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胃食管反流病对上食管括约肌功能的影响:PH 阻抗和高分辨率测压法的见解。

The impact of gastroesophageal reflux disease on upper esophageal sphincter function: Insights from PH impedance and high-resolution manometry.

机构信息

Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

Section on Gastroenterology and Hepatology. Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

出版信息

Physiol Rep. 2024 Aug;12(16):e70011. doi: 10.14814/phy2.70011.

Abstract

Lower esophageal sphincter (LES) pathophysiology has been established in gastroesophageal reflux disease (GERD); however, less is understood regarding the role the upper esophageal sphincter (UES) plays in preventing laryngopharynphageal reflux. Sustained UES basal pressure prevents reflux into the pharynx while allowing relaxation during ingestion. We investigate whether GERD influences UES function via HRM and pH Impedance testing. A retrospective analysis of 318 patients who underwent high-resolution manometry with trans-nasally placed manometric catheter and 24-h multichannel intraluminal impedance pH monitoring. One hundred and forty-seven patients met Lyon consensus criteria for GERD based on acid exposure time >6%. The most common chief concern was heartburn or reflux, present in 59% of these patients. Upper esophageal sphincter basal and residual pressures were not significantly different between patients with GERD when compared to those without GERD, including a subanalysis of patients with extraesophageal symptoms. The LES basal and residual pressures, DCI and MNBI are statistically lower in patients with pathologic GERD. HRM and pH Impedance testing demonstrates no difference in UES basal and residual pressures based on pH diagnosis of GERD. We redemonstrate the association with hypotonic LES, diminished DCI and MNBI with GERD.

摘要

下食管括约肌(LES)的生理学在胃食管反流病(GERD)中已经得到确立;然而,对于上食管括约肌(UES)在防止喉咽反流中的作用,人们了解得较少。UES 的持续基础压力可防止反流进入咽部,同时允许在摄入期间放松。我们通过 HRM 和 pH 阻抗测试研究 GERD 是否会影响 UES 功能。对 318 例经鼻放置测压导管进行高分辨率测压和 24 小时多通道腔内阻抗 pH 监测的患者进行回顾性分析。根据酸暴露时间>6%,147 例患者符合里昂共识 GERD 标准。最常见的主要问题是烧心或反流,这些患者中有 59%存在这些问题。与无 GERD 的患者相比,GERD 患者的 UES 基础和残余压力没有显著差异,包括对有食管外症状的患者进行亚分析。与病理性 GERD 患者相比,LES 基础和残余压力、DCI 和 MNBI 统计学上较低。基于 GERD 的 pH 诊断,HRM 和 pH 阻抗测试显示 UES 基础和残余压力没有差异。我们再次证明了 GERD 与低张力 LES、DCI 和 MNBI 减少之间的关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9098/11330701/8193471fcc71/PHY2-12-e70011-g001.jpg

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