Iascone C, DeMeester T R, Little A G, Skinner D B
Arch Surg. 1983 May;118(5):543-9. doi: 10.1001/archsurg.1983.01390050027005.
Esophageal function was assessed with manometry and 24-hour pH monitoring of the distal esophagus in 22 patients with histologically proven Barrett's esophagus (BE), 31 consecutive patients with endoscopic grade 2 or 3 esophagitis, and 33 normal volunteers. Patients with BE had less lower esophageal sphincter (LES) pressure, but similar length of sphincter exposed to the abdomen, than patients with esophagitis. Both groups had significantly less LES pressure and abdominal length than normal subjects. Patients with BE had statistically more esophageal acid exposure than patients with esophagitis, and both differed markedly from normal subjects. They also had a greater number of reflux episodes lasting longer than five minutes than patients with esophagitis, suggesting that the severity of acid exposure was due to a defect in esophageal clearance. The extent of Barrett's mucosal change was related to the level of LES pressure and the number of reflux episodes that were five minutes or longer in duration. We concluded that BE is related to a mechanical incompetency of the cardia and a decrease in esophageal clearance that requires reconstruction of the cardia for effective therapy.
对22例经组织学证实为巴雷特食管（BE）的患者、31例连续的内镜诊断为2级或3级食管炎的患者以及33名正常志愿者，采用测压法和对食管远端进行24小时pH监测来评估食管功能。与食管炎患者相比，BE患者的食管下括约肌（LES）压力较低，但括约肌暴露于腹部的长度相似。两组患者的LES压力和腹部长度均显著低于正常受试者。BE患者的食管酸暴露在统计学上高于食管炎患者，且两者均与正常受试者有显著差异。与食管炎患者相比，他们持续超过五分钟的反流发作次数也更多，这表明酸暴露的严重程度是由于食管清除功能缺陷所致。巴雷特黏膜改变的程度与LES压力水平以及持续五分钟或更长时间的反流发作次数有关。我们得出结论，BE与贲门的机械功能不全以及食管清除功能下降有关，有效的治疗需要重建贲门。
