Anggiansah A, Taylor G, Bright N, Wang J, Owen W A, Rokkas T, Jones A R, Owen W J
Department of Surgery, Guy's Hospital, London.
Gut. 1994 Nov;35(11):1536-42. doi: 10.1136/gut.35.11.1536.
This study examined the clearance of gastric acid from the oesophagus in ambulant patients with gastro-oesophageal reflux. Eighteen patients with proved reflux disease were studied, nine with (group 1) and nine without (group 2) endoscopic oesophagitis. Oesophageal pressure and pH were recorded over 24 hours. Pressures were measured by a probe with five sensors: a 5 cm long sensor in the lower oesophageal sphincter, three sensors in the body of the oesophagus, and one at the pharynx to detect swallowing. Oesophageal pH was monitored 5 cm above the lower oesophageal sphincter. Manometric activities were classified as either peristaltic or ineffective. The latter included simultaneous, non-transmitted, and low amplitude peristaltic contractions. A reflux episode was defined as starting when pH fell to less than 4 and ending when the pH rose to 5. When the rise to pH 5 took place in three or more discrete steps after motor responses to gastro-oesophageal reflux, the pH steps were labelled as initial change (I), middle changes (M), and last change (L). A total of 595 episodes of gastro-oesophageal reflux and 1626 associated motor events were analysed. Of these, 1331 (81.9%) were classed as primary peristaltic activity, 174 (10.7%) as primary ineffective activity, 46 (2.8%) as secondary peristaltic activity, and 75 (4.6%) as secondary ineffective activity. There were no significant differences in initial change (p > 0.05), middle changes (p > 0.05), and last change (p > 0.05) between group 1 and group 2. In all patients, the successive changes of pH in response to motor activity were significantly different (p = 0.0001) between initial, middle, and last changes. Last change was significantly higher when compared with initial (p=0.001) and middle changes (p<0.001). Primary oesophageal peristalsis was the most frequent motor response to gastro-oesophageal reflux. The last motor activity during reflux showed the greatest change in pH.
本研究检测了非卧床胃食管反流患者食管内胃酸的清除情况。研究了18例确诊为反流病的患者，其中9例有内镜下食管炎（第1组），9例无内镜下食管炎（第2组）。记录24小时内的食管压力和pH值。通过带有五个传感器的探头测量压力：一个5厘米长的传感器置于食管下括约肌，三个传感器置于食管体部，一个置于咽部以检测吞咽。在食管下括约肌上方5厘米处监测食管pH值。测压活动分为蠕动性或无效性。后者包括同步、非传导性和低振幅蠕动收缩。反流发作定义为pH值降至4以下开始，pH值升至5结束。当在对胃食管反流的运动反应后pH值升至5分三步或更多离散步骤发生时，pH值步骤标记为初始变化（I）、中间变化（M）和最终变化（L）。共分析了595次胃食管反流发作和1626次相关运动事件。其中,1331次(81.9%)归类为原发性蠕动活动，174次(10.7%)为原发性无效活动，46次(2.8%)为继发性蠕动活动，75次(4.6%)为继发性无效活动。第1组和第2组在初始变化（p>0.05）、中间变化（p>0.05）和最终变化（p>0.05）方面无显著差异。在所有患者中，初始、中间和最终变化时，pH值对运动活动的连续变化有显著差异（p = 0.0001）。与初始变化（p = 0.001）和中间变化（p<0.001）相比，最终变化显著更高。原发性食管蠕动是对胃食管反流最常见的运动反应。反流期间的最后一次运动活动显示pH值变化最大
