Basilisco G, Barbera R, Molgora M, Vanoli M, Bianchi P
Department of Gastroenterology, Università degli Studi di Milano, Italy.
Gut. 1993 Nov;34(11):1487-91. doi: 10.1136/gut.34.11.1487.
This study examined the hypothesis that impaired oesophageal peristalsis was associated with delayed oesophageal clearance of acid in patients with progressive systemic sclerosis (PSS), some of whom are thought to have impaired oesophageal sensitivity to acid. Sixteen patients with PSS had: (a) oesophageal manometry and endoscopy; (b) acid perfusion of the oesophagus with simultaneous measurement of intraoesophageal pH during perfusion and for the next 10 minutes; (c) 22 hour monitoring of intraoesophageal pH; and (d) an evaluation of reflux symptoms during and after perfusion and during overnight pH monitoring. By oesophageal manometry, eight patients had normal peristalsis and eight patients had impaired peristalsis. Oesophageal endoscopy was unremarkable in patients with normal peristalsis, whereas all patients with impaired peristalsis had oesophagitis. The time needed to clear the oesophagus of perfused acid was shorter (p < 0.01) in patients with normal peristalsis and acid clearance time was significantly correlated (p < 0.01) with acid exposure time during overnight pH monitoring. During and after oesophageal perfusion, the nature, duration, and severity of symptoms did not differ between the groups, but overnight symptoms lasted longer (p < 0.05) in patients with impaired peristalsis. It is concluded that in PSS: (1) Impaired oesophageal motility delayed the clearance of acid and increased the exposure time to acid. (2) Acid clearance time is a useful parameter of impaired oesophageal motor function. The assessment of acid clearance time can be used as an alternative to overnight pH monitoring, to assess the impairment of oesophageal acid clearance. (3) Oesophageal sensitivity to acid was preserved in patients with impaired peristalsis and oesophagitis. (4) Reflux symptoms lasted longer in patients with prolonged oesophageal acid exposure but were still reported for a small fraction of the total acid exposure time. Thus, reflux symptoms reflect poorly prolonged exposure of the oesophagus to acid and are not a reliable guide to acid injury of the oesophagus in PSS.
进行性系统性硬化症（PSS）患者食管蠕动受损与食管酸清除延迟有关，其中一些患者被认为食管对酸的敏感性受损。16例PSS患者接受了以下检查：（a）食管测压和内镜检查；（b）食管酸灌注，并在灌注期间及随后10分钟同步测量食管内pH值；（c）22小时食管内pH监测；（d）评估灌注期间及之后以及夜间pH监测期间的反流症状。通过食管测压，8例患者蠕动正常，8例患者蠕动受损。蠕动正常的患者食管内镜检查无异常，而所有蠕动受损的患者均有食管炎。蠕动正常的患者清除灌注酸所需的时间较短（p<0.01），且酸清除时间与夜间pH监测期间的酸暴露时间显著相关（p<0.01）。在食管灌注期间及之后，两组患者症状的性质、持续时间和严重程度并无差异，但蠕动受损的患者夜间症状持续时间更长（p<0.05）。研究得出结论，在PSS患者中：（1）食管动力受损会延迟酸清除并增加酸暴露时间。（2）酸清除时间是食管运动功能受损的一个有用参数。酸清除时间的评估可作为夜间pH监测的替代方法，用于评估食管酸清除受损情况。（3）蠕动受损和患有食管炎的患者食管对酸的敏感性得以保留。（4）食管酸暴露时间延长的患者反流症状持续时间更长，但在总的酸暴露时间中仍只有一小部分时间出现症状。因此，反流症状不能很好地反映食管长时间暴露于酸的情况，在PSS中也不是食管酸损伤的可靠指标。
