Bonavina L, Evander A, DeMeester T R, Walther B, Cheng S C, Palazzo L, Concannon J L
Am J Surg. 1986 Jan;151(1):25-34. doi: 10.1016/0002-9610(86)90007-3.
Pressure and abdominal length of the distal esophageal sphincter are important factors in maintaining competency of the cardia against challenges of intraabdominal pressure. Some patients with normal distal esophageal sphincter pressure and position may have reflux which could be due to the inability of the cardia to overcome challenges of intragastric pressure. Three experimental studies and one clinical study were designed to evaluate this problem. The results showed that the resistance to flow through the cardia is related to the integrated effect of distal esophageal sphincter pressure and length; the ratio of distal esophageal sphincter to intragastric pressure necessary to maintain competency is inversely related to the length of sphincter present; gastric dilatation has an adverse effect on the degree of competency achieved by a given distal esophageal sphincter length; and patients with an overall distal esophageal sphincter length of 2 cm or less measured at rest in the fasting state are subject to reflux caused by gastric dilatation, increased intragastric pressure independent of intraabdominal pressure, or both.
食管远端括约肌的压力和腹段长度是维持贲门抵抗腹内压挑战能力的重要因素。一些食管远端括约肌压力和位置正常的患者可能会出现反流，这可能是由于贲门无法克服胃内压的挑战所致。设计了三项实验研究和一项临床研究来评估这个问题。结果表明，通过贲门的血流阻力与食管远端括约肌压力和长度的综合作用有关；维持贲门功能所需的食管远端括约肌压力与胃内压之比与括约肌的现有长度呈负相关；胃扩张对给定食管远端括约肌长度所达到的功能程度有不利影响；在禁食状态下静息时测量的食管远端括约肌总长度为2厘米或更短的患者，易因胃扩张、与腹内压无关的胃内压升高或两者共同作用而发生反流。
