Lin S, Ke M, Xu J, Kahrilas P J
Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
Am J Gastroenterol. 1994 Jul;89(7):1003-6.
The symptoms and mucosal damage that occur in gastroesophageal reflux disease (GERD) may be a consequence of either an increased frequency of reflux events or of a prolonged process of esophageal acid clearance. Acid clearance is dependent both upon effective esophageal emptying of luminal fluid and on normal salivary function to titrate residual acid to neutrality. This investigation examined the efficacy of esophageal emptying in a large group of GERD patients.
Barium swallow examinations were done to categorize and quantify esophageal emptying dysfunction in 67 consecutive patients with reflux disease, compared with 85 patient asymptomatic controls. Quantitative fluoroscopic estimates of esophageal residua were compared with scintigraphic quantification in 14 controls and 20 GERD patients.
There was progressive impairment of esophageal emptying in the reflux patients without esophagitis compared with the controls, and it was even greater in patients with endoscopically evident esophagitis compared with reflux patients without esophagitis. Good correlation existed between the fluoroscopic and scintigraphic assessment of esophageal emptying.
These findings support the hypothesis that impaired esophageal emptying is an important determinant in the development of esophagitis among reflux patients. The dominant site of impaired emptying in the reflux patients was the phrenic ampulla as opposed to the tubular esophagus, suggesting a pathophysiological contribution of hiatus hernia.
胃食管反流病（GERD）中出现的症状和黏膜损伤可能是反流事件频率增加或食管酸清除过程延长的结果。酸清除既取决于管腔内液体的有效食管排空，也取决于正常的唾液功能，以将残留酸滴定至中性。本研究调查了一大组GERD患者的食管排空功效。
对67例连续的反流病患者进行了钡餐检查，以分类和量化食管排空功能障碍，并与85例无症状对照患者进行比较。对14例对照患者和20例GERD患者的食管残留进行了定量荧光透视估计，并与闪烁显像定量进行了比较。
与对照组相比，无食管炎的反流患者食管排空逐渐受损，与无食管炎的反流患者相比，内镜下有明显食管炎的患者食管排空受损更严重。食管排空的荧光透视和闪烁显像评估之间存在良好的相关性。
这些发现支持以下假设，即食管排空受损是反流患者食管炎发展的重要决定因素。反流患者排空受损的主要部位是膈壶腹，而非管状食管，提示食管裂孔疝的病理生理作用。
