Düx A
Rontgenblatter. 1979 Jul;32(7):362-74.
The inferior high-pressure zone acts like a functional sphincter. This is formed in the absence of a muscle correlate, via a regional predominance of the sphincter tone caused by inhibition of activity of the longitudinal muscles through the membrane phreno-oesophagea in the region of the vestibulum gastro-oesophageale. Pressure variations in the vestibulum caused by respiration, are governed by a "rein mechanism". Swallowing produces a brief reflectory breakdown of the inferior high-pressure zone in the longitudinal muscles of the ösophagus via myogenic ventricular stimulus condution. Gastro-ösophageal reflux can be regularly identified by means of suitable x-ray examination technique. Since, however, it is not possible to arrive at a quantitative and qualitative assessment of the reflux via roentgenology, the aim of radiological examination in case of clinical suspicion of reflux is to determine a) the factors favouring reflux, ie hiatal hernia, gastric and duodenal ulcer, stenosis of the pylorus, etc, b) the sequelae of a pathological reflux, eg reflux stenosis, reflux ulcer, brachyösophagus etc, as well as c) to assess the self-cleaning function of the ösophagus. It is possible to definitely identify hiatal hernia by radiology with a well-aimed examination technique, through the intrathoracal displacement of parts of the stomach, of Schatzki's ring, and the superhiatal displacement of the entire vestibulum gastro-oesophageale. It is also regularly possible to identify by serial radiography an organic ösophagus stenosis, using large quantities of barium swallow, although pathogenetic interpretation of the x-ray film may be difficulat. Functional stenosis can be defined by pharmacoradiography and manometry. In clinically suspected reflux ösophagitis, endoscopy and histology will supply more conclusive findings in respect of mucosal assessment than x-ray examination.
低位高压区起到功能性括约肌的作用。它在没有肌肉相关结构的情况下形成，是通过胃食管前庭区域的膈食管膜抑制纵肌活动，导致括约肌张力在该区域占优势而形成的。呼吸引起的前庭压力变化受“强化机制”控制。吞咽通过肌源性心室刺激传导，使食管纵肌中的低位高压区产生短暂的反射性破坏。通过合适的X线检查技术可经常发现胃食管反流。然而，由于通过放射学无法对反流进行定量和定性评估，临床怀疑有反流时，放射学检查的目的是确定：a）有利于反流的因素，即食管裂孔疝、胃和十二指肠溃疡、幽门狭窄等；b）病理性反流的后遗症，如反流性狭窄、反流性溃疡、短食管等；以及c）评估食管的自清洁功能。通过准确的检查技术，利用放射学可以明确识别食管裂孔疝，这是通过胃的部分、沙茨基环的胸腔内移位以及整个胃食管前庭的裂孔上移位来实现的。通过连续放射摄影，使用大量吞钡剂也经常能够识别器质性食管狭窄，尽管对X线片的病因学解释可能有困难。功能性狭窄可通过药物放射造影和测压来定义。在临床怀疑有反流性食管炎时，内镜检查和组织学检查在黏膜评估方面比X线检查能提供更具决定性的结果。
