Sifrim D, Janssens J, Vantrappen G
Department of Medical Research, University of Leuven, Belgium.
Gastroenterology. 1994 Apr;106(4):875-82. doi: 10.1016/0016-5085(94)90745-5.
BACKGROUND/AIMS: Primary esophageal motility disorders (achalasia, diffuse esophageal spasm, and intermediate forms) are suggested to be caused by different degrees of inhibitory dysfunction; however, direct evidence for this hypothesis has never been presented in humans. The aim of this study was to measure the degree of inhibition that precedes deglutitive contractions in patients with primary motility disorders.
Deglutitive inhibition was examined in patients with primary motility disorders: 9 with achalasia, 6 with symptomatic diffuse esophageal spasm, and 5 with intermediate forms. An artificial high-pressure zone was created in the esophageal body by inflating a balloon to a critical level, and pressure changes were measured at the interface between the balloon and esophageal wall. Inhibition was visualized as a relaxation of the artificial high-pressure zone.
An inverse relationship was found between the degree of inhibition and the propagation velocity of the deglutitive contraction (r = 0.75; P < 0.001). Normally propagated contractions were preceded by an inhibition of 84.2% +/- 3.6%; fast-propagating contractions were preceded by partial inhibition of 40.6% +/- 6.2%; and, in case of simultaneous contractions, inhibition was absent, i.e., 2.6% +/- 1.6%.
The spectrum of primary motility disorders is an expression of a progressively failing deglutitive inhibition.
背景/目的：原发性食管动力障碍（贲门失弛缓症、弥漫性食管痉挛及中间型）被认为是由不同程度的抑制功能障碍引起的；然而，这一假说在人类中从未有过直接证据。本研究的目的是测量原发性动力障碍患者吞咽收缩前的抑制程度。
对原发性动力障碍患者进行吞咽抑制检查：9例贲门失弛缓症患者、6例有症状的弥漫性食管痉挛患者和5例中间型患者。通过将气囊充气至临界水平在食管体部形成一个人工高压区，并在气囊与食管壁的界面处测量压力变化。抑制表现为人工高压区的松弛。
发现抑制程度与吞咽收缩的传播速度呈负相关（r = 0.75；P < 0.001）。正常传播的收缩之前有84.2%±3.6%的抑制；快速传播的收缩之前有40.6%±6.2%的部分抑制；而在同步收缩的情况下，无抑制，即2.6%±1.6%。
原发性动力障碍谱是吞咽抑制逐渐衰竭的一种表现。
