5（7-34））更常见（p=0.014），特别是在运动时（B 组 8（6-9）比 A 组 6（5-6.8））（p=0.007）。两组餐后 TLESR 伴酸反流在运动时均增加（A 组静息时中位数为每小时 2.4（0-6.4）次比运动时 4.7（0-17.3）次，p=0.005，B 组为 4（0.8-9.6）次比运动时 5.3（2.7-13.3）次，p=0.045）。
TLESR 是所有患者中与反流发作最相关的机制。在重度食管炎或 BE 患者中，酸反流发作更为常见，食管酸清除速度明显减慢。餐后运动增加了酸反流伴 TLESR，GERD 患者应避免餐后立即运动。
