Willing J, Furukawa Y, Davidson G P, Dent J
Gastroenterology Unit, Adelaide Children's Hospital, South Australia.
Gut. 1994 Feb;35(2):159-64. doi: 10.1136/gut.35.2.159.
The hypothesis that troublesome oesophagopharyngeal reflux arises from defective upper oesophageal sphincter response to straining has been evaluated in 53 children aged two to 81 months (median 13) referred with symptoms thought to be related to gastro-oesophageal reflux. Spontaneously occurring pharyngeal, upper oesophageal sphincter, oesophageal body, and gastric pressures were analysed after feeding. Inspiratory strain was the most common spontaneously occurring strain (172 episodes), defined as an oesophageal body inspiratory negative pressure dip at least twice the size of the normal inspiratory wave. Overall, during inspiratory strain, upper oesophageal sphincter pressure was significantly higher than before straining (p < 0.01) (5 v 27 mm Hg, p < 0.01). Sustained strains defined as increases in gastric and oesophageal body pressure for two to 20 seconds were also common (149 episodes) and when compared with just before straining, also augmented upper oesophageal sphincter pressure (60 v 39 mm Hg, p < 0.01). The vigour of straining, estimated as increase of gastric pressure, correlated significantly with the degree of augmentation of upper oesophageal sphincter pressure (p < 0.05). Children with and without evidence of troublesome oesophagopharyngeal reflux showed no difference in upper oesophageal sphincter response patterns to straining. Failure of augmentation of upper oesophageal sphincter tone in the face of strain induced increases of oesophageal body pressure is probably a secondary factor in the production of oesophagopharyngeal reflux in children.
对53名年龄在2至81个月（中位数13个月）、因被认为与胃食管反流相关的症状前来就诊的儿童，评估了关于麻烦的食管咽反流源于食管上括约肌对用力反应缺陷的假说。喂食后分析了自发出现的咽部、食管上括约肌、食管体和胃内压力。吸气用力是最常见的自发用力情况（172次发作），定义为食管体吸气负压下降至少是正常吸气波大小的两倍。总体而言，在吸气用力期间，食管上括约肌压力显著高于用力前（p<0.01）（5对27毫米汞柱，p<0.01）。持续用力定义为胃和食管体压力升高2至20秒的情况也很常见（149次发作），与用力前相比，也增加了食管上括约肌压力（60对39毫米汞柱，p<0.01）。以胃压力升高来估计的用力强度与食管上括约肌压力升高程度显著相关（p<0.05）。有和没有麻烦的食管咽反流证据的儿童在食管上括约肌对用力的反应模式上没有差异。面对用力诱导的食管体压力升高时食管上括约肌张力未增强可能是儿童食管咽反流产生的一个次要因素。
