Kim Sujin, Marquez-Lavenant Walter, Mittal Ravinder K
Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea.
Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
J Neurogastroenterol Motil. 2024 Oct 30;30(4):421-429. doi: 10.5056/jnm23162. Epub 2024 Aug 14.
BACKGROUND/AIMS: Pharyngeal pump, esophageal peristalsis, and phrenic ampulla emptying play important roles in the propulsion of bolus from the mouth to the stomach. There is limited information available on the mechanism of normal and abnormal phrenic ampulla emptying. The goal of our study is to describe the relationship between bolus flow and esophageal pressure profiles during the phrenic ampulla emptying in normal subjects and patient with phrenic ampulla dysfunction.
Pressure (using topography) and bolus flow (using changes in impedance) relationship through the esophagus and phrenic ampulla were determined in 15 normal subjects and 15 patients with retrograde escape of bolus from the phrenic ampulla into esophagus during primary peristalsis.
During the phrenic ampulla phase, 2 high pressure peaks (proximal, related to lower esophageal sphincter and distal, related to crural diaphragm) were observed in normal subjects and patients during the phrenic ampulla emptying phase. The proximal was always higher than the distal one in normal subjects; in contrast, reverse was the case in patients with the retrograde escape of bolus from the phrenic ampulla into the esophagus.
We propose that a strong after-contraction of the lower esophageal sphincter plays an important role in the normal phrenic ampullary emptying. A defective lower esophageal after-contraction, along with high crural diaphragm pressure are responsible for the phrenic ampulla emptying dysfunction.
背景/目的：咽泵、食管蠕动和膈壶腹排空在食团从口腔推进到胃的过程中起重要作用。关于正常和异常膈壶腹排空机制的信息有限。我们研究的目的是描述正常受试者和膈壶腹功能障碍患者在膈壶腹排空过程中食团流动与食管压力曲线之间的关系。
在15名正常受试者和15名在原发性蠕动期间食团从膈壶腹逆行逸入食管的患者中，测定通过食管和膈壶腹的压力（使用地形图）与食团流动（使用阻抗变化）之间的关系。
在膈壶腹阶段，正常受试者和患者在膈壶腹排空阶段观察到2个高压峰值（近端，与食管下括约肌有关；远端，与膈脚有关）。在正常受试者中，近端总是高于远端；相反，在食团从膈壶腹逆行逸入食管的患者中情况则相反。
我们认为食管下括约肌强烈的收缩后作用在正常膈壶腹排空中起重要作用。食管下收缩后作用缺陷以及膈脚高压是膈壶腹排空功能障碍的原因。
