Smart H L, Foster P N, Evans D F, Slevin B, Atkinson M
Department of Surgery, University Hospital, Queen's Medical Centre, Nottingham.
Gut. 1987 Jul;28(7):883-7. doi: 10.1136/gut.28.7.883.
Radiotelemetric ambulatory 24 hour oesophageal pH measurement was carried out in 17 patients with symptomatic manometrically proven achalasia before and after pneumatic dilatation. Before dilatation an abnormally high percentage acid exposure time was present but typical episodes of gastro-oesophageal reflux occurred in only one patient. In nine patients who had a oesophageal food residue these values were significantly greater than those found in the remaining patients without retained food. Analysis of oesophageal food residues revealed that the low pH was predominantly caused by lactic acid. These findings indicate that preoperative oesophageal pH studies do not offer a valid means of selection of patients in whom an antireflux procedure should be combined with cardiomyotomy. Repeat studies one week after pneumatic dilatation showed a fall in the acid exposure time in patients with initial food residue presumably resulting from improved oesophageal emptying after treatment. A significant rise in acid exposure time after dilatation was seen in those patients without initial food residue presumably resulting from gastro-oesophageal reflux after therapeutic disruption of the lower oesophageal sphincter. Troublesome symptoms of gastro-oesophageal reflux were, however, uncommon after bag dilatation.
对17例经测压证实有症状的贲门失弛缓症患者在气囊扩张前后进行了24小时食管pH值动态遥测。扩张前，酸暴露时间百分比异常高，但仅1例患者出现典型的胃食管反流发作。9例有食管食物残留的患者，这些值显著高于其余无食物残留患者的值。对食管食物残留的分析表明，低pH值主要由乳酸引起。这些发现表明，术前食管pH值研究并不能为选择应将抗反流手术与贲门肌切开术相结合的患者提供有效的方法。气囊扩张一周后重复研究显示，最初有食物残留的患者酸暴露时间下降，这可能是由于治疗后食管排空改善所致。在那些最初无食物残留的患者中，扩张后酸暴露时间显著上升，这可能是由于食管下括约肌治疗性破坏后发生胃食管反流所致。然而，气囊扩张后胃食管反流的麻烦症状并不常见。
