Dodds W J, Dent J, Hogan W J, Helm J F, Hauser R, Patel G K, Egide M S
N Engl J Med. 1982 Dec 16;307(25):1547-52. doi: 10.1056/NEJM198212163072503.
We evaluated the mechanisms of gastroesophageal reflux in 10 patients with reflux esophagitis and compared the results with findings from 10 controls. The patients had more episodes of reflux (35 +/- 15 in 12 hours, as compared with 9 +/- 8 in the controls) and a lower pressure of the lower esophageal sphincter (13 +/- 8 mm Hg as compared with 29 +/- 9 in the controls) (P less than 0.001). Reflux occurred by three different mechanisms: transient complete relaxation of the lower esophageal sphincter, a transient increase in intra-abdominal pressure, or spontaneous free reflux associated with a low resting pressure of the lower esophageal sphincter. In controls 94 per cent of reflux episodes were caused by transient sphincter sphincter relaxation. In the patients 65 per cent of episodes of reflux accompanied transient sphincter relaxation, 17 per cent accompanied a transient increase in intra-abdominal pressure, and 18 per cent occurred as spontaneous free reflux. The predominant reflux mechanism in individual patients varied: some had normal resting sphincter pressure and reflux that occurred primarily during transient sphincter relaxation, whereas others with low resting sphincter pressures had spontaneous free reflux or reflux that occurred during an increase in intra-abdominal pressure.
我们评估了10例反流性食管炎患者的胃食管反流机制，并将结果与10例对照者的检查结果进行比较。患者反流发作次数更多（12小时内35±15次，而对照者为9±8次），食管下括约肌压力更低（13±8mmHg，对照者为29±9mmHg）（P＜0.001）。反流通过三种不同机制发生：食管下括约肌短暂完全松弛、腹内压短暂升高或与食管下括约肌静息压力低相关的自发性自由反流。在对照者中，94%的反流发作由括约肌短暂松弛引起。在患者中，65%的反流发作伴有括约肌短暂松弛，17%伴有腹内压短暂升高，18%为自发性自由反流。个体患者的主要反流机制各不相同：一些患者括约肌静息压力正常，反流主要在括约肌短暂松弛时发生，而另一些括约肌静息压力低的患者则有自发性自由反流或在腹内压升高时发生反流。
